REDMO’S ANNUAL REPORT 2018
The results presented in this annual report have been compiled thanks to the work carried out by the staff at our donor, collection and transplant centers, umbilical cord blood banks, immunology laboratories and REDMO. All of them collaborated according to the guidelines and procedures established by the Transplant Coordination of each Autonomous Community, the National Transplant Organization and the JosĂŠ Carreras Foundation. To all of them and to all voluntary donors and their associations, our acknowledgment and gratitude. .
Population data Spain: Instituto Nacional de EstadĂstica Population data by country: Wikipedia International activity data: World Marrow Donor Association Iconography: Freepik Images: Pexels
Donors
373 196 available donors, meaning an increase of 16% from the previous year.
37% are male donors, 63% female, with 52% of all donors being under 40 years of age.
Throughout 2018 54 011 new donors joined the Registry, 75% of them under 40 years of age.
We received extended typing requests for 2041 donors, processing 171 each month. 50% were completed in a period under 14 days.
We received 1 083 confirmatory typing requests, processing an average of 91 requests per month. 80% were shipped in under 14 days. We received 302 requests for stem-cell collections (25 requests per month), with a total of 201 collections completed, meaning an increase of 36% when compared to the previous year.
3
Donors
Available donors worldwide 33 483 824
Evolution of available donors worldwide (x1000) 40000 35000 30000 25000 20000 15000 10000 5000 2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
0
Donor distribution by continent
14.723.026
9.553.612
4.613.186
4.338.459
181.979
73.562 Africa
Asia
Europe
4
North America
Oceania
South America
Donors Donor distribution by country United States Germany Brazil Poland United Kingdom Israel China Japan Canada India Italy Portugal Spain Taiwan Korea France Netherlands Turkey Thailand Australia Cyprus Argentina Switzerland Sweden Greece Austria Czech Rep. Singapore Belgium South Africa Denmark Arabia Saudi Croatia Finland Norway Iran Romania Armenia Ireland Slovenia Slovakia Mexico New Zealand Lithuania Luxembourg Chile Russia Hungary Serbia Macedonia Bulgaria Uruguay Nigeria
9.065.428 8.299.509 4.426.401 1.626.868 1.591.575 1.169.718 1.090.410 492.179 488.184 454.258 416.605 398.616 373.203 369.766 340.425 290.238 271.703 266.845 202.487 169.577 169.274 161.573 129.472 125.432 125.401 118.938 111.262 100.631 82.372 72.786 58.142 54.523 53.179 46.541 35.247 34.679 34.553 29.383 21.781 18.498 14.450 14.060 12.402 11.679 10.579 10.178 7.772 7.124 3.425 1.432 1.311 974 776
5
Donors Donor distribution within Europe By country
Per 1 000 people
Germany
8.299.509
Cyprus
198
Poland
1.626.868
Germany
100
United Kingdom
1.591.575
Poland
Italy
416.605
Portugal
Portugal
398.616
Turkey
Spain
373.203
42 39 33
United Kingdom
24
France
290.238
Luxembourg
18
Netherlands
271.703
Netherlands
16
Turkey
266.845
Switzerland
15
Austria
13
Cyprus
169.274
Switerzland
129.472
Croatia
13
Sweden
125.432
Sweden
12
Greece
125.401
Greece
11
Austria
118.938
Czech Rep.
10
Czech Rep.
111.262
Denmark
10
Slovenia
9
Belgium
82.372
Denmark
58.142
Finland
8
Croatia
53.179
Spain
8
Finland
46.541
Belgium
7
Norway
35.247
Italy
7
Romania
34.553
Norway
7
Ireland
21.781
Ireland
5
Slovenia
18.498
France
4
Slovakia
14.450
Lithuania
4
Lithuania
11.679
Slovakia
3
Luxembourg
10.579
Romania
2
Russia
7.772
Hungary
1
Hungary
7.124
Macedonia
1
Serbia
3.425
Serbia
0
Macedonia
1.432
Bulgaria
0
Bulgaria
1.311
Russia
0
6
Donors Evolution of number of available donors
Available donors 373 196*
400000 350000 300000 250000 200000 150000 100000 50000 0 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Increase in 2018 ď °16%
*The number of donors registered by REDMO may not match the numbers provided by the NTO nor the various Regional Transplant Coordinations. REDMO only considers as valid those donors who report all basic data and have their HLA typed. On the other hand, the NTO and the Autonomous Communities include within their data all donors who signed an informed consent, and who also provided a sample for HLA typing at a later point.
