Korean J Hematol.  2006 Dec;41(4):235-242. 10.5045/kjh.2006.41.4.235.

Current Status of Hematopoietic Stem Cell Transplantation in Korean Children

• Jeong DC
• Kang HJ
• Koo HH
• Kook H
• Kim SY
• Kim SK
• Ghim T
• Kim HK
• Kim HM
• Moon HN
• Park KD
• Park BK
• Park SG
• Park YS
• Park HJ
• Seo JJ
• Sung KW
• Shin HY
• Ahn HS
• Ryu KH
• Ryu KH
• Yoo ES
• Lyu CJ
• Lee KC
• Lee SY
• Lee YH
• Lim YT
• Lim JY
• Jang PS
• Jeon IS
• Chung NG
• Cho B
• Hah JO
• Hwang PH
• Hwang TJ

• KMID: 2305209
• DOI: http://doi.org/10.5045/kjh.2006.41.4.235

Abstract

BACKGROUND: Hematopoietic stem cell transplantation (HSCT) is one of the most important armamentarium against various hematologic malignancies or some solid tumors. We investigated the number of patients who might need transplants and compared with that of actual transplants to conceptualize current status and circumstances of HSCTs in Korean children.
METHODS
Questionnaires were sent to Korean Society of Hematopoietic Stem Cell Transplantation (KSHSCT) members who were taking care of children with malignancies or hematologic diseases. Almost all of the newly diagnosed patients between Jan, 1st and Dec, 31st, 2003 were enrolled in the study.
RESULTS
Seven hundred forty eight children (male to female ratio = 1.4:1) were enrolled. The median age was 6.1 years old (8 days~28.8 years old). Malignant diseases consisted of 695 cases (92.9%), and among them almost half were hematologic malignancies. The participating members speculated that HSCTs should be indicated in 285 children (38.1%) which included 209 allogeneic, and 76 autologous transplants. In reality, however, allogeneic HSCTs were performed only in 140 children (67.0%) with the median interval of 5.9 month, and autologous transplants in 44 children (57.9%) with 8.3 month. In autologous setting, all the patients received peripheral blood stem cells (PBSCs), whereas bone marrow (61%), cord blood (34%), and PBSC (5%) were used in allogeneic HSCTs. Donor types were as follows: unrelated donor (37%), cord blood (34%), sibling donor (25%), and family (4%). The reasons for not performing HSCTs were unfavorable disease status or death, no availability of suitable donor, economical situation, and refusal by parental preferences. Under the strict insurance regulations, many transplants were not covered by insurance. More autologous transplants were performed without insurance coverage than allogeneic HSCTs (P=0.013). Those cases were advanced cases and HLA mismatch transplants for allogeneic setting, and relatively rare diseases still awaiting favorable results of transplants for autologous setting.
CONCLUSION
HSCTs are essential part of treatment strategies for children with various diseases. Unfortunately, however, a third of patients who were in need of transplants did not receive HSCTs due to various reasons. It is necessary to expand unrelated donor pool or cord blood banks for the cases lacking HLA-identical sibling donors. Also medical insurances should cover HSCTs for rare diseases as well as for less favorable but novel situations where there are no suitable alternatives.

Keyword

Hematopoietic stem cell transplantation; Children; Allogeneic; Autologous

MeSH Terms

Autografts
Bone Marrow
Child*
Disulfiram
Female
Fetal Blood
Hematologic Diseases
Hematologic Neoplasms
Hematopoietic Stem Cell Transplantation*
Hematopoietic Stem Cells*
Humans
Insurance
Insurance Coverage
Parents
Rare Diseases
Siblings
Social Control, Formal
Stem Cells
Tissue Donors
Unrelated Donors
Surveys and Questionnaires
Disulfiram

Figure

• 

  Fig. 1 Geographic distribution of hospitals participating in this study.

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  Fig. 2 Distribution of Korean pediatric patients diagnosed with hemato-oncologic diseases in 2003. The hematologic malignancies are most common malignancies in childhood.

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  Fig. 3 Distribution of hematopoietic stem cells source (A) and donor type (B). Bone marrow and cord blood were the main source of hematopoietic stem cells used for transplant (A). Seventy percentage of HSCT was unrelated HSCT including UBMT and CB transplantation (B). Abbreviations: CB, cord blood; PBSC, peripheral blood stem cell; BM, bone marrow; UBMT, unrelated bone marrow transplantation.

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  Fig. 4 Distribution of organizations which were requested for donor search (A), and those actually facilitated unrelated HSCT including cord blood transplantation (B) available hematopoietic stem cells according to type of unrelated HSCT. Abbreviations: KMDP, Korean Marrow Donor Program; CHSCB, Catholic Hematopoietic Stem Cell Bank; SCB, Seoul Cord Bank; NMDP, National Marrow Donor Program.

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