據(jù)4月28日刊JAMA上的一則研究披露，一項(xiàng)在全球范圍內(nèi)的對(duì)造血干細(xì)胞移植（HSCT）的應(yīng)用調(diào)查（其中包括來(lái)自骨髓或血液的造血干細(xì)胞移植）發(fā)現(xiàn),，就移植指針和捐贈(zèng)者類型來(lái)說(shuō)，每個(gè)國(guó)家以及各個(gè)大陸地區(qū)之間的造血干細(xì)胞移植率存在著顯著的差異,；HSCT的應(yīng)用最常見于那些有著較高的國(guó)民收入總額及政府在健康上有著較高開支的國(guó)家。
文章的作者寫道：“HSCT已經(jīng)成為對(duì)許多病人的標(biāo)準(zhǔn)治療,，其中包括那些罹患明確的先天性或后天性造血系統(tǒng)[與血細(xì)胞形成有關(guān)]疾病者,，或是那些存在著對(duì)化療、放療或免疫治療敏感的惡性病變的患者,。在過(guò)去的20年中,，人們看到HSCT的使用已經(jīng)有了快速的擴(kuò)展，而且其技術(shù)也持續(xù)在演進(jìn),。”
University Hospital Basel, Switzerland的Alois Gratwohl, M.D.及其同僚開展了一項(xiàng)研究,，旨在評(píng)估全球范圍內(nèi)HSCT在應(yīng)用中存在的差異，并對(duì)不同的因子與該移植率之間的關(guān)聯(lián)性進(jìn)行了調(diào)查,。這項(xiàng)研究包括了那些在2006年接受了異體（即在遺傳上不同的）和自體（即來(lái)自同一個(gè)體的）HSCT的患者,，這些數(shù)據(jù)來(lái)自參加Worldwide Network for Blood and Marrow Transplantation的71個(gè)國(guó)家的1327個(gè)醫(yī)療中心。
在2006年,，共有5萬(wàn)417起首次接受HSCT的報(bào)道,，其中43%為異體移植，57%為自體移植,。大多數(shù)的自體HSCT發(fā)生在美洲和歐洲,。應(yīng)用異體HSCT來(lái)治療的最常見的惡性疾病是急性髓細(xì)胞樣白血病（33%）,；最常見的非惡性疾病是骨髓衰竭綜合癥（6%）,；而自體HSCT的最常見指針是一種漿細(xì)胞疾病（41%）,。
在5萬(wàn)417例HSCT中,，大多數(shù)是在歐洲進(jìn)行的（48%），接著是在美洲（36%）,、亞洲（14%）及東地中海國(guó)家和非洲（2%）,。HSCT的中位（中點(diǎn)）HSCT率（每1000萬(wàn)名居民中）在每個(gè)大陸地區(qū)以及參與國(guó)之間都不相同，從在美州的48.5,、亞洲的184,、歐洲的268.9到東地中海和非洲的47.7。在人口少于30萬(wàn)的國(guó)家或面積小于960平方公里或全國(guó)人均收入不到680美元的國(guó)家中沒(méi)有人接受過(guò)HSCT,。
研究人員寫道：“總之,，這一有關(guān)HSCT的全球性的回顧證明，盡管不同的地區(qū)有著不同的需求和重點(diǎn),，但這是一個(gè)在全世界范圍內(nèi)都被接受的治療方法,。移植術(shù)集中發(fā)生在那些健康支出較高、全國(guó)人均收入總額較高以及移植醫(yī)療團(tuán)隊(duì)密度較高的那些國(guó)家中,；因此,，資源的可獲得性,、政府的支持度以及移植中心設(shè)施的使用方便程度等決定了當(dāng)?shù)豀SCT的比率。”（生物谷Bioon.com）
生物谷推薦原文出處：
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.