Evolution of donor registration 90000 80000 70000 60000 50000 40000 30000 20000 10000
7
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
0 2004
Donors typed in 2018 54 011
Donors Donor profile Registered in 2018 (n=54 011)
Available (n=373 196) The average age of available donors is 39 (Standard deviation Âą9,97)
The average age of registered donors is 34 (Standard deviation Âą9,18)
By age and gender
18 to 30
31 to 40
41 to 50
51 to 60
18 to 30
52% of available donors are under 40.
31 to 40
41 to 50
1588
964
6938
Women
4190
13159
6853
14370
5949
32598
Men
25239
71278
Women
49028
73450
38647
57990
24966
Men
51 to 60
75% of new donors are under 40.
Men 33%
Men 37% Women 63%
Women 67%
Donor typing
HLA A, B, C and DR typed donors (or HLA A, B, C, DR and DQ) HLA A, B and DR typed donors (or HLA A, B, DR and DQ) HLA A and B typed donors (or HLA A, B y C) 8
Number of donors (n=373 196)
% of total
139 428*
37%
207 352
56%
26 416
7%
Donors Distribution of available donors by Autonomous Community Andalusia Catalonia Madrid Valencia Murcia Castile Leon Castile La Mancha Basque Country Navarre Canary Islands Galicia Asturias Extremadura Aragon Balearic Islands Cantabria La Rioja Ceuta Melilla
97860 51354 41183 35265 22140 18955 16011 13693 12659 12238 10779 9948 9304 7666 5897 4923 2255 587 351
Donors registered in 2018 by Autonomous Community Andalusia Catalonia Madrid Valencia Castile Leon Castile La Mancha Murcia Canary Islands Extremadura Balearic Islands Galicia Basque Country Asturias Aragon Navarre Cantabria Ceuta Melilla La Rioja
18387 8737 5026 5026 3857 2198 2189 1334 1241 1169 1074 1004 860 786 417 306 175 123 100 10
Donors Available donors per 100 000 people (media=798,47)
Percentage of donors by Autonomous Community
3% 3%
1%
4%
3%
1% 5%
2%
14%
11% 9%
4%
2%
2%
6% 26% 3%
11
398,96
406,33
522,36
575,18
585,76
622,67
626,06
675,70
689,42
710,46
714,34
786,79
789,96
848,46
867,21
967,47
1167,17
1497,45
1954,89
798,47
Donors Collection requests for hematopoietic stem cells during 2018
302*
201
89
(51% international; 49% national)
(18 from 2017 requests)
(includes postponed processes and 4 2017 requests)
Requests received
Cancelled prior to collection
Collections done
* As of Dec 31st 2018 there were 34 collections in process
Stem-cell collection requests increased 36% compared to 2017 (and by 521% since the start of our National Plan for Bone Marrow Donation in 2012). Evolution of requests for stem-cell collections 180 160 140 120 100 80 60 40 20 0 2009
2010
2011
2012
2013
2014
International
2015
2016
2017
2018
National
Profile of requested donors
Average age of requested donors 34 years
77% under 40.
Women 35%
123
109
56
14
Men 65%
18 to 30
31 to 40
41 to 50
51 to 60
15
Donors Distribution of collections by product
Collections completed in 2018 201
Bone Marrow (n=22) Peripheral Blood (n=170)
Increase in 2018 36%
Lymphocyte collection (n=9)
Evolution of stem-cell collections by destination
Increase from 2012-2018 477%
104 97
International
84
National
64 43 37
47 34
2014
2015
43 25 20 2009
29
22 13
20
10
22 12
2010
2011
2012
2013
55 52
2016
2017
2018
*By reason for cancellation (n=89)
Cancelled collection requests 89* * 4 requests from 2017 Includes postponements
Patient
50 Medical reasons
40
TC logistical issues
6
Exitus
2
Personal reasons
2
Donor
39 Medical reasons
22
Voluntary withdrawal
7
Donor’s logistical issues
7
CC’s logistical issues
3
17
Donors Distribution of collections by donor’s Autonomous Community Madrid Catalonia Andalusia Castile La Mancha Valencia Murcia Basque Country Navarre Canary I. Galicia Balearic I. Castile Leon Aragon Asturias Cantabria Extremadura La Rioja
60 43 36 12 12 8 6 5 3 3 3 3 2 2 1 1 1
Distribution of collections by country of destination Spain United States Germany France Italy United Kingdom Netherlands Sweden Belgium Switzerland Australia Romania Austria Hungary Argentina Singapore Chile Serbia Turkey Poland Canada Norway Czech Rep.
