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Stem cell sources for HSCT vary by region, gross national income
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The use of peripheral blood stem cells for allogeneic hematopoietic stem cell transplantation in patients with bone marrow failure appeared more common in underdeveloped regions, according to a research letter published in JAMA.
Due to the potential limitations of peripheral blood stem cells (PBSC), strategies for the utilization of stem cells derived from bone marrow — such as the promotion of regional-accredited bone marrow harvest centers and unrelated donor registries — should be implemented, according to the researchers.
“Bone marrow was initially the only stem cell source available until the 1990s, when PBSCs and cord blood began to be used,” Ayami Yoshimi, MD, PhD, a pediatric hematology and oncology specialist at University of Freiberg in Germany, and colleagues wrote. “Currently, PBSCs are the major stem cell source, owing to faster engraftment and ease of collection despite a higher rate of graft-versus-host disease and lower survival rates in patients with nonmalignant disorders. Therefore, bone marrow is currently recommended for HSCT in patients with bone marrow failure.”
Yoshimi and colleagues sought to examine the use of PBSCs and bone marrow as the stem cell source for HSCT in patients with bone marrow failure around the world, identifying potential factors associated with the use of each source.
The researchers used the Worldwide Network for Blood and Marrow Transplantation to access data from retrospective HSCT surveys. They primarily derived their data from transplant registries; for countries without registries, they directly contacted transplant centers.
They then divided countries into four WHO regions — Americas, Asia-Pacific, Eastern Mediterranean region (EM) and Africa, and Europe — and focused on procedures performed in 2009 and 2010.
Seventy-four WHO member states reported performing at least one HSCT in 2009 or 2010. The researchers identified 3,282 HSCTs performed for bone marrow failure (Americas, n = 843; Asia-Pacific, n = 936; EM and Africa, n = 266; Europe, n = 1,057).
The researchers observed that unrelated donor HSCT occurred most frequently in Europe (n = 515; 47%), whereas 91% of transplants in the EM/Africa region utilized matched-sibling donors (n = 249).
Stem cells were derived from bone marrow in 54% of transplants (n = 1,766). The remaining transplants utilized PBSCs (n = 1,336; 41%) or cord blood (n = 180; 5%).
Bone marrow served as the stem cell source in 75% of transplants performed in the Americas (n = 631) and 60% of transplants performed in Europe (n = 632). Use of bone marrow occurred less frequently in the EM/Africa region (n = 123; 46%) and the Asia-Pacific region (n = 380; 41%; excluding Japan, 19%; P < .001 comparing all regions).
Economic factors appeared associated with the use of bone marrow vs. PBSCs. Bone marrow use increased from 20% in countries with low and low-middle income, to 50% in countries with high-middle incomes, and to 64% in countries with high incomes (P < .001).
Further, the gross national income per capita appeared significantly associated with stem cell source (R2 = 0.2; P = .002).
The researchers identified limitations of their study, including the absence of formal data quality control in certain countries, the voluntary nature of participation and the limited number of procedures performed in low-income countries.
“National and international transplant organizations and authorities should foster regional-accredited bone marrow harvest centers for patients with nonmalignant disorders and provide resources to establish such infrastructures,” Yoshimi and colleagues wrote. “Unrelated donor registries should provide information on the necessity of bone marrow donation for patients with bone marrow failure.” – by Cameron Kelsall
Disclosure: Yoshimi reports no relevant financial disclosures. Other researchers report grants and personal fees from, as well as speakers bureau roles with, Alexion Pharmaceuticals Australia Pty Ltd., Bristol-Myers Squibb, and Novartis.
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