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District Health Board
Although studies have suggested that peripheral blood stem cells (PBSCs) are not the ideal graft source for patients with bone marrow failure (BMF), new research suggests transplant centers worldwide are still using PBSCs in these patients.
The study included data on more than 3000 hematopoietic stem cell transplants (HSCTs) performed in patients with BMF.
The numbers revealed that PBSCs were most-used in the Asia-Pacific region, Africa, and the Eastern Mediterranean region. But they were also used in Europe and the Americas.
Ayami Yoshimi, MD, PhD, of the University of Freiburg, Germany, and colleagues disclosed these findings in a letter to JAMA.
The researchers noted that bone marrow is the recommended graft source for HSCT in patients with BMF, as studies have shown that PBSCs are associated with higher rates of graft-vs-host disease and lower rates of survival.
With this in mind, the team examined the graft sources used in patients with BMF who underwent HSCTs from 2009 through 2010. The researchers looked at 194 World Health Organization member states and found that 74 had reported at least 1 HSCT during that time period.
Of the 114,217 transplants performed, there were 3282 allogeneic HSCTs in patients with BMF. Overall, the most-used graft source was bone marrow (54%), followed by PBSCs (41%), and then cord blood (5%).
Bone marrow was used most commonly in the Americas (75%) and in Europe (60%) but not in the Eastern Mediterranean region and Africa (46%) or in the Asia-Pacific region (41%; excluding Japan, 19%).
The researchers also looked at graft source according to donor type, both overall and by region, but they excluded the 180 cord blood transplants from this analysis.
The team found that, among patients who had a related donor, 57% received bone marrow and 43% received PBSCs.
For related HSCTs in the Americas, 75% of patients received bone marrow and 25% received PBSCs. In Europe, 63% received bone marrow and 37% received PBSCs. In the Eastern Mediterranean and Africa, 47% received bone marrow and 53% received PBSCs. And in the Asia-Pacific region, 37% received bone marrow and 63% received PBSCs.
Among patients who had unrelated donors, 57% received bone marrow and 43% received PBSCs.
For unrelated HSCTs in the Americas, 74% of patients received bone marrow and 26% received PBSCs. In Europe, 56% received bone marrow and 44% received PBSCs. In the Asia-Pacific region, 47% received bone marrow and 53% received PBSCs. And in the Eastern Mediterranean and Africa, 100% received PBSCs.
The use of bone marrow increased from 20% in countries with low and low-middle incomes to 50% in countries with high-middle incomes and 64% in countries with high incomes (P<0.001). There was a significant association between gross national income per capita and stem cell source (P=0.002).
The researchers speculated that PBSCs are still used in BMF patients, despite the disadvantages, because transplant centers routinely obtain PBSCs for other indications, cell separators are available at any transplant center, and PBSC transplants can be performed at a lower cost than bone marrow transplants.
The team said the association between graft source and income supports the idea that short-term financial considerations are important.
So transplant organizations and authorities should help foster regional-accredited bone marrow harvest centers for patients with nonmalignant disorders. And unrelated donor registries should provide information on the necessity of bone marrow donation for patients with BMF. 
Photo from the Canterbury
District Health Board
Although studies have suggested that peripheral blood stem cells (PBSCs) are not the ideal graft source for patients with bone marrow failure (BMF), new research suggests transplant centers worldwide are still using PBSCs in these patients.
The study included data on more than 3000 hematopoietic stem cell transplants (HSCTs) performed in patients with BMF.
The numbers revealed that PBSCs were most-used in the Asia-Pacific region, Africa, and the Eastern Mediterranean region. But they were also used in Europe and the Americas.
Ayami Yoshimi, MD, PhD, of the University of Freiburg, Germany, and colleagues disclosed these findings in a letter to JAMA.
The researchers noted that bone marrow is the recommended graft source for HSCT in patients with BMF, as studies have shown that PBSCs are associated with higher rates of graft-vs-host disease and lower rates of survival.
With this in mind, the team examined the graft sources used in patients with BMF who underwent HSCTs from 2009 through 2010. The researchers looked at 194 World Health Organization member states and found that 74 had reported at least 1 HSCT during that time period.
Of the 114,217 transplants performed, there were 3282 allogeneic HSCTs in patients with BMF. Overall, the most-used graft source was bone marrow (54%), followed by PBSCs (41%), and then cord blood (5%).
Bone marrow was used most commonly in the Americas (75%) and in Europe (60%) but not in the Eastern Mediterranean region and Africa (46%) or in the Asia-Pacific region (41%; excluding Japan, 19%).
The researchers also looked at graft source according to donor type, both overall and by region, but they excluded the 180 cord blood transplants from this analysis.