104 16 16 13 12 8 4 3 3 3 3 2 2 2 2 1 1 1 1 1 1 1 1 19
Cords
64 526 cord blood units available. Throughout 2018 931 new units were added.
We received extended typing requests for 119 cord blood units, with results provided in an average time of 6 days.
We received 282 requests for DNA samples for confirmatory typing, which were shipped in an average time of 7 days.
We coordinated shipments for 163 units for transplant, 23 for national patients and 140 for international patients.
26
Cords Available cord blood units worldwide 709 308
Evolution of cord blood units available worldwide (x1000) 800 700 600 500 400 300 200 100
Distribution of cord blood units by continent
271.774
219.166
168.253
36.344 13.771 Africa
North America
South America
27
Asia
Europe
Oceania
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
0
Cords Distribution of cord blood units by country United States
204.809
Taiwan
67.371
Spain
64.526
Jorea
54.031
Germany
38.036
Italy
37.241
France
36.607
Australia
36.344
United Kingdom
27.972
Belgim
21.708
Israel
15.890
Canada
14.357
Iran
8.662
Brazil
8.350
Singapore
7.515
China
7.049
Russia
5.731
India
5.714
Switzerland
4.771
Netherlands
4.600
Sweden
4.321
Greece
4.312
Czech Rep.
4.197
Argentina
3.849
Croatia
3.387
Finland
3.340
Cyprus
3.318
Poland
3.256
Slovakia
1.744
Thailand
1.515
Turkey
1.472
Austria
1.424
Chile
1.190
Hong Kong
506
Mexico
382
Slovenia
342
Bulgaria
224
28
Cords
Distribution of cord blood units through Europe By country
Spain
By 100 000 people
64.526
Cyprus
388
Germany
38.036
Belgium
190
Italy
37.241
Spain
138
France
36.607
Croatia
United‌
27.972
Belgium
21.708
Russia
5.731
81
Italy
62
Finland
61
Switzerland
56 56
Switzerland
4.771
France
Netherlands
4.600
Germany
Sweden
4.321
Sweden
42
Greece
4.312
United Kingdom
42
Czech Rep.
4.197
Czech Rep.
39
Croatia
3.387
Greece
38
Finland
3.340
Slovakia
Cyprus
3.318
Netherlands
Poland
3.256
Turkey
18
46
32 27
Slovakia
1.744
Slovenia
17
Turkey
1.472
Austria
16
Austria
1.424
Poland
8
Slovenia
342
Russia
4
Bulgaria
224
Bulgaria
3
29
Cords Evolution of number of cord blood units available
Available cord blood units 64 526
70000 60000 50000 40000 30000 20000 10000 2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
0 1997
Increase in 2018 ď °1%
Distribution of available cord blood units by cord blood bank Vidacord ; 102; 0% Basque Country; 1590; 3% Ivida ; 21; 0% Valencia; 4997; 8%
Galicia; 6364; 10% Andalusia; 24160; 37%
Madrid; 7722; 12%
Catalonia; 19570; 30%
30
Cords Shipments of cord blood units throughout 2018 Evolution of cord blood shipments
Shipments throughout 2018 163
400 350 300 250 200 150 100 50 0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Distribution of cord blood shipments by cord blood bank and patient’s origin Cord blood bank
National patients
International patients
Total
Catalunya
7 (8)
72 (65)
79 (73)
Andalucía
12 (9)
55 (66)
67 (75)
País Vasco
1 (0)
6 (6)
7 (6)
C. Valenciana
1 (2)
4 (9)
5 (11)
Madrid
2 (2)
3 (9)
5 (11)
Galicia
- (0)
- (1)
- (1)
23 (21)
140 (156)
163 (177)
Total
Distribution of cord blood shipments by country of destination Colombia United States Spain France Netherlands United Kingdom Italy Greece Finland Australia Chile Belgium Canada Slovenia Portugal Czech Rep.
