Context Hematopoietic stem cell transplantation (HSCT) requires significant infrastructure. Little is known on its 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. Design Structured worldwide collection of numbers of allogeneic and autologous HSCT by main indication, donor type and stem cell source for the year 2006. Setting Worldwide Network for Blood and Marrow Transplantation (WBMT), a global non-profit umbrella organization for clinical HSCT. Patients All patients with an allogeneic or autologous HSCT for any indication transplanted in 2006 within any of the participating countries. Interventions none Main Outcome measures Transplant rates (number of HSCT per 10 million inhabitants) by indication, donor type and country; description of main differences in HSCT use; macroeconomic factors of reporting countries associated with transplant rates. Results There were 50’417 first HSCT, 21’516 allogeneic (43%), 28’901 autologous (57%) reported from 1’327 centers in 71 countries for leukemia (17’049 (34%; 89% allogeneic)), lymphoma (27’492 (54%; 87% autologous)), solid tumors (2’925 (6%, 95% autologous)), non-malignant disorder (2’593 (5%; 92% allogeneic)) or, “others” 358 (1%). Use of allogeneic or autologous HSCT, use of unrelated or family donors for allogeneic HSCT and proportions of disease indications varied significantly between countries and continental regions. In linear regression analyses, Government Health Care Expenditures (r2 = 77.33), team density (r2 =76.28), Human Development Index (r2 = 74.36) and Gross National Income /Capita (r2 = 74.04) showed the highest association with transplant rates. Conclusions HSCT is an accepted therapy today with different use and needs worldwide. Availability of resources, Governmental support and, access for patients to a team were identified as key factors for higher transplant rates.

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Six hundred and twenty-four centers from 43 countries reported a total of 31 322 hematopoietic SCT (HSCT) to this 2009 European Group for Blood and Marrow Transplantation (EBMT) survey with 28 033 first transplants (41% allogeneic, 59% autologous). The main indications were leukemias (31%; 92% allogeneic), lymphomas (58%; 12% allogeneic), solid tumors (5%; 6% allogeneic) and non-malignant disorders (6%; 88% allogeneic). There were more unrelated than HLAidentical sibling donors (51 vs 43%) for allogeneic HSCT; the proportion of peripheral blood as stem cell source was 99% for autologous and 71% for allogeneic HSCT. Allogeneic and autologous HSCT continued to increase by about 1000 HSCT per year since 2004. Patterns of increase were distinct and different. In a trend analysis, allogeneic HSCT increased in all World Bank Categories (P ¼ 0.01, two sided; all categories), autologous HSCT increased in middle-(P ¼ 0.01, two sided) and low-income (P ¼ 0.01, two sided) countries. EBMT practice guidelines appeared to have an impact on trend, with a clear increase in absolute numbers within the categories 'standard' and 'clinical option' for both allogeneic and autologous HSCT (P ¼ 0.01, two sided; for both allogeneic and autologous HSCT) and a clear decrease in autologous HSCT for the 'developmental' and 'generally not recommended' indications (P ¼ 0.01, two sided). These data illustrate the status and trends of HST in Europe.

This fifteenth annual European Group for Blood and Marrow Transplantation activity report lists the transplant activity in Europe in 2004 and documents the changes in indication over the past 15 years. In 2004, there were 22 216 first hematopoetic stem cells (HSCT), 7407 allogeneic (33%), 14 809 autologous (67%) and 4378 additional re-or multiple transplants reported from 592 centres in 38 European and five affiliated countries. Main indications were leukemias (7045 (32%; 78% allogeneic)); lymphomas (12 310 (55%; 94% autologous)); solid tumors (1759 (8%; 93% autologous)) and nonmalignant disorders (1015 (5%; 92% allogeneic)). In comparison, 145 teams from 20 countries performed 4234 HSCT (2137 allogeneic, 50%; 2097 autologous, 50%) in 1990. The overall increase was accompanied by major changes. Stem cell source changed from bone marrow to peripheral blood. More than one-third of allogeneic HSCT are now from unrelated donors. Reduced intensity conditioning is employed for one-third of allogeneic HSCT. Leukemias for allogeneic and lymphoproliferative disorders for autologous HSCT continue to increase. The decline in HSCT for chronic myeloid leukemia appears to level off for the first time since 1999. These data are informative for patient counselling and decision making for health care professionals. Bone Marrow Transplantation (2006) 37, 1069-1085. doi:10.1038/sj.bmt.1705377 Keywords: hematopoietic stem cell transplantation; Europe; transplant rates; leukemia; solid tumor; nonmalignant diseases IntroductionTransplantation of hematopoietic stem cells (HSCT) offers a unique opportunity for long-term disease control to many patients with severe malignant or hematopoietic stem cells malignant, acquired or congenital disorders of the hematopoietic system or with chemo-radiosensitive tumors. [1][2][3] HSC has seen rapid expansion over the last decade and the increasing demand for this high-cost procedure can present a challenge for health care systems in any country. Precise information on current use and trends is essential for patients, physicians and health care providers alike. 4,5 The activity survey of the European Group for Blood and Marrow Transplantation (EBMT) was designed in 1990 to provide this information in a most efficient way and to disseminate it rapidly on an annual basis. 6 All EBMT members and affiliated teams, known to perform transplants, were requested to report their numbers of patients transplanted by indication, stem cell source and donor type on an annual basis. The initial survey sheet was slightly changed over the years, to respond to changes in indication and to collect additional generic information on the numbers of re-or multiple transplants, on the percentage of cord blood HSCT and on the percentage of transplants with reduced intensity conditioning (RIC HSCT). The EBMT survey was adopted by the General Assembly as a mandatory self-reporting system. It forms now an integral part of a comprehensive quality assurance program JACIE (Joint Accreditation Committee of the International Socie...