Narrowing the Gap for Hematopoietic Cell Transplantation in the East-Mediterranean/African Region: Comparison with Global HSCT Indications and Trends. A Report on Behalf of the East Mediterranean (EMBMT), African Blood and Marrow Transplantation Group (AFBMT) and Worldwide Network for Blood and Marrow Transplantation (WBMT)

Introduction: Hematopoietic Cell Transplantation (HCT) activity in the EMRO/African (EMRO/AFR) region was compared to the global activity in relation to frequency, indication, trends, donor type and geographical distribution.

Methods: Surveys were obtained from international and national registries or by direct reporting by individual centers from 2006-2013. In 2013, activities were summarized from a total of 1570 teams in 78 countries over 6 WHO continental regions. Of these 1570 teams, only 29 teams were active in 12 countries of the EMRO/AFR region.

Results: A total of 464,100 HCT have been reported worldwide since 2006, 54% of which were autologous and 46% allogeneic. The most frequent indications were lymphoproliferative disorders (53.1%), leukemias (35.5%), non-malignant diseases (6.2%), solid tumors (4.9%) and other non-specified rare diseases (0.3%). The annual HSCT activity increased by 52.6% from 46,543 in 2006 to 71,036 in 2013, primarily among allogeneic HSCT (+65%), particularly for non-malignant disorders (+86%), acute leukemias/MDS/MPN (+80%) and lymphoproliferative disorders (+42%). Of the allogeneic HSCT, 106,662 (49.8%) were performed from a family donor. Frequencies of autologous HSCT rose from 26,230 to 37,464 between 2006 and 2013 (+42.8%) primarily for Plasma Cell Disorders (PCD; +75.8%), non-malignant diseases (+50.3%) and lymphomas (+33.7%). Only 2.331 of the 71.036 HCT in 2013 were performed in the EMRO/AFR region. This represents a 90% increase from 2006, characterized by a high frequency of allogeneic compared to autologous HCT and by the almost exclusive use of family donors. Alternative HSCT in the EMRO/AFR region tended to use haploidentical donors rather than cord blood. This contrasts with the global activities, where the frequency of haploidentical HCT did not start to increase until 2012. There was an increase of 200% in HCT for hemoglobinopathies (Thalassemia and Sickle cell anemia; from 72/year in 2006 to 216/year in 2013), but this remains lower than in all other world regions. A total of 1033 HCT for hemoglobinopathies were performed globally in 2013 representing an increase of 164% from 2006 (n=392). This is an extremely low number considering the high prevalence and incidence of Thalassemia (40.000 born annually and 80 million carriers; Modell, WHO Bulletin 2008) and of sickle cell anemia patients in the EMRO/AFR region (e.g. 91,011 in Nigeria and 39,743 in Congo).

Conclusion: The global data on HCT demonstrate the benefits of intensive global collaboration and data sharing, but illustrate important unmet needs, especially the continued underuse of HCT in the region despite evident progress. This information establishes a basis for competent authorities to provide adequate infrastructure and to improve the current situation in which access often remains limited.