HSCT most common in countries with higher gross national income per capita

Although used worldwide, there are significant differences in hematopoietic stem cell transplantation use by region — it is most commonly used in countries with a higher gross national income and governmental health care expenditures, according to findings from a retrospective survey study.

Researchers from the Worldwide Network of Blood and Bone Marrow Transplantation assessed the current use of hematopoietic stem cell transplantation (HSCT) and differences in administration on a global level.

The regional areas studied were: North and South America; Southeast Asia and the Western Pacific Region (Australia and New Zealand); Europe; and the Eastern Mediterranean and Africa.

Patients included had received allogeneic or autologous HSCTs in 2006 at 1,327 centers in 71 participating countries. Primary outcome measures were transplant rates according to indication, donor type, and country. Secondary measures were differences in HSCT use and macroeconomic factors.

In 2006, 50,417 first time HSCTs were reported, of which 43% were allogeneic and 57% autologous. HSCTs were most frequently performed in North and South America (36%) and Europe (48%), followed by Asia (14%) and the Eastern Mediterranean and Africa (2%).

Median HSCT rates per 10 million inhabitants varied from 47.7 in the Eastern Mediterranean and Africa to 48.5 in North and South America, 184 in Asia and 268.9 in Europe.

HSCTs were not performed in countries that were smaller than 960 km², had less than 300,000 inhabitants; or had less than $680 U.S. gross national income per capita.

High rates for HSCT were associated with government health care expenditures (R²= 77.33), the number of transplant teams per 1 million inhabitants (R²=76.28), human development index (R²=74.36), and gross national income per capita (R²=74.04).

Acute myeloid leukemia was the most frequent malignant disease for an allogeneic HSCT (33%); bone marrow failure syndrome was the most frequent nonmalignant disease (6%). Conversely, 41% of indications for autologous HSCTs were plasma cell disorders (41%).

Gratwohl A. JAMA.2010; 303: 1617-1624.