Hematopoietic cell transplantation (HCT) is an established procedure for many acquired or inherited disorders of the hematopoietic system, benign or neoplastic, including those of the immune system, and as enzyme replacement in metabolic disorders.
The activity survey of the EBMT, describing the status of HCT, has become an instrument with which to observe trends and monitor changes in HCT technology in Europe and neighboring countries.
The survey, using a standardized structure, captures the numbers of HCT from highly committed participating centers, stratified by indication, donor type, and stem cell source. In the last few years, the survey has also included information on cellular therapies with hematopoietic cells for uses other than to replace the hematopoietic system.
The analysis of the survey data since 1990 shows a continued and constant increase in the annual numbers of HCT and transplant rates for both allogeneic and autologous HCT.
This report, based on the 2019 survey data, shows recent trends, changes in indications, and use in Europe and collaborating countries and summarizes the last 30 years.
Hematopoietic cellular therapies include immune effector cells as defined in FACT-JACIE standards for Hematopoietic Cellular Therapy: “A cell that has differentiated into a form capable of modulating or effecting a specific immune response”. This definition covers CAR-T cells and forms the basis for accreditation requirements in recent EBMT-JACIE recommendations.
Hematopoietic cellular therapies were categorized as chimeric antigen receptor T-cells (CAR -T); in vitro selected/and or expanded T-cells or cytokine activated, such as virus speci fic T-cells; cytokine-induced killer cells (CIK); regulatory T cells (TREGS); genetically modi fied T cells other than CAR-T; natural killer cells; dendritic cells; mesenchymal stromal cells; in vitro expanded CD34cells; and genetically modified CD34 cells.
This survey does not include cells from sources other than hematopoietic
tissue. On the other hand, gene therapy protocols, such as those used to treat thalassemia or SCID are part of this survey, but currently numbers are low.
Numbers of Hematopoietic cell transplantation (HCT) in Europe and collaborating countries continues to rise with 48,512 HCT in 43,581 patients, comprising of 19,798 (41%) allogeneic and 28,714 (59%) autologous, reported by 700 centers in 51 countries during 2019.
Main indications were myeloid malignancies 10,764 (25%), lymphoid malignancies 27,895 (64%), and nonmalignant disorders 3173 (7%). A marked growth in CAR-T cellular therapies from 151 in 2017 to 1134 patients in 2019 is observed.
This year’s analyses focus on changes over 30 years. Since the first survey in 1990 where 143 centers reported 4234 HCT, the number has increased to 700 centers and 48,512 HCT. Transplants were reported in 20 countries in
1990, and 51, 30 years later. More than 800,000 HCT in 715,000 patients were reported overall.
Next to the massive expansion of HCT technology, most notable developments include the success of unrelated donor and haploidentical HCT, an increase followed by decrease in the number of cord blood transplants, use of reduced intensity HCT in older patients and
the phenomenal rise in cellular therapy.
This annual report of the European Society for Blood and Marrow Transplantation (EBMT) reflects current activity and highlights important trends vital for health care planning.