Page 41 - Haematologica May 2022

HCT worldwide access
Figure 1. Transplant rates. Hematopoietic cell transplantation (HCT)/10 million population according to transplant type (autologous, allogeneic, related mismatched and cord blood) and world regions in 2016. EUR: Europe, EMR: East Mediterranean Region; AFR: Africa; SEAR/WPR: South East Asia Pacific Region/West Pacific Region.
tion period. Increased allogeneic HCT activities were observed for almost all indications in all regions. The high- est increase was noted for related donors in the SEAR/WPR region (279%; Table 1; Figure 3). The only observed decrease involved solid tumors (44% decrease) in almost all regions except for SEAR/WPR and LPD in North America.
Autologous hematopoietic cell transplantation
The most frequent indication for autologous HCT in 2016 was LPD (n=39,878, 84.2% of all autologous HCT; Table 1) and the most frequent single indication PCD and HD/NHL with 59.4% and 40.4%, respectively. HCT for solid tumors (n=2,853) accounted for 6.4% of autologous HCT and 844 (1.9%) were performed for leukemias most- ly for AML (74.8%) and ALL (18.4%). Autoimmune dis- eases (AID) (92.2%) were the predominant indication for autologous HCT within non-malignant diseases (n=691). Frequencies of autologous HCT increased in almost all indications and regions especially for LPD and non-malig- nant disorders. Decreases in autologous HCT were observed for leukemia (except SEAR/WPR) and for solid tumors in Europe. The highest increase in autologous HCT was observed in Latin America for non-malignant disorders. The frequency of autologous HCT increased by 68.9% predominantly in non-malignant disorders (258%), primarily AID (246.2%) in PCD (122%) and in lymphoma (46.7%; Online Supplementary Figure 4B; Table 1). Decreased activity of autologous HCT was reported for all leukemias (-51.1%; Figure 3).
Trends in donor type and stem cell source
Autologous HCT (range, 0-11,655) were reported from 85 participating countries, while allogeneic HCT (range, 0- 7,850) were reported from 76 countries, including proce- dures from unrelated donors and from CB in 55 and in 41 countries, respectively. Overall, related HCT has become
more frequent than unrelated HCT starting in 2014 (Online Supplementary Figure S5). The increase in related HCT was mainly due to the use of non-identical related donors (39.5% of related HCT), which increased signifi- cantly over the last 4 years, while unrelated CB showed a moderate decline. A detailed analysis of identical and non- identical related HCT according to indication and in com- parison to unrelated HCT is given in Table 2. Highest increases were observed for severe aplastic anemia and hemoglobinopathies (Delta 2007-2016 >1,000%) and for leukemia (Delta 2007-2016 >550%; especially AML CR1, ALL CR1, CML first CP with maximum 2,456%, data not shown), but also in LPD (especially in HD and NHL max Delta 2007-2016 =711%). In comparison, HCT from relat- ed identical donors showed Delta 2007-2016 of maximum 189% for ALL CR1 and from unrelated for AML CR1 of 430%.
Amongst allogeneic HCT, the proportion of unrelated donor HCT ranged from 4.4% to 78.3% (median 20%), with 30 countries performing more unrelated than related donor HCT. Absolute unrelated HCT numbers ranged from 0 to 4,311 and those of CB ranged from 0 to 1,233 in individual countries. It is not surprising that more related HCT were performed in regions without an unrelated donor registry (Latin America, EMR, AFR and SEAR/WPR). Related haploidentical HCT (n=8,131) were evenly distributed in 62 countries; with absolute numbers ranging from 0 to 2,554 and proportions of all allogeneic HCT ranging between 1.5% to 77% (median 8%). TR for haploidentical HCT was highest in North America (n=38), 25 in Europe, eight in Latin America and ≤4 in Asia Pacific, AFR and EMR (Figure 1). However, TR as % of allogeneic HCT reached 34% in SEAR/WPR and 26% in Latin America, while it was only 14% in Europe and EMR.
Peripheral blood (PB) was the predominant graft source in both autologous (99.7%) and allogeneic (72.8%) HCT, while CB as a source has declined (in 2016 13.9% of all
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