46 45 23 16 13 7 3 2 1 1 1 1 1 1 1 1 34
Patients
909 searches for Spanish patients, with 808 being first time searches.
1 251 compatible donors located for 677 patients. In the last 10 years we were able to reduce by 36% the average search time, which is now at 30 days. 90% of located donors are found before 60 days. We coordinated 494 transplants for Spanish patients, representing an increase of 7% from 2017 data, and of 60% in the last 10 years. Transplants with adult donor went up by 11%. Peripheral blood collections represent 83% and those from bone marrow 17%.
Transplants from umbilical cord blood units(33) continue their downward trend, with a cumulative decrease of 78% since 2011.
35
Patients Evolution of searches by product BM/PB
BM/PB+BCU
CBU
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
1000 900 800 700 600 500 400 300 200 100 0 2005
Search activations 909
By product Bone marrow and/or peripheral blood (BM/PB)
629
Umbilical cord blood (CBU)
12
Bone marrow and/or peripheral blood and umbilical cord blood (BM/PB +CBU)
By type of search First time search
808
Second search (or subsequent)
101
268
45% of second time searches were carried out for a new transplant, 29% to search for a new donor and 25% to proceed with transplant with an already located donor.
36
Patients
2008
Donors located before 2 months 90%
2010
2012
2014
53% 56% 58% 60% 59% 56% 61%
2016
677
676
642
613
608
584
542
514
472
422
386
Patients with a located donor 677
2018
83% 85% 90% 72% 77% 78%
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Time to locate donor BM/PB (n=677) Before 30 days
(51%) 342
Between 31 and 61 days
(39%) 265
Between 62 and 90 days
42
Over 3 months
19
Over 6 months
9
150
182 105 118 107 94 96 108 98 96 83 87 70 62 59 52 47 43 41
Average search time 41 days 2000 83 78
Median time for searches (in days) 30
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
65 57 53 53 58 54 52 51 48 51 46 41 37 33 36 32 30
2002
2004
2006 39
2008
2010
2012
2014
2016
2018
Patients 1400
Located donors 1 250
1200 1000 800 600 400 200 0 2008
2010
2012
2014
2016
2018
Actuarial probability of compatible donor 1 38%
75%
82%
84%
88%
86%
Probability of donor 9/10 - 10/10 (n= 2513) 0,8
0,6
Result of 3150 first international searches started during the period 2015 - 2018
0,4
Actuarial probability
0,2
Probability of donor 10/10 (n= 1518) 0 0
28% 30
57%
63%
60
90
65%
64% 120
150
180
210
240
270
300
330
Time since the start of search (days)
This distribution is not based exclusively on HLA compatibility, since many centers require 10/10 donors, rejecting lower compatibilities. For this reason, the search is geared to this type of donors, excluding those with a 9/10 compatibility.
40
360
Patients Distribution of located donors by country of origin (n=1 250)
Germany Spain United States United Kingdom Israel Poland Brazil France Italy Portugal Netherlands Argentina Switzerland Canada Sweden Greece Belgium Finland Denmark Cyprus Turkey Taiwan Saudi Arabia Norway Austria Slovenia Thailand India Armenia Czech Rep. China Australia
410 (33%) 263 (21%) 170 (14%) 79 57 57 33 29 27 22 19 18 13 12 6 4 4 3 3 3 3 2 2 2 2 1 1 1 1 1 1 1
Back in 2012 only 5% of located donors were Spanish. Since the start of the National Plan for Bone Marrow Donation, the number of fully compatible Spanish donors that have been located increased by 21%.
41
Patients Hematopoietic transplants 2018 496 ( 6%)
By product Bone marrow (BM)
76
Peripheral blood (PB)*
387
Umbilical cord blood (CBU)
33
Lymphocyte collections
21
* Includes 3 CD34+ boosts 500 450
PB
400
BM
350
CBU
300
BOOST
250 200 150 100 50 0
Note: REDMO’s statistics for transplant activity do not necessarily match those of the NTO. This is due to the fact that ocassionally TCs cryopreserve parts of a donation with high cellularity. If this part of the donation is used later on, the TC views it as a second transplant, whereas for REDMO there’s only been one donation. The opposite may also take place, that is, a second and immediate donation is carried out after a first donation with very low cellularity, and although the TC will consider it one single transplant, for REDMO it would count as two separate transplants.