The team found that, among patients who had a related donor, 57% received bone marrow and 43% received PBSCs.
For related HSCTs in the Americas, 75% of patients received bone marrow and 25% received PBSCs. In Europe, 63% received bone marrow and 37% received PBSCs. In the Eastern Mediterranean and Africa, 47% received bone marrow and 53% received PBSCs. And in the Asia-Pacific region, 37% received bone marrow and 63% received PBSCs.
Among patients who had unrelated donors, 57% received bone marrow and 43% received PBSCs.
For unrelated HSCTs in the Americas, 74% of patients received bone marrow and 26% received PBSCs. In Europe, 56% received bone marrow and 44% received PBSCs. In the Asia-Pacific region, 47% received bone marrow and 53% received PBSCs. And in the Eastern Mediterranean and Africa, 100% received PBSCs.
The use of bone marrow increased from 20% in countries with low and low-middle incomes to 50% in countries with high-middle incomes and 64% in countries with high incomes (P<0.001). There was a significant association between gross national income per capita and stem cell source (P=0.002).
The researchers speculated that PBSCs are still used in BMF patients, despite the disadvantages, because transplant centers routinely obtain PBSCs for other indications, cell separators are available at any transplant center, and PBSC transplants can be performed at a lower cost than bone marrow transplants.
The team said the association between graft source and income supports the idea that short-term financial considerations are important.
So transplant organizations and authorities should help foster regional-accredited bone marrow harvest centers for patients with nonmalignant disorders. And unrelated donor registries should provide information on the necessity of bone marrow donation for patients with BMF.
Photo from the Canterbury
District Health Board
Although studies have suggested that peripheral blood stem cells (PBSCs) are not the ideal graft source for patients with bone marrow failure (BMF), new research suggests transplant centers worldwide are still using PBSCs in these patients.
The study included data on more than 3000 hematopoietic stem cell transplants (HSCTs) performed in patients with BMF.
The numbers revealed that PBSCs were most-used in the Asia-Pacific region, Africa, and the Eastern Mediterranean region. But they were also used in Europe and the Americas.
Ayami Yoshimi, MD, PhD, of the University of Freiburg, Germany, and colleagues disclosed these findings in a letter to JAMA.
The researchers noted that bone marrow is the recommended graft source for HSCT in patients with BMF, as studies have shown that PBSCs are associated with higher rates of graft-vs-host disease and lower rates of survival.
With this in mind, the team examined the graft sources used in patients with BMF who underwent HSCTs from 2009 through 2010. The researchers looked at 194 World Health Organization member states and found that 74 had reported at least 1 HSCT during that time period.
Of the 114,217 transplants performed, there were 3282 allogeneic HSCTs in patients with BMF. Overall, the most-used graft source was bone marrow (54%), followed by PBSCs (41%), and then cord blood (5%).
Bone marrow was used most commonly in the Americas (75%) and in Europe (60%) but not in the Eastern Mediterranean region and Africa (46%) or in the Asia-Pacific region (41%; excluding Japan, 19%).
The researchers also looked at graft source according to donor type, both overall and by region, but they excluded the 180 cord blood transplants from this analysis.
The team found that, among patients who had a related donor, 57% received bone marrow and 43% received PBSCs.
For related HSCTs in the Americas, 75% of patients received bone marrow and 25% received PBSCs. In Europe, 63% received bone marrow and 37% received PBSCs. In the Eastern Mediterranean and Africa, 47% received bone marrow and 53% received PBSCs. And in the Asia-Pacific region, 37% received bone marrow and 63% received PBSCs.
Among patients who had unrelated donors, 57% received bone marrow and 43% received PBSCs.
For unrelated HSCTs in the Americas, 74% of patients received bone marrow and 26% received PBSCs. In Europe, 56% received bone marrow and 44% received PBSCs. In the Asia-Pacific region, 47% received bone marrow and 53% received PBSCs. And in the Eastern Mediterranean and Africa, 100% received PBSCs.
The use of bone marrow increased from 20% in countries with low and low-middle incomes to 50% in countries with high-middle incomes and 64% in countries with high incomes (P<0.001). There was a significant association between gross national income per capita and stem cell source (P=0.002).
The researchers speculated that PBSCs are still used in BMF patients, despite the disadvantages, because transplant centers routinely obtain PBSCs for other indications, cell separators are available at any transplant center, and PBSC transplants can be performed at a lower cost than bone marrow transplants.
The team said the association between graft source and income supports the idea that short-term financial considerations are important.
So transplant organizations and authorities should help foster regional-accredited bone marrow harvest centers for patients with nonmalignant disorders. And unrelated donor registries should provide information on the necessity of bone marrow donation for patients with BMF.