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Narrowing the Gap for Hematopoietic Stem Cell Transplantation in the East-Mediterranean/African Region: Comparison with Global HSCT Indications and Trends

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Narrowing the Gap for Hematopoietic Stem Cell Transplantation in the East-Mediterranean/African Region: Comparison with Global HSCT Indications and Trends Bone Marrow Transplantation (2019) 54:402–417 https://doi.org/10.1038/s41409-018-0275-5 ARTICLE Narrowing the gap for hematopoietic stem cell transplantation in the East-Mediterranean/African region: comparison with global HSCT indications and trends 1 2 3 2 4 Helen Baldomero ● Mahmoud Aljurf ● Syed Z. A. Zaidi ● Shahrukh K. Hashmi ● Ardeshir Ghavamzadeh ● 5 6 7 8 9 Alaa Elhaddad ● Rose-Marie Hamladji ● Parvez Ahmed ● Lamia Torjemane ● Miguel Abboud ● 10 11 12 13 14 Abdelghani Tbakhi ● Murtadha Al Khabori ● Asma El Quessar ● Nosa Bazuaye ● Mohamed Amine Bekadja ● 15 16 17 18 2 8 Salman Adil ● Omar Fahmy ● Mani Ramzi ● Ahmed Ibrahim ● Amal Alseraihy ● Nour Ben Abdejalil ● 10 11 19 2 2 Mahmoud Sarhan ● Mohammed Al Huneini ● Lahoucine Mahmal ● Hassan ElSolh ● Fazal Hussain ● 5 20 4 21 22 23 Amr Nassar ● Hani Al-Hashmi ● Amir Ali Hamidieh ● Marcelo Pasquini ● Yoshihisa Kodera ● Nicolaus Kröger ● 24 25 26 27 28 Mohamed Mohty ● Gregorio Jaimovich ● Juliana Martinez Rolon ● Kristjan Paulson ● Hildegard Greinix ● 29 20 30 1 1 31 Daniel Weisdorf ● Mary Horowitz ● José Nunez ● Alois Gratwohl ● Jacob Passweg ● Mickey Koh ● 32 33 34 Jeff Szer ● Dietger Niederwieser ● Nicolas Novitzky ● On behalf of the East-Mediterranean (EMBMT) and African (AfBMT) Blood and Marrow Transplantation Groups and the Worldwide Network for Blood and Marrow Transplantation (WBMT) 1234567890();,: 1234567890();,: Received: 12 December 2017 / Revised: 31 March 2018 / Accepted: 3 April 2018 / Published online: 6 August 2018 © Macmillan Publishers Limited, part of Springer Nature 2018 Abstract Hematopoietic Stem Cell Transplantation (HSCT) activity was evaluated in the African (AFR)/EMRO region and compared to the global activity for the years 2006–2013. Data were obtained from 1570 teams in the 6 WHO continental regions. Of these, 29 (1.85%) of all teams were active in 12 of the 68 AFR/EMRO countries. They reported 2.331 (3.3%) of the worldwide 71.036 HSCT, and a transplant rate of 32.8 (TR; HSCT/10 million inhabitants; worldwide 128.5). This reflects still the lowest regional TR despite an increase of 90% since 2006. HSCT activity in AFR/EMRO countries was characterized by a higher use of allogeneic compared to autologous HSCT, an almost exclusive use of family donors, including haploidentical family donors. These findings contrast with the prevalence of autologous over allogeneic HSCT, and a higher frequency of unrelated HSCT in other parts of the world. Of note, the increase by 200% in HSCT for hemoglobinopathies from 2006 to 2013 (72 per year) in the AFR/EMRO region. This reflects the specific role of HSCT for these disease categories with high prevalence and incidence in the AFR/EMRO region. This report provides information for the competent authorities to foster adequate infrastructure. It urges transplant organization to optimize their cooperation. Introduction successful therapy [1]. Transplantation of hematopoietic stem cells and tissues has extended the lifespan and Hematopoietic stem cell transplantation (HSCT) has enhanced the quality of life of hundreds of thousands of evolved from the beginnings of experimental bone marrow patients worldwide. Over the last two decades, global transplantation 60 years ago to a globally accepted HSCT has seen a constant evolution in technology, a decrease in transplant-related mortality and rapid expansion. HSCT is no longer limited to younger patients or to patients with a matched donor. Novel conditioning regimens with lower intensity and new techniques have expanded the use List of participating centers are given below Acknowledgments of HSCT to older patients, to patients with comorbidities section. and to patients with haploidentical donors [1, 2]. Today, * Dietger Niederwieser HSCT is an established but still complex form of therapy [email protected] for patients with chemo- and immune-sensitive diseases, for Extended author information available on the last page of the article the replacement of deficient cells or cellular components Narrowing the gap for hematopoietic stem cell transplantation in the East-Mediterranean/African region:. 