Mohamed Said Yousef Ahmed, Fadhil Ibtihal, Hamladji Rose-Marie, Hamidieh Amir Ali, Fahmy Omar, Ladeb Saloua, Alimoghaddam Kamran, Elhaddad Alaa, Nacer Redhouane Ahmed, Alsharif Fahad, Rasheed Walid, Jahani Mohammad, Mousavi Seyed Asadollah, Alseraihy Amal, Abdel-Rahman Fawzi, Al Jefri Abdullah, Hussein Ayad Ahmed, Alabdulaaly Abdulaziz, Ibrahim Ahmad, Bekadja Mohamed-Amine, Abboud Miguel, Ahmed Parvez, Dennison David, Bakr Mohammad, Benchekroun Said, Hussain Fazal, Othman Tarek Ben, Aljurf Mahmoud, Ghavamzadeh Ardeshir
King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Hematol Oncol Stem Cell Ther. 2011;4(2):81-93. doi: 10.5144/1658-3876.2011.81.
The Eastern Mediterranean Bone Marrow Transplantation (EMBMT) Group has accumulated over 25 years of data and experience in hematopoietic stem cell transplantation (HSCT), most particularly in hemoglobinopathies, severe aplastic anemia (SAA), and inherited metabolic and immune disorders, in addition to hematologic malignancies peculiar to the region and where recent updates in trends in activities are warranted.
To study trends in HSCT activities in the World Health Organization-Eastern Mediterranean (EM) region surveyed by EMBMT between 2008 and 2009.
Retrospective analysis of the survey data, mainly of the cumulative number of transplants, types of transplants (autologous vs. allogeneic), types of conditioning as myeloablative (MAC) vs. reduced intensity conditioning (RIC) and trends in leukemias, hemoglobinopathies, SAA, inherited bone marrow failure syndromes amongst others.
Fourteen teams from ten Eastern Mediterranean Region Organization (EMRO) countries reported their data (100% return rate) to the EMBMT for the years 2008-2009 with a total of 2608 first HSCT (1286 in 2008; 1322 in 2009). Allogeneic HSCT represented the majority (63%) in both years. The main indications for allogeneic HSCT were acute leukemias (732; 44%), bone marrow failure syndromes (331, 20%), hemoglobinopathies (255; 15%) and immune deficiencies (90; 5%). There was a progressive increase in the proportions of chronic myeloid leukemia (CML) cases transplanted beyond the first chronic phase (3; 7% of all CML cases in 2008 vs 13; 29% in 2009). The main indications for autologous transplants were plasma cell disorders (345; 36%) Hodgkin disease (256; 27%), non-Hodgkin lymphoma (207; 22%) and solid tumors (83; 9%). RIC continued to show a progressive increase over the years (7% in 2007, 11% in 2008 and 13% in 2009), yet remained relatively low compared to contemporary practices in Europe published by EBMT. The vast majority (95%) of allo-HSCT sources were from sibling donors with a continued dominance of peripheral blood (PB) (1076; 63%), while cord blood transplant (CBT) increased to 83 (5% of allo-HSCT), matched unrelated donor (MUD) remained underutilized (1; 0%) and there were no haploidentical transplants reported. Large centers with >50 HSCT/year showed a plateau of the total number of allo-HSCT over the last 5 years that may be related to capacity issues and needs further study.
There is an overall increased rate of HSCT in the EMRO region with a significant increase in utilization of CBT and allogeneic PB-HSCT as a valuable source. However, further research on outcome data and development of regional donor banks (CB and MUD) may help facilitate future planning to satisfy the regional needs and increase collaboration within the group and globally.
东地中海骨髓移植（EMBMT）小组在造血干细胞移植（HSCT）方面积累了超过25年的数据和经验，尤其在血红蛋白病、重型再生障碍性贫血（SAA）、遗传性代谢和免疫疾病方面，此外还涉及该地区特有的血液系统恶性肿瘤，且近期活动趋势需要更新。
研究2008年至2009年EMBMT调查的世界卫生组织东地中海（EM）地区HSCT活动趋势。
对调查数据进行回顾性分析，主要包括移植累计数量、移植类型（自体与异体）、清髓性预处理（MAC）与减低强度预处理（RIC）的预处理类型以及白血病、血红蛋白病、SAA、遗传性骨髓衰竭综合征等的趋势。
来自十个东地中海区域组织（EMRO）国家的14个团队向EMBMT报告了2008 - 2009年的数据（回复率100%），共有2608例首次HSCT（2008年1286例；2009年1322例）。两年中异体HSCT均占多数（占63%）。异体HSCT的主要适应证为急性白血病（732例；44%）、骨髓衰竭综合征（331例，20%）、血红蛋白病（255例；15%）和免疫缺陷（90例；5%）。超过慢性期移植的慢性髓性白血病（CML）病例比例呈逐年上升趋势（2008年占所有CML病例的7%，共3例；2009年占29%，共13例）。自体移植的主要适应证为浆细胞疾病（345例；36%）、霍奇金病（256例；27%）、非霍奇金淋巴瘤（207例；22%）和实体瘤（83例；9%）。多年来RIC持续呈上升趋势（2007年为7%，2008年为11%，2009年为13%），但与欧洲骨髓移植协作组（EBMT）公布的欧洲当代实践相比仍相对较低。绝大多数（95%）的异基因HSCT供体来自同胞，外周血（PB）持续占主导地位（1076例；63%），而脐带血移植（CBT）增至83例（占异基因HSCT的5%），匹配无关供体（MUD）利用不足（1例；0%），且未报告单倍型相合移植。每年进行超过50例HSCT的大型中心在过去5年中异体HSCT总数呈平稳状态，这可能与容量问题有关，需要进一步研究。
EMRO地区HSCT总体发生率上升，CBT和异体PB - HSCT作为宝贵来源的利用率显著增加。然而，对结局数据的进一步研究以及区域供体库（CBT和MUD）的发展可能有助于促进未来规划，以满足区域需求并加强该小组内部及全球的合作。
