National estimates of the use of hematopoietic stem-cell transplantation in children with cancer in the United States.

National utilization data for hematopoietic stem-cell transplantation (HSCT) for childhood cancers in the United States have not been reported. We identified cancer encounters for children aged 18 years and younger from 1997 to 2001 in US nonfederal, acute care hospitals. We compared patient, hospital, and resource use characteristics and in-patient mortality associated with HSCT and non-HSCT encounters, estimated the number of HSCT encounters by stem-cell source and cancer type, and examined resource use and mortality in each category. We identified 461,175 cancer encounters, of which 6380 (1.4%) were HSCT encounters. There was wide variation in resource use and mortality by stem-cell source and cancer type. Of note, 17% of HSCT encounters were for patients with acute lymphoblastic leukemia without remission or sarcoma, conditions for which there is little evidence of benefit from HSCT in children. These encounters were associated with high in-patient mortality and long lengths of stay. Also, we observed an increasing use of cord blood over the study period. Future research should examine potentially important sociodemographic differences in patients undergoing HSCT compared to those who do not. Additional analyses incorporating disease stage and severity are needed.