403 and other life-threatening disorders. Its use has also been Participating groups, continents, countries, and extended to severe inherited or acquired disorders of the teams hematopoietic system. However, HSCT is still associated with significant In 2013, 29 teams in 12 of the 68 countries of the AFR/ morbidity and mortality and remains an example of high- EMRO region reported their activities. In contrast, the global cost and highly specialized medicine. It requires extensive survey included reports from 1570 teams in 78 reporting experience, significant infrastructure and a network of countries over 6 WHO continental regions ((www.who.int/a specialists from all fields of medicine. It also requires the bout/regions/en/) America (AMR/PAH; WHO regions ability to provide specialist continued follow-up and man- North-, Middle, and South America, and Canada); Asia agement of patients. The accumulated experience covering (SEAR/WPR; WHO regions South East Asia and Western a range of past errors and successes should therefore be Pacific Region, which includes Australia and New Zealand); used to improve access for all patients in need and serve as a Europe (EUR; includes Turkey and Israel); and AFR/EMRO model for the application of medical products of human (WHO regions Eastern Mediterranean and Africa)). Ana- origin in general. lyses were performed as previously described [7]. Information on indications, the use of specific technol- Data were provided by the Australasian Bone Marrow ogies, and trends in HSCT is essential for correct patient Transplant Recipient Registry ABMTRR (www.abmtrr. counseling and to allow health care agencies to prepare the org), the African Blood and Marrow Transplant Group necessary infrastructure and to avoid errors in planning. In AfBMT, the Asian Pacific Blood and Marrow Transplant addition, the guiding principles of the World Health Orga- Group APBMT (www.apbmt.org), the Canadian Blood and nization (WHO; www.who.org) declare the transplantation Marrow Transplant Group CBMTG (www.cbmtg.org), the of organs, cells and tissues to be a global task, with the Center for International Blood and Marrow Transplantation collection of activity data being one of the prime pre- CIBMTR (www.cibmtr.org), the Eastern Mediterranean requisites [3]. The Worldwide Network for Blood and Blood and Marrow Transplant Group EMBMT (www. Marrow Transplantation (WBMT; www.wbmt.org), as an embmt.org), the European Group for Blood and Marrow umbrella organization in the field of HSCT and a non- Transplantation EBMT (www.ebmt.org), and the Latin governmental organization in working relation with the American Blood and Marrow Transplantation Group WHO, has taken up the challenge of collecting and dis- LABMT ([email protected]). seminating worldwide HSCT data on a regular basis. The Collection system and data validation were obtained as first report was based on the global HSCT activity in 2006 previously described [7]. Data were validated by different [4], and was followed by a report on the data available in independent systems; through confirmation by the reporting 2010 and thereafter a retrospective view of the first one teams, following receipt of a computer printout of the million HSCTs in the year 2015 [5, 6]. The fourth report entered data, by selective comparison with MED-A/TED was focused on the HSCT activity in 2012 and looked at datasets in the EBMT or CIBMTR data system or by cross- major trends since 2006 [7]. The report included a SWOT checking with national registries. On-site visits to selected analysis of the current WBMT policy by key personnel in teams were part of the quality-control program within the field, to identify the strengths, weaknesses, opportu- CIBMTR and EBMT teams. Based on quality controls and nities, and threats of the current perspectives in HSCT. contacts with regulatory agencies or national offices, the In the current study, we analyzed the global HSCT response rate for allogeneic HSCT was estimated to be activities reported between 2006 and 2013 concentrating on >95% and for autologous HSCT 80–90%. The survey the African (AFR)/EMRO region in the global context focuses on the numbers of patients treated for the first time regarding frequency, indication, donor type, and geo- with HSCT. Transplant rates (TRs) were computed as the graphical distribution in 2013. number of HSCT per 10 million inhabitants not corrected for population age. Population data were obtained from the US census office (http://www.census.gov). Patients and methods Study design Results This was a retrospective survey involving all HSCT teams Transplant activities in the AFR/EMRO region from known to the investigators, organized by WBMT through 2006 to 2013 established international and/or regional organizations. No individual patient data were used, thus no ethics committee Up to 34 centers from the AFR/EMRO region were noted to approval was mandated. have HSCT activity during the period from 2006 to 2013 404 Table 1 Trends of HSCT worldwide and in the AFRICAN/EMRO region in 2006 and 2013 African/EMRO region Worldwide 2006 2013 Δ 2006– 2006 2013 Δ 2006–2013 2013 Total Related Unrelated Total Total Related Unre- Total lated Allogeneic HSCT Leukemias 492 670 50 720 46% 14,392 11,424 12,912 24,336 69% AML 186 336 26 362 95% 6611 5592 6334 11,926 80% ALL 132 226 16 242 83% 3488 2926 2753 5679 63% CML 139 48 0 48 −65% 1334 554 496 1050 −21% MDS/MPS 33 52 6 58 76% 2268 1957 2745 4702
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