HSCT use varies with region

By Lynda Williams, Senior medwireNews Reporter

A review of almost one million haematopoietic stem cell transplantation (HSCT) procedures has highlighted differences in the availability of the procedure and the use of autologous and allogeneic transplants across the world.

The Worldwide Network for Blood and Marrow Transplantation recorded 953,651 HSCTs between 1957 and 2012 in 71 of 194 World Health Organization member states, 42% of which were allogeneic.

The highest number of transplants occurred in Europe (52%; 45% allogeneic), followed by procedures within the Americas (31%; 32% allogeneic), southeast Asia and the western Pacific regions (15%; 21% allogeneic) and the eastern Mediterranean and Africa (2%; 2% allogeneic).

But there were no transplants reported in countries smaller than 700 km2, with a population fewer than 300,000 or a gross national income per person of less than US$ 1260, say Alois Gratwohl, from University Hospital in Basel, Switzerland, and co-authors in The Lancet Haematology.

The researchers observe that the use of allogeneic HSCT increased over the study period in all the regions, except the Americas, without evidence of saturation, while autologous HSCT use plateaued in Europe and the Americas, but continued to increase in other regions.

“The association of transplant rate with team density might suggest a tendency for overuse; autologous HSCT might be done without stringent indication when infrastructure and resources are available”, they hypothesise.

The researchers note that the use of unrelated donor transplantations increased during the study period, as did the transfer of donations over international borders.

Acknowledging the need for national registries of unrelated donors, the researchers conclude: “Competent authorities are challenged to provide a locally adapted regulatory framework, professional organisations to provide evidence as to the indications for HSCT compared with any non-transplant strategy regarding survival, quality of life, and costs, depending on the economic situation of the respective region or countries.”

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