title: Hematopoietic stem cell transplantation in the Eastern Mediterranean Region (EMRO) 2011-2012: A comprehensive report on behalf of the Eastern Mediterranean Blood and Marrow Transplantation group (EMBMT).
abstract: OBJECTIVE
  The Eastern Mediterranean Blood and Marrow Transplantation (EMBMT) group has accumulated over 31 years of data and experience in hematopoietic stem cell transplantation (HSCT), particularly in hemoglobinopathies, severe aplastic anemia, inherited metabolic and immune disorders, in addition to a wide array of hematologic malignancies unique to this region. A regional update in current HSCT trends is highly warranted. We studied the trends of HSCT activities in World Health Organization-Eastern Mediterranean (EMRO) region, surveyed by the EMBMT, between 2011 and 2012.
  
  
  METHODS
  Retrospective analysis of the survey data mainly of cumulative number of transplants, types of transplants (autologous vs. allogeneic), types of conditioning such as myeloablative versus reduced intensity was conducted. Also, trends in leukemias, hemoglobinopathies, severe aplastic anemia, inherited bone marrow failure syndromes, amongst others were analyzed.
  
  
  RESULTS
  Twenty-one teams from nine EMRO countries reported their data (100% return rate) to the EMBMT for the years 2011-2012, with a total of 3,546 first HSCT (1,670 in 2011; 1,876 in 2012). Allogeneic HSCT (allo-HSCT) represented the majority (62%) in both years. The main indications for allo-HSCT were acute leukemias (988; 46%), bone marrow failure syndromes (421, 20%), hemoglobinopathies (242; 11%), and immune deficiencies (157; 7%). There was a progressive increase in the proportions of chronic myeloid leukemia cases transplanted beyond first chronic phase (37 [7%] of all chronic myeloid leukemia cases in 2011 vs. 39 [29%] in 2012). The main indications for autologous transplants were multiple myeloma/plasma cell disorders (510; 39%), Hodgkin lymphoma (311; 24%), non-Hodgkin lymphoma (259; 20%), and solid tumors (163; 12%). Reduced intensity conditioning continued to show a progressive decrease over years (9.5% in 2011 vs. 7.9% in 2012), yet remained relatively low compared with contemporary practices in Europe published by EBMT. The vast majority (91%) of allo-HSCT source was from sibling donors with continued dominance of peripheral blood (64%) followed by bone marrow (33%).While umbilical cord blood transplants increased to 4% of allo-HSCT, matched unrelated donor remained underutilized and there was no haplo-identical transplant reported. Large centers with >50 HSCT/year, showed a continued increase in the total number of allo-HSCT over the past 2years that may be related to capacity building issues and require further studies.
  
