Is the use of unrelated donor transplantation leveling off in Europe? The 2016 European Society for Blood and Marrow Transplant activity survey report

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Abstract

Hematopoietic cell transplantation (HCT) is an established procedure for acquired and congenital disorders of the hematopoietic system. In 2016, there was a tendency for continued activity in this field with 43,636 HCT in 39,313 patients [16,507 allogeneic (42%), 22,806 autologous (58%)] reported by 679 centers in 49 countries in 2016. The main indications were myeloid malignancies 9547 (24%; 96% allogeneic), lymphoid malignancies 25,618 (65%; 20% allogeneic), solid tumors 1516 (4%; 2% allogeneic), and non-malignant disorders 2459 (6%; 85% allogeneic). There was a remarkable leveling off in the use of unrelated donor HCT being replaced by haploidentical HCT. Continued growth in allogeneic HCT for marrow failure, AML, and MPN was seen, whereas MDS appears stable. Allogeneic HCT for lymphoid malignancies vary in trend with increases for NHL and decreases for Hodgkin lymphoma and myeloma. Trends in CLL are not clear, with recent increases after a decrease in activity. In autologous HCT, the use in myeloma continues to expand but is stable in Hodgkin lymphoma. There is a notable increase in autologous HCT for autoimmune disease. These data reflect the most recent advances in the field, in which some trends and changes are likely to be related to development of non-transplant technologies.

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Nivolumab for classical Hodgkin lymphoma after autologous stem-cell transplantation and brentuximab vedotin failure: a prospective phase 2 multi-cohort study

Anas Younes, Armando Santoro, Margaret A. Shipp … (2016)

Background Malignant cells of classical Hodgkin lymphoma (cHL) are characterised by genetic alterations at the 9p24·1 locus. This leads to overexpression of the programmed death 1 (PD-1) ligands and enables tumour cells to evade immune surveillance. A phase 1b study showed that nivolumab, a PD-1-blocking antibody, produced a high response rate in patients with relapsed and refractory cHL, with an acceptable safety profile. This phase 2 study assessed the clinical benefit of nivolumab monotherapy in patients with cHL after autologous stem-cell transplantation and brentuximab vedotin failure. Methods This ongoing phase 2 study (NCT02181738) assessed the efficacy and safety of nivolumab, administered intravenously over 60 minutes at 3 mg/kg every 2 weeks, in adult patients with cHL who had failed both autologous stem-cell transplantation and brentuximab vedotin. The primary endpoint was objective response rate by independent radiologic review committee (IRRC) assessment. Secondary and other endpoints included duration of response, safety, and assessment of PD-L1 and PD-L2 loci and PD-L1 and PD-L2 protein expression. Findings Among 80 treated patients, the median number of prior therapies was four (range 3–15). With a mean (SD) follow-up of 8·6 months (2·02), objective response rate per IRRC was 66·3% (53/80). The most common drug-related adverse events (≥15%) included fatigue, infusion-related reaction, and rash. The most common drug-related grade 3–4 adverse events were neutropenia and increased lipase levels (both n=4). The most common serious adverse event (any grade) was pyrexia (n=3). Interpretation Nivolumab demonstrated a high response rate and an acceptable safety profile in patients with cHL who progressed following autologous stem-cell transplantation and brentuximab vedotin. Nivolumab may therefore provide a novel treatment option for a patient population with a high unmet need. Ongoing follow-up will help to assess the durability of response. Funding Bristol-Myers Squibb.

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Hematopoietic stem cell transplantation: a global perspective.

Alois Gratwohl, Helen Baldomero, Mahmoud Aljurf … (2010)

Hematopoietic stem cell transplantation (HSCT) requires significant infrastructure. Little is known about HSCT use and the factors associated with it on a global level. To determine current use of HSCT to assess differences in its application and to explore associations of macroeconomic factors with transplant rates on a global level. Retrospective survey study of patients receiving allogeneic and autologous HSCTs for 2006 collected by 1327 centers in 71 participating countries of the Worldwide Network for Blood and Marrow Transplantation. The regional areas used herein are (1) the Americas (the corresponding World Health Organization regions are North and South America); (2) Asia (Southeast Asia and the Western Pacific Region, which includes Australia and New Zealand); (3) Europe (includes Turkey and Israel); and (4) the Eastern Mediterranean and Africa. Transplant rates (number of HSCTs per 10 million inhabitants) by indication, donor type, and country; description of main differences in HSCT use; and macroeconomic factors of reporting countries associated with HSCT rates. There were 50 417 first HSCTs; 21 516 allogeneic (43%) and 28 901 autologous (57%). The median HSCT rates varied between regions and countries from 48.5 (range, 2.5-505.4) in the Americas, 184 (range, 0.6-488.5) in Asia, 268.9 (range, 5.7-792.1) in Europe, and 47.7 (range, 2.8-95.3) in the Eastern Mediterranean and Africa. No HSCTs were performed in countries with less than 300,000 inhabitants, smaller than 960 km(2), or having less than US $680 gross national income per capita. Use of allogeneic or autologous HSCT, unrelated or family donors for allogeneic HSCT, and proportions of disease indications varied significantly between countries and regions. In linear regression analyses, government health care expenditures (r(2) = 77.33), HSCT team density (indicates the number of transplant teams per 1 million inhabitants; r(2) = 76.28), human development index (r(2) = 74.36), and gross national income per capita (r(2) = 74.04) showed the highest associations with HSCT rates. Hematopoietic stem cell transplantation is used for a broad spectrum of indications worldwide, but most frequently in countries with higher gross national incomes, higher governmental health care expenditures, and higher team densities.

