Blood Journal
Leading the way in experimental and clinical research in hematology

Association of Human Development Index with rates and outcomes of hematopoietic stem cell transplantation for patients with acute leukemia

  1. Sebastian Giebel1,*,
  2. Myriam Labopin2,
  3. Gerhard Ehninger3,
  4. Dietrich Beelen4,
  5. Didier Blaise5,
  6. Arnold Ganser6,
  7. Andrea Bacigalupo7,
  8. Tomasz Czerw8,
  9. Jerzy Holowiecki1,
  10. Evandro M. Fagundes9,
  11. Elzbieta Nowara1,
  12. Francesco Frassoni10, and
  13. Vanderson Rocha11
  1. 1 Department of Clinical and Experimental Oncology, Div. of Bone Marrow Transplantation and Lymphoma, Comprehensive Cancer Centre, Maria Sklodowska-Curie Memorial Institute - Gliwice Branch, Gliwice, Poland;
  2. 2 European Group for Blood and Marrow Transplantation, Acute Leukemia Working Party, Hopital Saint Antoine, Assistance Publique des Hopitaux de Paris and Universite Paris 6, Pierre et Marie Curie, Paris, France;
  3. 3 Universitaetsklinikum Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany;
  4. 4 Department of Bone Marrow Transplantation, University Hospital, Essen, Germany;
  5. 5 Unite de transplantation et de therapie cellulaire, Inserm UMR 891 Institut Paoli Calmettes, Marseille, France;
  6. 6 Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany;
  7. 7 Department of Hematology and Bone Marrow Transplantation, San Martino Hospital, Genoa, Italy;
  8. 8 Department of Hematology and Bone Marrow Transplantation, Silesian Medical Universty, Katowice, Poland;
  9. 9 Department of Hematology, Federal University of Minas Gerais, Belo Horizonte, Brazil;
  10. 10 Stem Cells and Cell Therapy Centre, San Martino Hospital, Genoa, Italy;
  11. 11 Department of Hematology, Hopital Saint-Louis, Assistance Publique Hopitaux de Paris, Paris, France
  1. * Corresponding author; email: sgiebel{at}


Human development Index (HDI) is used by the United Nations Organization to measure socioeconomic achievements of countries. We evaluated association of HDI with rates and outcomes of hematopoietic stem cell transplantation (HSCT) for patients with acute leukemia. For the analysis of HSCT rates, all adults with acute leukemia (n=16403) treated in 30 European countries, between 2001 - 2005 were included. Association of HDI with the outcome was analyzed for 2015 patients with acute myeloid leukemia treated with myeloablative allotransplantation. Countries were classified according to HDI percentiles into 5 categories. Highly significant correlation was found for HDI and the total number of HSCT per population (R=0.78; p<0.0001), as well as separately for sibling-HSCT (R=0.84; p<0.0001), unrelated-HSCT (R=0.66; p<0.0001) and autologous-HSCT (R=0.43; p=0.02). The probabilities of LFS for 5 consecutive groups of countries with increasing HDI were as follows: 56%, 59%, 63%, 58%, and 68% (p=0.01). In a multivariate analysis transplants performed in countries belonging to the upper HDI category were associated with significantly higher LFS compared to the remaining ones (HR=1.36, p=0.008), which resulted mainly from reduced risk of relapse (HR=0.72, p=0.04). We conclude that in Europe, the HDI is associated with both rates and results of HSCT for acute leukemia.

  • Submitted January 25, 2010.
  • Accepted March 30, 2010.