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Trends of hematopoietic stem cell transplantation in the third millennium

Gratwohl, Aloisa; Baldomero, Helenb

doi: 10.1097/MOH.0b013e328330990f
Hematopoietic stem cell transplantation: Edited by Andrea Bacigalupo

Purpose of review Hematopoietic stem cell transplantation (HSCT) has evolved into an accepted therapy for many congenital or acquired disorders of the hematopoietic system. It has seen major changes in indications and use of transplant techniques. HSCT is a high cost procedure and requires investments; information on trends is essential for patient counselling and healthcare planning.

Recent findings HSCT rates have increased worldwide. Increase is constant and predictable; the reasons therefore are manifold. Introduction of reduced intensity conditioning regimens has opened access to patients at older age and with comorbidities. Higher numbers of unrelated volunteer donors and cord blood products give access to HSCT for patients without family donors. For some well defined indications, HSCT has become the most cost efficient therapy in countries with limited resources. Use of HSCT is under discussion for nonhematopoietic indications, as is the use of nonhematopoietic stem cells for organ repair.

Summary HSCT is likely to continue to increase for currently established indications. Indications and technologies will vary between countries with limited or nonrestricted resources. The most cost effective approach might not be the same everywhere. Novel indications will emerge but time will be needed to confirm their benefit. Close observation of global trends will become an essential tool for healthcare agencies in order to provide the necessary infrastructure in time.

aHematology, Department of Medicine, University Hospital, Basel, Switzerland

bTransplant Activity Survey office of the European Group for Blood and Marrow Transplantation (EBMT), University Hospital, Basel, Switzerland

Correspondence to Professor Dr A. Gratwohl, Hematology, University Hospital Basel, CH-4031 Basel, Switzerland Tel: +41 61 265 42 54; fax: +41 61 265 44 50; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.