title: One million haemopoietic stem-cell transplants: a retrospective observational study.
abstract: BACKGROUND
  The transplantation of cells, tissues, and organs has been recognised by WHO as an important medical task for its member states; however, information about how to best organise transplantation is scarce. We aimed to document the activity worldwide from the beginning of transplantation and search for region adapted indications and associations between transplant rates and macroeconomics.
  
  
  METHODS
  Between Jan 1, 2006, and Dec 31, 2014, the Worldwide Network for Blood and Marrow Transplantation collected data for the evolution of haemopoietic stem-cell transplantation (HSCT) activity and volunteer donors in the 194 WHO member states.
  
  
  RESULTS
  953,651 HSCTs (553,350 [58%] autologous and 400,301 [42%] allogeneic) were reported by 1516 transplant centres from 75 countries. No transplants were done in countries with fewer than 300,000 inhabitants, a surface area less than 700 km(2), and a gross national income per person of US$1260 or lower. Use of HSCT increased from the first transplant in 1957 to almost 10,000 by 1985. We recorded a cumulative total of about 100,000 transplants by 1995, and an estimated 1 million by December, 2012. Unrelated donor registries contributed 22·3 million typed volunteer donors and 645,646 cord blood products by 2012. Numbers of allogeneic HSCTs increased in the past 35 years with no signs of saturation (R(2)=0·989). Transplant rates were higher in countries with more resources, more transplant teams, and an unrelated donor infrastructure.
  
  
  CONCLUSIONS
  Our findings show achievements and high unmet needs and give guidance for decisions; to grant access for patients, to provide a donor infrastructure, and to limit overuse by defining risk and region adapted indications for HSCT as an efficient and cost-effective approach for life-threatening, potentially curable diseases.
  
  
  BACKGROUND
  Funding for this study was indirectly provided by support of the WBMT.
authors.affiliation: Worldwide Network for Blood and Marrow Transplantation (WBMT) Transplant Activity Survey Office, University Hospital, Basel, Switzerland.
authors.forename: Alois
authors.initials: A
authors.lastname: Gratwohl
authors.affiliation: The Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin, Milwaukee, USA.
authors.forename: Marcelo C
authors.initials: MC
authors.lastname: Pasquini
authors.affiliation: The Eastern Mediterranean Blood and Marrow Transplantation Group (EMBMT), King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Aljurf
authors.affiliation: Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Atsuta
authors.affiliation: Worldwide Network for Blood and Marrow Transplantation (WBMT) Transplant Activity Survey Office, University Hospital, Basel, Switzerland.
authors.forename: Helen
authors.initials: H
authors.lastname: Baldomero
authors.affiliation: World Marrow Donor Association, Europdonor Foundation, Leiden, Netherlands.
authors.forename: Lydia
authors.initials: L
authors.lastname: Foeken
authors.affiliation: Institute for Operations Research and Computational Finances, University of St Gallen, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Gratwohl
authors.affiliation: The Latin American Blood and Marrow Transplantation Group (LABMT), Instituto Nacional de Cancer, Rio de Janeiro, Brazil.
authors.forename: Luis Fernando
authors.initials: LF
authors.lastname: Bouzas
authors.affiliation: National Marrow Donor Program, Minneapolis, USA.
authors.forename: Dennis
authors.initials: D
authors.lastname: Confer
authors.affiliation: Institute for Operations Research and Computational Finances, University of St Gallen, Switzerland.
authors.forename: Karl
authors.initials: K
authors.lastname: Frauendorfer
authors.affiliation: Eurocord Foundation, Paris, France.
authors.forename: Eliane
authors.initials: E
authors.lastname: Gluckman
authors.affiliation: Medical Clinic, University of Vienna, Vienna, Austria.
authors.forename: Hildegard
authors.initials: H
authors.lastname: Greinix
authors.affiliation: The Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin, Milwaukee, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Horowitz
authors.affiliation: The Asian Pacific Blood and Marrow Transplantation Group (APBMT) Data Centre, Aichi Medical University, School of Medicine, Japan.
authors.forename: Minako
authors.initials: M
authors.lastname: Iida
authors.affiliation: The Canadian Blood and Marrow Transplantation Group (CBMTG), Princess Margaret Hospital, Toronto, Canada.
authors.forename: Jeff
authors.initials: J
authors.lastname: Lipton
authors.affiliation: Anthony Nolan Research Institute, Royal Free and University College London, UK.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Madrigal
authors.affiliation: The European Society for Blood and Marrow Transplantation (EBMT), Hôpital St. Antoine, Paris, France.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Mohty
authors.affiliation: WHO, Geneva, Switzerland.
authors.forename: Luc
authors.initials: L
authors.lastname: Noel
authors.affiliation: The African Blood and Marrow Transplantation Group (AFBMT), Johannesburg, South Africa.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Novitzky
authors.affiliation: WHO, Geneva, Switzerland.
authors.forename: José
authors.initials: J
authors.lastname: Nunez
authors.affiliation: World Marrow Donor Association, Europdonor Foundation, Leiden, Netherlands.
authors.forename: Machteld
authors.initials: M
authors.lastname: Oudshoorn
authors.affiliation: Worldwide Network for Blood and Marrow Transplantation (WBMT) Transplant Activity Survey Office, University Hospital, Basel, Switzerland.
authors.forename: Jakob
authors.initials: J
authors.lastname: Passweg
authors.affiliation: Bone Marrow Donors Worldwide, Leiden, Netherlands.
authors.forename: Jon
authors.initials: J
authors.lastname: van Rood
authors.affiliation: The Australasian Bone Marrow Transplant Recipient Registry (ABMTRR), Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: Jeff
authors.initials: J
authors.lastname: Szer
authors.affiliation: Stanford University School of Medicine, Standford, USA.
authors.forename: Karl
authors.initials: K
authors.lastname: Blume
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, USA.
authors.forename: Frederic R
authors.initials: FR
authors.lastname: Appelbaum
authors.affiliation: Aichi Medical University, School of Medicine, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kodera
authors.affiliation: Hematology-Oncology Department, University Hospital, Leipzig, Germany. Electronic address: dietger.niederwieser@medizin.uni-leipzig.de.
authors.forename: Dietger
authors.initials: D
authors.lastname: Niederwieser
mesh_terms: D003625:Data Collection; D014943:Global Health; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D012042:Registries; D012189:Retrospective Studies