CLINICAL SCIENCES Evolution of Hematopoietic Stem Cell Transplantation in Eastern andWestern Europe from 1990 to 2003. A Report from the EBMT Activity Survey

Transplantation of hematopoietic stem cells (HSCT) has seen rapid expansion during the last decade. It is evident that there are differences between eastern andwestern European countries when this high cost procedure is concerned. In order to obtain more insight into the mechanisms associated with these differences, we compared the transplant rates (number of transplants per 10 million population) for allogeneic and autologous HSCT between selected eastern and western European countries and looked for factors associatedwith their differences. Datawere obtained by the annual European Group for Blood and Marrow Transplantation (EBMT) activity survey for the period from 1990 to 2003. Transplant rates were substantially lower in eastern European countries for autologous, allogeneic, and unrelated HSCT throughout the observation period. The rapid increase in transplant rates during the 1990s occurred later in eastern European countries. Transplant rates continued to rise during the last three years in eastern European countries in contrast to aplateau in transplant rates inwesternEuropeancountries. Therewas a clear correlationbetweeneconomic factors, measured as gross national income per capita, and transplant rates for low-income countries. Therewas also a clear correlation between team density (number of teams per 10 million population) and transplant rates. These data document that economic factors explain the differences in transplant rates between eastern and western European countries only in part. Another important factor seems to be the access to the therapeutic procedure. These data provide a basis for health care planning.