Elsevier

European Journal of Cancer

Volume 43, Issue 16, November 2007, Pages 2359-2365
European Journal of Cancer

Stem cell transplantation in Europe: Trends and prospects

https://doi.org/10.1016/j.ejca.2007.08.020Get rights and content

Abstract

The aim of the present study was to identify trends in numbers of European patients treated with autologous and allogeneic haematopoietic stem cell transplantation (HSCT) as well as to provide anticipated transplant rates for the upcoming years. The following indications were considered: haematological malignancies (acute leukaemias, myeloproliferative disorders, lymphoproliferative disorders and multiple myeloma), solid tumours and non-malignant diseases. Numbers of patients treated from 1990 to 2004 were extracted from the European Group for Blood and Marrow Transplantation database, extrapolated to 2012 using mathematic models and adjusted to the literature study and expert opinion. In Europe, a 13% raise in HSCT utilisation is to be expected from 2005 to 2010, mostly due to the growing application of reduced-intensity conditioning regimens followed by allogeneic HSCT. Growing transplant rates are likely to exert health expenditure budgets and put pressure on health care providers and health insurers in Europe. Therefore, the rapid expansion would ideally imply a simultaneous increase in HSCT budgets.

Introduction

During the last century, autologous haematopoietic stem cell transplantation (auto-HSCT) and allogeneic haematopoietic stem cell transplantation (allo-HSCT) have developed into effective therapies for patients with a variety of haematological and genetic diseases. Increases in transplant rates were caused by the shift towards more HSCT derived from peripheral blood, improved possibilities to prevent and treat graft versus host disease (GVHD), the clear trend towards more unrelated donor HSCT and a wider range of indications for which HSCT is applicable.1, 2 Currently, HSCT is most commonly performed in patients with haematological malignancies.2

In 1990, the European Group for Blood and Marrow Transplantation (EBMT) started an initiative to prospectively make an inventory of HSCT performed in Europe according to indication, treatment modality, donor type and stem cell source.3 Results are presented through annual surveys, in which applications of HSCT are assessed and trends are recognised. Similar reviews have been conducted by others.1, 4, 5 However, these analyses were all restricted to past and current practice and imply no prognosis for future developments. Anticipation on transplant rates is a useful tool for the identification of budgetary capability and future use of medical resources, such as transplant centres and medical staffing. Therefore, the aim of the present study was to identify trends in numbers of European patients treated with auto-HSCT and allo-HSCT as well as to provide anticipated transplant rates for the upcoming years.

Section snippets

Materials and methods

MEDLINE, controlled by the United States National Library of Medicine, was searched by using the individual search terms ‘leukaemia’, ‘Hodgkin’, ‘non-Hodgkin’, ‘myeloma’, ‘neuroblastoma’, ‘germ cell cancer’, ‘Ewing’, ‘breast cancer’, ‘soft tissue sarcoma’, ‘renal cell carcinoma’, ‘severe aplastic anaemia’, ‘thalassaemia’, ‘severe combined immunodeficiency’, ‘metabolism’, ‘auto immune disease’, in combination with ‘stem cell’, ‘stem cell therapy’, ‘transplantation’, ‘bone marrow’, ‘blood’ and

Results

Actual numbers of HSCT performed in Europe from 1990 to 2004 specified per indication and treatment modality are presented. The figures also show anticipated HSCT activity from 2005 to 2012. Fig. 1 shows the number of reduced-intensity conditioning regimens followed by allo-HSCT (RIC-HSCT) as a percentage of allo-HSCT. Specifications of HSCT utilisation specified per donor type and stem cell source have been reported elsewhere.2

Acute leukaemia

With conventional chemotherapy in acute lymphoblastic leukaemia (ALL), the event-free survival in children is over 70%, whereas only 20–38% of adults are eventually cured. The addition of both auto-HSCT and allo-HSCT to chemotherapy has proven to be effective in the treatment of more selected patient categories.6, 7 Newer chemotherapy regimens are continuously being proposed for adult patients with ALL and some recent studies suggest that intensifying the early phases of therapy may have an

Auto-HSCT

Actual numbers of HSCT performed in Europe in 1990, 1995 and 2000 and anticipated numbers of HSCT in 2005 and 2010 are shown in Fig. 8. Overall, an increase in auto-HSCT utilisation of 6% from around 15,000 in 2005 to almost 16,000 in 2010 is predicted. Even though the introduction of alternative strategies might cause a slight decrease in activity for LPD, MM and solid tumours, transplant rates are likely to remain continuously high. Increase in auto-HSCT utilisation is mainly expected in

Discussion

Our analyses show an overall anticipated increase in HSCT utilisation of 13% from 2005 to 2010 in Europe. Growing transplant rates are likely to exert health expenditure budgets and put pressure on health care providers and health insurers in Europe. Therefore, the rapid expansion would ideally imply a simultaneous increase in HSCT budgets. In an earlier study, budgetary implications were assessed for the Netherlands in a scenario analysis taking the average price indexation of 2% into account

Conflict of interest statement

No financial or personal relationships with other people or organisations that could inappropriately influence this work to declare.

Acknowledgements

The authors would like to thank Prof. Dr. J.J. Cornelissen, haemato-oncologist, of the Erasmus University Medical Center (Rotterdam), Prof. Dr. A.V. Schattenberg, haemato-oncologist, of the St. Radboud University Medical Center, Prof. Dr. S. Rodenhuis, oncologist, of the Antoni van Leeuwenhoek Hospital (Amsterdam), Prof. Dr. E.G. de Vries, oncologist, University Medical Center Groningen (Groningen), Prof. Dr. E.C. Wolters, neurologist, of the VU University Medical Center (Amsterdam), Dr. A.E.M.

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