Hematopoietic Stem Cell Transplantation<subtitle>A Global Perspective</subtitle>

Abstract

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.

Having a sibling as donor: Patients' experiences immediately before allogeneic hematopoietic stem cell transplantation

“…The indications for HSCT are mainly haematological malignancies, but it is also used for a variety of other disorders ( Figure 1) (Copelan, 2006;Gratwohl et al, 2010;Ljungman et al, 2010;Passweg et al, 2014). In Europe there has been a doubling in numbers between 2001 and 2011, with more than 14 000 allogeneic HSCTs performed in 2011 (Gratwohl et al, 2013;Passweg et al, 2013).…”

Mortalidade relacionada ao transplante e fatores associados em pacientes submetidos ao transplante de células tronco hematopoiéticas: estudo de coorte

“…Tornou-se, assim, um procedimento terapêutico e curativo mundialmente aceito e, apesar de ainda tratar-se de uma terapia de alto custo, representa hoje um impacto importante na sobrevida e na qualidade de vida dos pacientes com doenças oncohematológicas malignas e não malignas (1)(2)(3)(4).…”

“…As principais indicações diagnosticas para TCTH alogênico são leucemias (72%), desordens linfoproliferativas (15%) e doenças não malignas (12%). No caso do TCTH autólogo são desordens linfoproliferativas (84%) (1,2,13) .…”

“…Cerca da metade (51%) dos TCTHs realizados no mundo ocorrem na Europa, seguido do continente americano (29%), Ásia (18%), Oeste do mediterrâneo e África(3%) (1,2,6,14) . O estado de São Paulo é um dos destaques na realização desta terapia devido à concentração de centros e equipes especializadas, entre os quais figura a UNICAMP (Universidade Estadual de Campinas), uma das referências nesse tipo de tratamento (12,15) Em decorrência dos avanços terapêuticos ocorridos no âmbito do TCTH, inúmeros indivíduos, apesar de determinadas características clinicas, têm se beneficiado desta terapia (7,9) .…”

“…Adicionalmente, o uso de células do sangue periférico como fonte de células e doadores não aparentados é excelente alternativa na vigência de inexistência de compatibilidade imunológica entre o doador e o receptor (1,2,6,9) .…”