据4月28日刊JAMA上的一则研究披露，一项在全球范围内的对造血干细胞移植（HSCT）的应用调查（其中包括来自骨髓或血液的造血干细胞移植）发现，就移植指针和捐赠者类型来说，每个国家以及各个大陆地区之间的造血干细胞移植率存在着显著的差异；HSCT的应用最常见于那些有着较高的国民收入总额及政府在健康上有着较高开支的国家。
文章的作者写道：“HSCT已经成为对许多病人的标准治疗，其中包括那些罹患明确的先天性或后天性造血系统[与血细胞形成有关]疾病者，或是那些存在着对化疗、放疗或免疫治疗敏感的恶性病变的患者。在过去的20年中，人们看到HSCT的使用已经有了快速的扩展，而且其技术也持续在演进。”
University Hospital Basel, Switzerland的Alois Gratwohl, M.D.及其同僚开展了一项研究，旨在评估全球范围内HSCT在应用中存在的差异，并对不同的因子与该移植率之间的关联性进行了调查。这项研究包括了那些在2006年接受了异体（即在遗传上不同的）和自体（即来自同一个体的）HSCT的患者，这些数据来自参加Worldwide Network for Blood and Marrow Transplantation的71个国家的1327个医疗中心。
在2006年，共有5万417起首次接受HSCT的报道，其中43%为异体移植，57%为自体移植。大多数的自体HSCT发生在美洲和欧洲。应用异体HSCT来治疗的最常见的恶性疾病是急性髓细胞样白血病（33%）；最常见的非恶性疾病是骨髓衰竭综合症（6%）；而自体HSCT的最常见指针是一种浆细胞疾病（41%）。
在5万417例HSCT中，大多数是在欧洲进行的（48%），接着是在美洲（36%）、亚洲（14%）及东地中海国家和非洲（2%）。HSCT的中位（中点）HSCT率（每1000万名居民中）在每个大陆地区以及参与国之间都不相同，从在美州的48.5、亚洲的184、欧洲的268.9到东地中海和非洲的47.7。在人口少于30万的国家或面积小于960平方公里或全国人均收入不到680美元的国家中没有人接受过HSCT。
研究人员写道：“总之，这一有关HSCT的全球性的回顾证明，尽管不同的地区有着不同的需求和重点，但这是一个在全世界范围内都被接受的治疗方法。移植术集中发生在那些健康支出较高、全国人均收入总额较高以及移植医疗团队密度较高的那些国家中；因此，资源的可获得性、政府的支持度以及移植中心设施的使用方便程度等决定了当地HSCT的比率。”
生物谷推荐原文出处：
JAMA. 2010;303[16]:1617-1624
Hematopoietic Stem Cell Transplantation
A Global Perspective
Alois Gratwohl, MD; Helen Baldomero, BMS; Mahmoud Aljurf, MD; Marcelo C. Pasquini, MD; Luis Fernando Bouzas, MD; Ayami Yoshimi, MD; Jeff Szer, MD; Jeff Lipton, MD; Alvin Schwendener, MA; Michael Gratwohl, PhD; Karl Frauendorfer, PhD; Dietger Niederwieser, MD; Mary Horowitz, MD; Yoshihisa Kodera, MD; for the Worldwide Network of Blood and Marrow Transplantation
Context Hematopoietic stem cell transplantation (HSCT) requires significant infrastructure. Little is known about HSCT use and the factors associated with it on a global level.
Objectives 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.
Design, Setting, and Patients 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.
Main Outcome Measures 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.
Results 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 km2, 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 (r2 = 77.33), HSCT team density (indicates the number of transplant teams per 1 million inhabitants; r2 = 76.28), human development index (r2 = 74.36), and gross national income per capita (r2 = 74.04) showed the highest associations with HSCT rates.
Conclusion 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.
