Trends of hematopoietic stem cell transplantation in the Eastern Mediterranean region, 1984-2007

Abstract

Hematopoietic stem cell transplantation (HSCT) activity was surveyed in the 9 countries in the World Health Organization Eastern Mediterranean region that reported transplantation activity. Between the years of 1984 and 2007, 7933 transplantations were performed. The number of HSCTs per year has continued to increase, with a plateau in allogeneic HSCT (allo-HSCT) between 2005 and 2007. Overall, a greater proportion of transplantations were allo-HSCT (n = 5761, 77%) compared with autologous HSCT (ASCT) (n = 2172, 23%). Of 5761 allo-HSCT, acute leukemia constituted the main indication (n = 2124, 37%). There was a significant proportion of allo-HSCT for bone marrow failures (n = 1001, 17%) and hemoglobinopathies (n = 885, 15%). The rate of unrelated donor transplantations remained low, with only 2 matched unrelated donor allo-HSCTs reported. One hundred umbilical cord blood transplantations were reported (0.017% of allo-HSCT). Peripheral blood stem cells were the main source of graft in allo-HSCT, and peripheral blood stem cells increasingly constitute the main source of hematopoietic stem cells overall. Reduced-intensity conditioning was utilized in 5.7% of allografts over the surveyed period. ASCT numbers continue to increase. There has been a shift in the indication for ASCT from acute leukemia to lymphoproliferative disorders (45%), followed by myeloma (26%). The survey reflects transplantation activity according to the unique health settings of this region. Notable differences in transplantation practices as reported to the European Group for Blood and Marrow Transplantation over recent years are highlighted.

Figure 1

Trends in total numbers of autotogous and allogeneic transplant procedures 1984–2007 Abbreviations: Auto SCT= autologous hematopoietic stem cell transplantation; allo = allogeneic hematopoietic stem cell transplantation

Figure 2

Overall autologous and allogeneic hematopoietic stem cell transplant numbers 1984–2007 by country. Abbreviations: KSA= Kingdom of Saudi Arabia

Figure 3

Trends in total numbers first allo-HSCT activity 1984–2007 by country reported to EMBMT Abbreviations: KSA= Kingdom of Saudi Arabia

Figure 4

Trends in Allo- HSCT in EM region by disease indication 1984–2007, expressed as percentage of annual transplants. Abbreviations: AML= acute myeloid leukemia; ALL=acute lymphoblastic leukemia; CML= chronic myeloid leukemia; MDS=myelodysplasia; MPD= myeloproliferative disorder; LPD= lymphoproliferative disorders; BMF=bone marrow failure

Figure 5

Trends in Allo- HSCT for CML in 1^st chronic phase (CP1) and beyond (>CP1).

Figure 6

Total numbers of allo-HSCT by conditioning. Abbreviations: RIC=reduced intensity conditioning; UK=unknown

Figure 7

Trends in stem cell source for allo-HSCT 1984–2007. Abbreviations: BM=bone marrow; PB=peripheral blood; CB= cord blood; MUD= matched unrelated donor

Figure 8

Trends in autologous HSCT in EM region by disease indication 1984–2007, expressed as percentage of annual transplants. Abbreviations: (Abbreviations: AML= acute myeloid leukemia; ALL=acute lymphoblastic leukemia; CML= chronic myeloid leukemia; MDS=myelodysplasia; MPD= myeloproliferative disorder; PCD= plasma cell disorders; NHL=non-Hodgkins lymphoma; HD=Hodgkin’s disease; CLL=chronic lymphocytic leukemia; PLL=prolymphocytic leukemia)

Figure 9

Correlation of gross national income (US$) per capita in 2007 of countries reporting to EMBMT against transplant rates Abbreviations: SCT=stem cell transplant; GNI=gross national income; KSA=Kingdom of Saudi Arabia