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One million haemopoietic stem-cell transplants: a retrospective observational study.

Alois Gratwohl, Marcelo C. Pasquini, Mahmoud Aljurf … (2015)

The transplantation of cells, tissues, and organs has been recognised by WHO as an important medical task for its member states; however, information about how to best organise transplantation is scarce. We aimed to document the activity worldwide from the beginning of transplantation and search for region adapted indications and associations between transplant rates and macroeconomics.

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Author and article information

Contributors

Jakob R Passweg: +41 61 265 42 54 , jakob.passweg@usb.ch

Journal

Journal ID (nlm-ta): Bone Marrow Transplant

Journal ID (iso-abbrev): Bone Marrow Transplant

Title: Bone Marrow Transplantation

Publisher: Nature Publishing Group UK (London )

ISSN (Print): 0268-3369

ISSN (Electronic): 1476-5365

Publication date (Electronic): 14 March 2018

Publication date PMC-release: 14 March 2018

Publication date (Print): 2018

Volume: 53

Issue: 9

Pages: 1139-1148

Affiliations

[1 ]GRID grid.410567.1, EBMT Activity Survey Office, Hematology, Department of Medicine, , University Hospital, ; Basel, Switzerland

[2 ]ISNI 0000 0004 0578 8220, GRID grid.411088.4, Universitätsklinikum Frankfurt, Goethe-Universität, ; Frankfurt am Main, Germany

[3 ]ISNI 0000000113287408, GRID grid.13339.3b, Department of Hematology, Oncology and Internal Medicine, , Medical University of Warsaw, ; Warsaw, Poland

[4 ]GRID grid.15496.3f, Università Vita-Salute San Raffaele, ; Milan, Italy

[5 ]ISNI 0000 0004 1767 8416, GRID grid.73221.35, Servicio de Hematologia y Hemoterapia, , Hospital Universitario Puerta de Hierro, ; Madrid, Spain

[6 ]Hematology Unit, G. Gaslini Children’s Institute, Genova, Italy

[7 ]ISNI 0000 0001 2180 3484, GRID grid.13648.38, Department of Stem Cell Transplantation, , University Hospital Eppendorf, ; Hamburg, Germany

[8 ]ISNI 0000000090126352, GRID grid.7692.a, Department of Haematology, , University Medical Centre, ; Utrecht, The Netherlands

[9 ]ISNI 0000000089452978, GRID grid.10419.3d, Department of Pediatrics, , Leiden University Medical Centre Leiden, ; Leiden, The Netherlands

[10 ]ISNI 0000 0001 0372 5777, GRID grid.139534.9, St Bartholomew’s Hospital, , Barts Health NHS Trust, ; London, UK

[11 ]ISNI 0000 0001 2107 2845, GRID grid.413795.d, Chaim Sheba Medical Center, ; Tel-Hashomer, Israel

[12 ]ISNI 0000 0004 0641 6031, GRID grid.416126.6, Sheffield Teaching Hospitals NHS Foundation, , Royal Hallamshire Hospital, ; Sheffield, UK

[13 ]ISNI 0000 0001 0595 5584, GRID grid.411797.d, Pediatric Hematology and Oncology, , University Hospital, Collegium Medicum UMK, ; Bydgoszcz, Poland

[14 ]ISNI 0000 0004 1937 1100, GRID grid.412370.3, Department of Hematology, , Hospital Saint Antoine, ; Paris, France

Article

Publisher ID: 153

DOI: 10.1038/s41409-018-0153-1

PMC ID: 6128821

PubMed ID: 29540849

SO-VID: 1b4909a1-ce31-45a5-896c-aa3491497660

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Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, and provide a link to the Creative Commons license. You do not have permission under this license to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, http://creativecommons.org/licenses/by-nc-nd/4.0/

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Is the use of unrelated donor transplantation leveling off in Europe? The 2016 European Society for Blood and Marrow Transplant activity survey report

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Regulatory T cell (Treg) therapy

Most cited references 20

Nivolumab for classical Hodgkin lymphoma after autologous stem-cell transplantation and brentuximab vedotin failure: a prospective phase 2 multi-cohort study

Hematopoietic stem cell transplantation: a global perspective.

One million haemopoietic stem-cell transplants: a retrospective observational study.

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Cited by 43

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