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21 May 2009

Bone marrow transplantation in Poland

J Hołowiecki,

Ann Transplant 2009; 14(1): 15-15 :: ID: 880247


The first documented experimental studies on BMT in Poland were carried
out at the University of Lwow in 1938. This initiative was interrupted by the 2nd World War but the results were published by Raszek in 1949. Activities employing new techniques were restarted in eighties and resulted in first successful allogeneic transplantation performed 25 years ago by the team of WW.Jedrzejczak (Nov. 1984). However, due to difficult political and economic situation of Poland the regular transplant program supported by the Ministry of Health was originated much later in early nineties. Thanks to collaboration of centers belonging to the Polish Adult Leukemia Group and pediatric centers the number of transplants increased stepwise from 48 in 1992 up to 837 in 2006 (URDHSCT-138, SibHSCT-179, AHSCT-537) and the number of transplant centers grow up from 4 to 17. In spite of this progress the corresponding indices calculated for 10 millions of inhabitants equaling 219 HSCT/10 mln. and 4.44 teams/10 mln. respectively are more than twice lower compared to Western European countries. The more the worst in 2007 the HSCT number performed in Poland dropped by 6% to 789, and has remained 3.6% below that noted in 2006 also in the next year 2008 (807 procedures: URDHSCT-131, SibHSCT-148, AHSCT-524). Of note is that the decrease concerns mainly allogeneic transplantations. In 2008 the number of alloHSCT was by 12.3% lower than in 2006. Polish BMT centers are accredited at the Ministry of Health and at EBMT, some started preparation for JACIE accreditation. The data on the performed transplant procedures are reported by all centers to EBMT, some have reported it also to IBMTR. There are no sufficient data available on the results of transplant procedures in Poland for relevant comparison with other countries. However, there was one comparative analysis of the registry data for sibling transplants in acute myeloid leukemia suggests that the results obtained in Western Europe and in Middle Europe are comparable. The indications for transplantation in particular diseases are in Poland similar to other countries. In 2006 the proportions of autotransplantations, sibling-allografts and URD-allografts were following: Acute Myeloid Leukemia: 6.5%/39%/29.7%, Acute Lymphoblastic Leuke,oa: 1.3%/25%/22.5%, Chronic Myeloid Leukemia: 0.2%/10%/16.7%, Severe Aplastic Anaemia: 0%/6%/1.4%, Non Hodgkin Lymphoma: 22.9%/6%/2.9%, Hodgkin's Lymphoma: 24.4%/5%/0.7%, Myeloma: 33.1%/2%/2.2%, Myelo Dysplastic Syndroms: 0%/1%/6.5% and Chronic Lymphocytic Leukemia: 0%/2% /0.7%.. A rather high percentage of allografts in chronic myeloid leukemia refl ects insuffi cient access to tyrosine kinase inhibitors at the beginning of the current decade. The URD transplantations were started in 2007, based mainly on donors from Western European Registries, with domination of German ones. Starting from 1999 also the NMDP donors became available. The proportion of URDHSCT from Polish donors has increased from 13% for 1999-2006, to 16% in 2007 and 25% in 2008. This refl ects a rather very retarded development of Polish URD registries. In the last two years there is some improvement due to Poltransplant activities and development of 5 different URD registries. The expected number of URD voluntary donors is going to exceed in 2009 50 thousands. corresponding to 12.8/10 thousand of inhabitants. One half of that number has been fully HLA and DR typed. Of note is that two Polish laboratories performing HLA typing obtained EFI accreditation.
Conclusions. A progress has been made in the last 15 years but the HSC-
transplant rate in Poland is still 2 times lower compared to leading countries. This is due to insufficient finances, non optimal health service system and retarded development of URD registries.

Keywords: Transplantation

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358