  
  CONCLUSIONS
  There is a discernable increase of HSCT rate in the EMRO region with a significant expansion in utilization of cord blood transplants and allogeneic peripheral blood-HSCT as a valuable source. However, further research of outcome data and the development of regional donor banks (cord blood and matched unrelated donors) may help to facilitate future planning to satisfy the escalating regional needs and augment collaboration within the EMBMT and globally.
authors.affiliation: King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Aljurf
authors.affiliation: National Research Center, Cairo, Egypt. Electronic address: amrnassar5@gmail.com.
authors.forename: Amr
authors.initials: A
authors.lastname: Nassar
authors.affiliation: Tehran University of Medical Sciences, Hematology, Oncology and SCT Research Center, Tehran, Iran.
authors.forename: Amir Ali
authors.initials: AA
authors.lastname: Hamidieh
authors.affiliation: National Cancer Institute, Cairo University, Cairo, Egypt.
authors.forename: Alaa
authors.initials: A
authors.lastname: Elhaddad
authors.affiliation: Pierre and Marie Curie Center, Algiers, Algeria.
authors.forename: Rose-Marie
authors.initials: RM
authors.lastname: Hamladji
authors.affiliation: American University Beirut Medical Center, Beirut, Lebanon.
authors.forename: Ali
authors.initials: A
authors.lastname: Bazarbachi
authors.affiliation: Makassed General Hospital, Beirut, Lebanon.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Ibrahim
authors.affiliation: Center National de Greffe de Moelle Osseuse de Tunis, Tunis, Tunisia.
authors.forename: Tarek
authors.initials: T
authors.lastname: Ben Othman
authors.affiliation: King Hussein Cancer Center, Amman, Jordan.
authors.forename: Fawzi
authors.initials: F
authors.lastname: Abdel-Rahman
authors.affiliation: King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
authors.forename: Amal
authors.initials: A
authors.lastname: Alseraihy
authors.affiliation: National Cancer Institute, Cairo University, Cairo, Egypt.
authors.forename: Omar
authors.initials: O
authors.lastname: Fahmy
authors.affiliation: King Hussein Cancer Center, Amman, Jordan.
authors.forename: Ayad Ahmed
authors.initials: AA
authors.lastname: Hussein
authors.affiliation: Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
authors.forename: Abdulaziz
authors.initials: A
authors.lastname: Alabdulaaly
authors.affiliation: Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Salman
authors.initials: S
authors.lastname: Adil
authors.affiliation: Sultan Qaboos University Hospital, Muscat, Oman.
authors.forename: Salam Salim Amur
authors.initials: SS
authors.lastname: Alkindi
authors.affiliation: King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Bayoumy
authors.affiliation: Sultan Qaboos University Hospital, Muscat, Oman.
authors.forename: David
authors.initials: D
authors.lastname: Dennison
authors.affiliation: University Hospital Establishment, Oran, Algeria.
authors.forename: Mohamed Amine
authors.initials: MA
authors.lastname: Bekadja
authors.affiliation: Pierre and Marie Curie Center, Algiers, Algeria.
authors.forename: Ahmed Nacer
authors.initials: AN
authors.lastname: Redhouane
authors.affiliation: King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
authors.forename: Walid
authors.initials: W
authors.lastname: Rasheed
authors.affiliation: King Fahad Specialist Hospital, Dammam, Saudi Arabia.
authors.forename: Ahmed
authors.initials: A
authors.lastname: AlSagheir
authors.affiliation: King Abdulaziz Medical City, Riyadh, Saudi Arabia.
authors.forename: Reem
authors.initials: R
authors.lastname: Alsudairy
authors.affiliation: Center National de Greffe de Moelle Osseuse de Tunis, Tunis, Tunisia.
authors.forename: Saloua
authors.initials: S
authors.lastname: Ladeb
authors.affiliation: Service d'Hematologie et Oncologie Pediatrique, Casablanca, Morocco.
authors.forename: Said
authors.initials: S
authors.lastname: Benchekroun
authors.affiliation: Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Mani
authors.initials: M
authors.lastname: Ramzi
authors.affiliation: Armed Forces Institute of Transplantation, Rawalpindi, Pakistan.
authors.forename: Parvez
authors.initials: P
authors.lastname: Ahmed
authors.affiliation: King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
authors.forename: Hassan
authors.initials: H
authors.lastname: ElSolh
authors.affiliation: King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
authors.forename: Syed Osman
authors.initials: SO
authors.lastname: Ahmed
authors.affiliation: King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
authors.forename: Fazal
authors.initials: F
authors.lastname: Hussain
authors.affiliation: Tehran University of Medical Sciences, Hematology, Oncology and SCT Research Center, Tehran, Iran.
authors.forename: Ardeshir
authors.initials: A
authors.lastname: Ghavamzadeh
mesh_terms: D016026:Bone Marrow Transplantation; D018380:Hematopoietic Stem Cell Transplantation; D006412:Hematopoietic Stem Cells / Q000166:cytology; D006801:Humans; D019083:Mediterranean Region; D058028:Research Report; D014019:Tissue Donors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous
keywords: Conditioning; EMRO; Hematopoietic stem cell transplantation; Stem cell source