Spain breaks bone marrow transplant record

Hematopoietic stem cell transplantation (HSCT) or bone marrow transplant reached its record number in Spain in 2023, with 3,717 procedures, which represents a rate of 77.4 transplants per million population (pmp).

These data come from the TPH report that has just been published by the National Transplant Organisation (ONT). Of the HSCTs carried out last year, 2,253 (61%) were performed with the patient’s own cells (autologous transplants) and 1,464 (39%) with cells from a donor (allogeneic transplants), which in 832 cases were related to the patient and 632 were unrelated voluntary donors.

This is the first year that more than 600 TPH from unrelated donors have been performed in Spain.

Increased allogeneic TPH activity

TPH activity has been increasing in Spain for more than a decade. In particular, allogeneic HSCT has increased by 46% since 2012 (related donor HSCT by 54% and unrelated donor HSCT by 37%). In this way, Spain exceeded 30 allogeneic TPH pmp for the first time in 2023 and was among the European countries with the highest activity of this type of transplant.

This success is part of the National Bone Marrow Plan (PNMO), which brings together the efforts of the ONT, the autonomous communities, scientific societies, patient associations and the Josep Carreras International Foundation, which manages the Spanish Registry of Bone Marrow Donors. Bone Marrow (REDMO), after the signing of the Framework Agreement between this entity, the Ministry of Health and the ONT.

By autonomous community, the maximum TPH activity last year was recorded in Madrid, with 701 transplants, followed by Catalonia (635) and Andalusia (592). In pmp rates, the highest TPH activity was recorded in Navarra (150.7), Cantabria (112.1) and Madrid (102.3).

Regarding the indications for HSCT, of the 3,717 performed in 2023, 2,244 (60%) were performed for the treatment of lymphoproliferative diseases, 1,208 (33%) for leukaemia, 147 (4%) for solid tumours, 99 (3 %) for non-malignant diseases and 19 (<1%) for other diseases.

On the other hand, 275 (7%) HSCT were performed in children.

Constant growth of the REDMO

Performing HSCT from unrelated donors depends on the voluntary donation of people registered in the World Marrow Donor Registry (WMDA), which brings together the data of 42 million donors worldwide and more than 800,000 units of blood. of stored umbilical cord (UCS). The WMDA is made up of 103 donor registries from 56 countries, including Spain through REDMO.

In 2023, 23,686 new donors joined REDMO, which represents a growth of 8% compared to 2022. As of June 1, 2024, REDMO had 492,958 donors, a figure that contrasts with the 100,000 donors registered in 2012, when it was launched. PNMO launched. The rate of people registered in REDMO is 10,083 people pmp. Navarra (19,022), Murcia (16,800) and Extremadura (15,651) are the autonomous communities with the highest pmp rates of donors registered in REDMO.

The average age of donors in REDMO is 32 years. Half of registered donors (51%) are under 40 years of age. Regarding the sex of the donors, the female population continues to be the majority and represents 64% of the registry.

However, the need to incorporate more male donors is evident in the requests from transplant centres, since these donors increase the effectiveness of the transplant.

As a result of the rejuvenation of the REDMO and the better characterisation of voluntary donors (HLA typing) established by the PNMO, in 2023 there were 396 effective donations, which represents a growth of 24% compared to 2022 and 1000% compared to 2012. The effective donation rate is thus placed at 8/10,000, exceeding the objective set by the PNMO.

Umbilical cord blood units

Spain has 62,097 units of umbilical cord blood (UCB), 7.4% of those stored in the world (831,000), being the largest registry in Europe and the second in the world, only behind the United States.

In 2023, 81 SCU units in Spain were used to perform HSCT, 7 for national patients and 74 for foreign patients. In the 14 UCB transplants carried out in Spain in 2023, UCB units from public banks were used.

To facilitate the use of SCU units stored in Spain, the ONT launched the Ready to Ship (R2S) project, financed by the Ministry of Health. The project consists of the detailed characterisation of very high quality SCU units to respond to patients in urgent need of HSCT. As a result of this initiative, the release of SCU units for transplant has increased by 73% during the first four months of this year, compared to the same period of the previous year.