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Indications for haemopoietic precursor cell transplants in Europe. European Group for Blood and Marrow
A Gratwohl1, J Hermans, H Baldomero
1Department of Internal Medicine, Kantonsspital Basel, Switzerland.
Insights
European countries show varied rates of haemopoietic precursor cell transplants. Consensus exists for specific leukaemia and lymphoma treatments, aiding healthcare planning and patient guidance.
Area of Science:
- Hematology
- Transplantation Medicine
- Public Health
Background:
- Haemopoietic precursor cell transplantation (HPCT) practices varied across Europe in the early 1990s.
- Understanding geographical and clinical variations in HPCT is crucial for resource allocation and treatment standardization.
Purpose of the Study:
- To analyze the utilization rates of HPCT across 12 European countries between 1991 and 1993.
- To assess the degree of clinical consensus for various HPCT indications and donor sources.
Main Methods:
- Utilized data from 17,206 HPCT procedures across 12 European countries.
- Calculated transplants per million inhabitants per year, stratified by indication and donor type.
- Employed the coefficient of variation (CV) to quantify clinical agreement, with CV ≤ 45% indicating consensus.
Main Results:
- Overall HPCT rate was 16.6 per million inhabitants annually, with significant country-to-country variation.
- Allogeneic transplantation rates were more homogenous (CV 20%) than autologous rates (CV 40%).
- Clinical consensus (CV < 45%) was observed for specific indications including chronic myeloid leukaemia, acute myeloid leukaemia, acute lymphoblastic leukaemia, severe aplastic anaemia, Hodgkin's disease, and non-Hodgkin's lymphoma.
Conclusions:
- Significant variations in HPCT utilization exist across Europe, potentially due to resource availability and differing clinical opinions.
- A high degree of consensus was found for established HPCT indications, suggesting a 'state of the art' practice.
- These findings provide valuable insights for patient counseling and European healthcare planning in transplantation medicine.
Abstract:
Information on 17,206 haemopoietic precursor cell transplants performed in 12 European countries between 1991 and 1993 was used to assess the number of transplants per million inhabitants per year by principal indication and donor source. 16.6 transplants were performed per million inhabitants per year with a range of 9.4-27.7. Differences between countries may be due to the availability of beds and resources or to divergent opinions about treatments. We used the coefficient of variation (CV) to assess the degree of agreement between clinicians with regard to different procedures and indications, with a cut-off of < or = 45% to indicate consensus. The rate of allogeneic transplantation between the 12 countries was more 'homogenous' than that of autologous transplantation (mean 6.8 per million inhabitants, range 5.2-9.5, CV 20% versus mean 9.8 per million inhabitants, range 3.6-18.4, CV 40%). Consensus was found for allografting in chronic myeloid leukaemia (CML) in first chronic phase (CV 19%), CML in later phases (CV 31%), acute myeloid leukaemia (AML) in first complete remission (CV 41%), AML beyond first complete remission (CV 34%), acute lymphoblastic leukaemia beyond first complete remission (23%), and severe aplastic anaemia (29%). Consensus for autografting was observed for Hodgkin's disease (CV 44%), non-Hodgkin's lymphoma (CV 44%), and AML beyond first remission (CV 41%). With this method an assessment of medical opinion can be made in spite of the different availabilities of resources. These data reflect the state of the art in haemopoietic precursor cell usage in Europe; they provide a basis for patient counselling and health-care planning.