Gratwohl Alois, Baldomero Helen, Horisberger Bruno, Schmid Caroline, Passweg Jakob, Urbano-Ispizua Alvaro
Division of Hematology, Department of Internal Medicine and Department of Research, Kantonsspital Basel, Switzerland.
Blood. 2002 Oct 1;100(7):2374-86. doi: 10.1182/blood-2002-03-0675.
Major changes have occurred in the transplantation of hematopoietic stem cells (HSCs) during the last decade. This report reveals the changes, reflects current status, and provides medium-term projections of HSC transplantation (HSCT) development in Europe. Data on 132 963 patients, 44 165 with allogeneic HSC transplant (33%) and 88 798 with an autologous HSC transplant (67%), collected prospectively from 619 centers by the European Group for Blood and Marrow Transplantation (EBMT) in 35 European countries between 1990 (4234 HSCTs) and 2000 (19 136 HSCTs) illustrate utilization of HSCT. HSCT increased in all European countries and for all indications. There were major differences depending on disease indication and donor type. Transplantation rates (numbers of HSCTs per 10 million inhabitants) varied from less than 1 for some rare indications to 37.7 +/- 4.1 for acute myeloid leukemia in allogeneic HSCT or 95.5 +/- 13.5 for non-Hodgkin lymphoma in autologous HSCT. There were indications with a steady, continuing increase and others with initial increase but subsequent decrease. Projections on medium-term development for each disease based on a weighted sensitivity analysis predict an ongoing increase in allogeneic HSCT except for chronic myeloid leukemia. In autologous HSCT they predict an increase for lymphoproliferative disorders, acute myeloid leukemia, myelodysplastic syndromes, and some solid tumors but a decrease for most solid tumors, acute lymphoid leukemia, and chronic myeloid leukemia. Transplantation rates can be predicted with reasonable sensitivity for most disease indications. Despite marked changes in the rapidly developing field of HSCT, this information on current use, trends, and midterm predictions forms a rational basis for patient counseling and health care planning.
在过去十年中，造血干细胞（HSCs）移植领域发生了重大变化。本报告揭示了这些变化，反映了当前状况，并对欧洲造血干细胞移植（HSCT）的发展提供了中期预测。欧洲血液和骨髓移植组（EBMT）于1990年（4234例HSCT）至2000年（19136例HSCT）期间，在35个欧洲国家的619个中心前瞻性收集了132963例患者的数据，其中44165例接受异基因造血干细胞移植（33%），88798例接受自体造血干细胞移植（67%），这些数据说明了HSCT的使用情况。在所有欧洲国家以及所有适应症中，HSCT均有所增加。根据疾病适应症和供体类型存在重大差异。移植率（每1000万居民中的HSCT例数）因罕见适应症的某些情况低于1，至异基因HSCT中急性髓细胞白血病的37.7±4.1，或自体HSCT中非霍奇金淋巴瘤的95.5±13.5不等。有些适应症呈稳定持续增长，而其他一些则先增加后减少。基于加权敏感性分析对每种疾病的中期发展预测表明，除慢性髓细胞白血病外，异基因HSCT将持续增加。在自体HSCT中，预测淋巴增生性疾病、急性髓细胞白血病、骨髓增生异常综合征和一些实体瘤会增加，但大多数实体瘤、急性淋巴细胞白血病和慢性髓细胞白血病会减少。对于大多数疾病适应症，移植率可以以合理的敏感性进行预测。尽管HSCT快速发展领域发生了显著变化，但有关当前使用情况、趋势和中期预测的这些信息为患者咨询和医疗保健规划提供了合理依据。
