Hematopoietic stem cell transplantation: a global perspective.
BACKGROUND
Hematopoietic stem cell transplantation (HSCT) requires significant infrastructure. Little is known about HSCT use and the factors associated with it on a global level.


OBJECTIVE
To determine current use of HSCT to assess differences in its application and to explore associations of macroeconomic factors with transplant rates on a global level.


METHODS
Retrospective survey study of patients receiving allogeneic and autologous HSCTs for 2006 collected by 1327 centers in 71 participating countries of the Worldwide Network for Blood and Marrow Transplantation. The regional areas used herein are (1) the Americas (the corresponding World Health Organization regions are North and South America); (2) Asia (Southeast Asia and the Western Pacific Region, which includes Australia and New Zealand); (3) Europe (includes Turkey and Israel); and (4) the Eastern Mediterranean and Africa.


METHODS
Transplant rates (number of HSCTs per 10 million inhabitants) by indication, donor type, and country; description of main differences in HSCT use; and macroeconomic factors of reporting countries associated with HSCT rates.


RESULTS
There were 50 417 first HSCTs; 21 516 allogeneic (43%) and 28 901 autologous (57%). The median HSCT rates varied between regions and countries from 48.5 (range, 2.5-505.4) in the Americas, 184 (range, 0.6-488.5) in Asia, 268.9 (range, 5.7-792.1) in Europe, and 47.7 (range, 2.8-95.3) in the Eastern Mediterranean and Africa. No HSCTs were performed in countries with less than 300,000 inhabitants, smaller than 960 km(2), or having less than US $680 gross national income per capita. Use of allogeneic or autologous HSCT, unrelated or family donors for allogeneic HSCT, and proportions of disease indications varied significantly between countries and regions. In linear regression analyses, government health care expenditures (r(2) = 77.33), HSCT team density (indicates the number of transplant teams per 1 million inhabitants; r(2) = 76.28), human development index (r(2) = 74.36), and gross national income per capita (r(2) = 74.04) showed the highest associations with HSCT rates.


CONCLUSIONS
Hematopoietic stem cell transplantation is used for a broad spectrum of indications worldwide, but most frequently in countries with higher gross national incomes, higher governmental health care expenditures, and higher team densities.
Gratwohl
Alois
A
European Group for Blood andMarrow Transplantation, Transplant Activity Survey Office, Department of Hematology, University Hospital Basel, Basel, Switzerland. hematology@uhbs.ch
Baldomero
Helen
H
Aljurf
Mahmoud
M
Pasquini
Marcelo C
MC
Bouzas
Luis Fernando
LF
Yoshimi
Ayami
A
Szer
Jeff
J
Lipton
Jeff
J
Schwendener
Alvin
A
Gratwohl
Michael
M
Frauendorfer
Karl
K
Niederwieser
Dietger
D
Horowitz
Mary
M
Kodera
Yoshihisa
Y
D003625:Data Collection; D003906:Developing Countries; D004467:Economics / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income; D012189:Retrospective Studies; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous