Introduction: Autologous hematopoietic stem cell transplantation (AHSCT) has emerged as a pivotal therapeutic modality for lymphoma and multiple myeloma (MM), offering promising outcomes in improving patient prognosis. In China, the utilization of AHSCT has seen significant growth, yet regional variations and demographic factors present challenges in ensuring equitable access to this life-saving treatment. A retrospective study conducted across China sheds light on the trends, disparities, and areas for improvement in AHSCT utilization for lymphoproliferative disorders.Abstract:
This retrospective study aimed to delineate the utilization trends of autologous hematopoietic stem cell transplantation (AHSCT) for lymphoma and multiple myeloma (MM) in China, utilizing data from 211 AHSCT centers across 29 provinces. Data from the Global Burden of Disease Study 2019 were employed to calculate AHSCT utilization rates relative to the incidence of lymphoma and MM cases. A total of 4556 transplantations were identified, with 2443 cases for lymphoma and 2113 cases for MM.
Study Design:
To investigate the utilization of autologous hematopoietic stem cell transplantation (AHSCT) for the treatment of lymphoma and multiple myeloma (MM) in China, a retrospective study was conducted. The study was led by the autologous stem cell transplantation group of the Chinese Society of Clinical Oncology and involved data collection from 211 AHSCT centers spread across 29 provinces. The data were collected at both national and provincial levels, with a focus on capturing AHSCT activity for lymphoma and MM cases.
The study utilized data derived from the Global Burden of Disease Study 2019 to calculate AHSCT utilization rates relative to the newly incident cases of lymphoma and MM. This methodology provided a robust framework for assessing epidemiological trends in AHSCT utilization. The study included a total of 4556 transplantations, with 2443 cases for lymphoma and 2113 cases for MM.
Data analysis also considered demographic factors such as patient age and gender. Additionally, geographic distribution of AHSCT activity across different regions of China was examined to identify any disparities in transplantation rates. Limitations of the study included potential influences from migration on AHSCT numbers and the possibility of shared infrastructure across transplantation centers affecting data accuracy.
Results:
The retrospective study identified a total of 4556 AHSCT procedures conducted for the treatment of lymphoma and MM in China. Of these, 2443 transplantations were for lymphoma cases, while 2113 were for MM cases. Notably, the utilization rate of AHSCT for MM (11.3%) was higher compared to lymphoma (2.4%).
The median age of patients undergoing AHSCT was 52 years, with a male predominance observed (male-to-female ratio of 1.3:1). Older patients, particularly those over 60, faced challenges in achieving adequate stem cell yield for transplantation.
Geographically, significant disparities were observed in AHSCT utilization across different regions of China. The eastern regions of the country accounted for the majority of transplantations (55.8%), while the central and western territories reported lower rates of AHSCT activity (just over 20% each). Provinces such as Beijing, Tianjin, and Shanghai exhibited the highest utilization rates, particularly for MM, whereas provinces like Hainan, Jiangsu, and Guizhou reported the lowest utilization rates.
Overall, the study findings highlight an increasing trend in AHSCT activity for lymphoma and MM in China, but also underscore the need to address demographic and geographic disparities to ensure equitable access to this life-saving treatment modality.
Discussion and Implications: The study reflects a notable increase in AHSCT procedures over the years, indicating growing recognition of its efficacy in treating lymphoma and MM. However, age-related barriers and geographic disparities pose significant challenges. Older patients, particularly those over 60, encounter difficulties in meeting transplantation eligibility criteria due to inadequate stem cell yield. Furthermore, regional discrepancies underscore the influence of socioeconomic factors and healthcare accessibility on AHSCT utilization. Developed regions exhibit higher transplantation rates, while lesser-developed provinces struggle with limited resources and expertise.
Addressing these challenges necessitates tailored strategies to enhance stem cell harvest efficiency and ensure the safety of AHSCT, especially for older demographics. Moreover, efforts to intensify training for transplantation teams and promote broader AHSCT utilization in central and western China are imperative. Despite study limitations such as migration influencing transplant numbers and shared infrastructure potentially skewing data, the findings provide valuable insights into AHSCT trends and underscore the importance of regional development to achieve equitable healthcare access.
Conclusion: The retrospective study offers a comprehensive overview of AHSCT utilization for lymphoma and MM in mainland China, highlighting both advancements and disparities. While the increasing adoption of AHSCT signifies progress in cancer treatment, addressing age-related barriers and regional discrepancies is essential to ensure equal access to life-saving therapies across diverse populations. Moving forward, concerted efforts are needed to promote AHSCT expertise, infrastructure development, and healthcare equity throughout China.
Authors collaboration: The study on autologous hematopoietic stem cell transplantation (AHSCT) for lymphoma and multiple myeloma in China was led by notable authors and institutions across the country. Dr. Dehui Zou, among others, played a key role in conceptualizing and executing the research. Collaborating hospitals like the First Affiliated Hospital of Chongqing Medical University and Renji Hospital provided expertise and crucial data.
Published in ‘Bone Marrow Transplantation,’ a respected journal, the study received a platform with established impact. Corresponding authors Jun Zhu and Jun Ma led the study’s objectives and data interpretation. Their commitment to transparency, without competing interests, underlined the study’s integrity.
The diverse collaboration of institutions highlighted the study’s significance in understanding AHSCT utilization in China for lymphoma and MM treatment, aiming to improve patient outcomes.