42
Patients By diagnostic BM
PB
Myeloblastic Acute Leukemia
12
Myelodysplastic Syndrome
CBU
Total
136
8
156
11
66
4
81
Acute Lymphoblastic Leukemia
11
49
10
71
Non-Hodgkin’s Lymphomas
1
47
48
28
28
Monoclonal Gammopathies
Boost
1
Severe Aplastic Anemia
17
4
Other Leukemias
2
13
Other Malignant Diseases
1
16
Chronic Myeloid Leukemia
3
11
1
15
Congenital Diseases of the Immune System
7
2
3
12
Congenital Metabolical Diseases
6
2
9
Hodgkin’s Lymphomas
1
22 3
17
1 8
Other Non-Malignant Diseases
2
Histiocytosis
2
Congenital Erithrocyte Diseases
3
2
43
18
8 1
6
1
3 2
Patients BM/PB* transplants in 2018 463 * Includes 3 CD34+ Boosts
Percentage of Spanish donations 22%
By country of origin BM/PB Germany
(37%) 170
Spain
(22%) 100
United States
(11%) 53
United Kingdom
30
Poland
29
Israel
14
Portugal
12
Italy
12
Brazil
11
France
7
Switzerland
3
Canada
3
Netherlands
3
Belgium
3
Sweden
2
Finland
2
Argentina
2
Other
7 Evolution of self-supply
25% 20% 15% 10% 5% 0% 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
44
Patients
CBU transplant 2018 33* * 1 double cord transplant
By country of origin of CBU (n=34) Spain
18
United States
12
France
1
United Kingdom
1
Sweden
1
Italy
1
120 100 80 60 40 20 0
<=15 years
45
>15 years
Patients Average of worldwide transplants by population in 2017 15,85
Germany Cyprus Denmark Japan Netherlands Sweden Belgium Brazil Finland Lithuania Switzerland United States United Kigdom France Taiwan Czech Rep. Austria Poland Canada Italy Slovenia Australia Norway Turkey Ireland Croatia New Zealand Spain 2018 Korea Spain 2017 Slovakia Portugal Greece Singapore Hungary Serbia Bulgaria Argentina Romania South Africa Iran Thailand India Mexico China Russia
29,03 27,50 23,62 20,86 20,81 20,20 20,00 19,50 19,09 16,43 16,24 15,67 15,62 15,52 15,51 14,72 14,55 14,30 14,18 14,04 13,00 11,95 11,89 11,57 11,22 11,22 10,82 10,67 10,45 10,02 8,70 8,06 7,89 7,68 7,24 3,29 3,00 2,36 1,85 0,78 0,38 0,24 0,08 0,08 0,05 0,03
48
Global activity REDMO 1991-2019
DONORS 423 018 Donors registered in REDMO
31 069 Extended typing requests
8 981 Blood sample requests
SPANISH DONATIONS
1 661 Transplant requests
1 169 Collections completed
SPANISH CORDS
73 695 Stored cord blood units
10 914 Extended typing and samples requests
3 179 CBUs shipped
SPANISH PATIENTS
13 202 Searches initiated
53
14 561 Located donors
8 220 Collections coordinated
Global activity REDMO 1991-2019 Evolution of Spanish donations BM/PB/DLI donations
CBU shipments
342 320
312 289
246
234
212 206 181 153 127 107 75
1
4
11 7 5
48 43 39 45 39 46 34 35 29 24 28 35 23 23 19 15 10 12 9 17 15 15
63
Cumulative Spanish donations 3500 3000 2500 2000 1500 1000 500 0
BM/PB donations (n=1 169)
54
CBU shipments (n=3 179)
80 81
201 177 163 148
Global activity REDMO 1991-2019 Transplants coordinated by REDMO
Donors BM/PB/BOOST/CBU/LYM
Patients
Spanish
Foreign
Total
Spanish
1 339
5 221
6 560
Foreign
3 050
Total
4 3 89
3 050 5 221
9 610
4500 4000 3500 3000 2500 2000 1500 1000 500 0
BM (n=1 626)
PB (n=3 714)
55
CBU (n=4 058)
DLI (n=212)
Muntaner, 383, 2-2 08021 Barcelona Tel. +34 93 414 55 66 Fax +34 93 414 00 28 redmo@fcarreras.es www.fcarreras.org