Alois Gratwohl1, Marcelo C Pasquini2, Mahmoud Aljurf3, Yoshiko Atsuta4, Helen Baldomero1, Lydia Foeken5, Michael Gratwohl6, Luis Fernando Bouzas7, Dennis Confer8, Karl Frauendorfer6, Eliane Gluckman9, Hildegard Greinix10, Mary Horowitz2, Minako Iida11, Jeff Lipton12, Alejandro Madrigal13, Mohamad Mohty14, Luc Noel15, Nicolas Novitzky16, José Nunez15, Machteld Oudshoorn5, Jakob Passweg1, Jon van Rood17, Jeff Szer18, Karl Blume19, Frederic R Appelbaum20, Yoshihisa Kodera21, Dietger Niederwieser22. 1. Worldwide Network for Blood and Marrow Transplantation (WBMT) Transplant Activity Survey Office, University Hospital, Basel, Switzerland. 2. The Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin, Milwaukee, USA. 3. The Eastern Mediterranean Blood and Marrow Transplantation Group (EMBMT), King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia. 4. Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan. 5. World Marrow Donor Association, Europdonor Foundation, Leiden, Netherlands. 6. Institute for Operations Research and Computational Finances, University of St Gallen, Switzerland. 7. The Latin American Blood and Marrow Transplantation Group (LABMT), Instituto Nacional de Cancer, Rio de Janeiro, Brazil. 8. National Marrow Donor Program, Minneapolis, USA. 9. Eurocord Foundation, Paris, France. 10. Medical Clinic, University of Vienna, Vienna, Austria. 11. The Asian Pacific Blood and Marrow Transplantation Group (APBMT) Data Centre, Aichi Medical University, School of Medicine, Japan. 12. The Canadian Blood and Marrow Transplantation Group (CBMTG), Princess Margaret Hospital, Toronto, Canada. 13. Anthony Nolan Research Institute, Royal Free and University College London, UK. 14. The European Society for Blood and Marrow Transplantation (EBMT), Hôpital St. Antoine, Paris, France. 15. WHO, Geneva, Switzerland. 16. The African Blood and Marrow Transplantation Group (AFBMT), Johannesburg, South Africa. 17. Bone Marrow Donors Worldwide, Leiden, Netherlands. 18. The Australasian Bone Marrow Transplant Recipient Registry (ABMTRR), Royal Melbourne Hospital, Parkville, Victoria, Australia. 19. Stanford University School of Medicine, Standford, USA. 20. Fred Hutchinson Cancer Research Center, Seattle, USA. 21. Aichi Medical University, School of Medicine, Japan. 22. Hematology-Oncology Department, University Hospital, Leipzig, Germany. Electronic address: dietger.niederwieser@medizin.uni-leipzig.de.
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. FINDINGS: 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. INTERPRETATION: 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. FUNDING: Funding for this study was indirectly provided by support of the WBMT.
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. FINDINGS: 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. INTERPRETATION: 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. FUNDING: Funding for this study was indirectly provided by support of the WBMT.
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