1998年欧洲的造血干细胞移植

Gratwohl A, Passweg J, Baldomero H, Hermans J, Urbano-Ispizua A

Division of Hematology, Department of Internal Medicine, Kantonsspital Basel, CH-4031 Basel, Switzerland.

Hematol J. 2000;1(5):333-50. doi: 10.1038/sj.thj.6200046.

INTRODUCTION

Transplantation of hematopoietic stem cells from blood or bone marrow has become accepted therapy for many diseases. Numbers of transplants have increased significantly and stem cell source, donor type and indications have changed during this decade. Information on these changes is essential for interpretation of current data, patient counseling and health care planning.

PATIENTS AND METHODS

Since 1990, members of the European Group for Blood and Marrow Transplantation and teams known to perform blood or marrow transplants have been invited annually to report their transplant numbers by indication, donor type and stem cell source. Data from these surveys have been used to present data for 1998, to assess current status and to give numbers of transplants per participating country, coefficients of variation between countries for individual indications and changes in indication, stem cell source and donor type over the past decade.

RESULTS

In 1998, a total of 20 892 transplants were performed by 528 teams in 31 European countries. Of these transplants 18 400 were first transplants, 5308 (29%) were allogenic, and 13 092 (71%) were autologous. Of the autologous transplants, 809 (6%) were bone marrow derived, and 12 283 (94%) were from peripheral blood stems cells. Of the allogeneic transplants, 3372 (64%) were bone marrow derived, and 1936 (36%) were peripheral blood stem cell transplants. In 1990, the respective figures were 2137 allogeneic (50%) and 2097 (50%) autologous transplants, all exclusively bone marrow derived. Main indications in 1998 were leukemias with 6015 transplants (33%), 68% thereof allogeneic transplants; lymphomas with 7492 transplants (41%), 94% thereof autologous transplants; solid tumors with 4025 transplants (22%), 99% thereof autologous transplants; non-malignant disorders with 868 transplants (5%), 80% thereof allogeneic transplants. Absolute numbers of transplants per year did increase from 4234 in 1990 to 20 892 in 1998. Increase is higher for autologous, than for allogeneic transplants. There were differences in absolute or relative increase over time for individual indications. Transplant rates per number of inhabitants varied between countries, ranging from 0 to >500 total transplants per 10 million inhabitants with a clear correlation between number of teams and transplants per 10 million inhabitants (r=0.61, P<0.001). The least variation between countries was observed for acute leukemias, chronic myeloid leukemia and severe aplastic anemia in allogeneic transplants, for Hodgkin's disease and non-Hodgkin's lymphoma in autologous transplants.

CONCLUSION

These data reflect the current status of blood and marrow transplantation in Europe. They show the continuing increase in utilization, highlight the change from bone marrow to blood as stem cell source and give an objective assessment on presence or absence of trends.

引言

血液或骨髓造血干细胞移植已成为许多疾病被认可的治疗方法。在过去十年间，移植数量显著增加，干细胞来源、供体类型和适应证都发生了变化。了解这些变化对于解读当前数据、为患者提供咨询以及制定医疗保健计划至关重要。

患者与方法

自1990年以来，欧洲血液与骨髓移植组的成员以及已知开展血液或骨髓移植的团队每年都会被邀请按适应证、供体类型和干细胞来源报告其移植数量。这些调查数据已用于呈现1998年的数据，评估当前状况，并给出每个参与国家的移植数量、各适应证在不同国家之间的变异系数，以及过去十年间适应证、干细胞来源和供体类型的变化情况。

结果

1998年，31个欧洲国家的528个团队共进行了20892例移植。其中，18400例为首次移植，5308例（29%）为异体移植，13092例（71%）为自体移植。在自体移植中，809例（6%）来源于骨髓，12283例（94%）来源于外周血干细胞。在异体移植中，3372例（64%）来源于骨髓，1936例（36%）为外周血干细胞移植。1990年，相应的数据为2137例异体移植（50%）和2097例自体移植（50%），且均完全来源于骨髓。1998年的主要适应证为白血病，共6015例移植（33%），其中68%为异体移植；淋巴瘤7492例移植（41%），其中94%为自体移植；实体瘤4025例移植（22%），其中99%为自体移植；非恶性疾病868例移植（5%），其中80%为异体移植。每年的移植绝对数量确实从1990年的4234例增加到了1998年的20892例。自体移植的增长幅度高于异体移植。各适应证在绝对或相对增长方面随时间存在差异。每百万居民的移植率在不同国家之间有所不同，范围从0到每1000万居民超过500例移植，团队数量与每1000万居民的移植数量之间存在明显的相关性（r = 0.61，P < 0.001）。在异体移植中，急性白血病、慢性粒细胞白血病和重型再生障碍性贫血，以及在自体移植中霍奇金淋巴瘤和非霍奇金淋巴瘤，在不同国家之间的变异最小。