1. ¹Department of Paediatric Haematology and Oncology, IRCSS Giannina Gaslini, Genova, Italy
2. ²Acute Leukaemia Working Party of the European Group for Blood and Marrow Transplantation (ALWP-EBMT), Hôpital Saint Antoine AP/HP, Paris, France
3. ³Bone Marrow Transplantation Unit, Department of Paediatric Oncology, Institut Gustave Roussy, Villejuif, France
4. ⁴Department of Haematology, Pesaro Hospital, Pesaro, Italy
5. ⁵Department of Haematology, Ospedale A. Businco, Cagliari, Italy
6. ⁶Department of Paediatric Oncology and Bone Marrow Transplantation, Bristol Royal Hospital for Children, Bristol, UK
7. ⁷Department of Haematology and Bone Marrow Transplantation, Hôpital St Louis, Paris, France
8. ⁸Department of Paediatric Haematology-Oncology, IRCCS Policlinico San Matteo, Pavia, Italy
9. ⁹Department of Immunology and Haematology, Hôpital Necker, Paris, France
10. ¹⁰Department of Paediatrics, University Hospital, Leiden, The Netherlands
11. ¹¹Department of Bone Marrow Transplantation, Hadassah Hebrew University Medical Centre, Ein-Karem, Jerusalem, Israel
12. ¹²BMT Unit, St Anna Kinderspital, Wien, Austria
13. ¹³Department of Paediatric Haematology and Oncology, Hospital Vall d'Hebron, Barcelona, Spain
14. ¹⁴Bone Marrow Transplantation Unit, Great Ormond Street Hospital for Children NHS Trust, London, UK
15. ¹⁵Bone Marrow Transplantation Unit, Hôpital d'Enfants, Medicine Infantile, Vandoevre, France
16. ¹⁶Department of Haematology, Università La Sapienza, Roma, Italy
17. ¹⁷Department of Paediatrics, University Hospital, Tubingen, Germany
18. ¹⁸Acute Leukaemia Working Party of the European Bone and Marrow Transplant group (ALWP-EBMT), Hôpital St Louis, Paris, France

Correspondence: Dr G Dini, Department of Paediatric Haematology and Oncology, IRCCS Giannina Gaslini, Largo Gerolamo, Gaslini, 5, 16148 Genova, Italy. E-mail: giorgiodini@ospedale-gaslini.ge.it

Received 30 August 2006; Revised 27 October 2006; Accepted 27 October 2006.

Abstract

This paper describes the trends in haematopoietic stem cell transplantation (HSCT) activity for children in Europe over the last three decades. We analysed 31 713 consecutive paediatric HSCTs reported by the European Group for Blood and Marrow Transplantation (EBMT) centres between 1970 and 2002. Data were taken from the EBMT registry and were compared according to period and centre category (paediatric or combined). Since 1996, there has been a significant increase in the number of HSCTs performed exclusively by paediatric centres, as well as in the number of alternative donor HSCTs, and in the use of peripheral blood stem cells (P<0.0001). The number of allogeneic HSCTs (allo-HSCTs) for acute lymphoblastic leukaemia, acute myeloblastic leukaemia and chronic myeloid leukaemia remained stable, whereas it increased for myelodysplastic syndromes and lymphomas, and decreased significantly for non-malignant diseases (P<0.0001). Multivariate analysis showed that younger age, human leukocyte antigen genoidentical donors, HSCT performed after 1996 and transplant centres performing more than 10 allo-HSCT/year were all associated with decreased transplant-related mortality (TRM) (P<0.0001). The number of autologus HSCTs (auto-HSCTs) for acute leukaemia decreased significantly, whereas it increased for solid tumours (P<0.0001). Multivariate analysis showed that both auto-HSCT performed before 1996 and paediatric solid tumours (P<0.0001) had higher TRM. Indications for paediatric HSCT have changed considerably during the last seven years. These changes provide tools for decision making in health-care planning and counselling.