AVAILABILITY AND APPROPRIATENESS OF ALLOGENEIC BONE-MARROW TRANSPLANTATION FOR CHRONIC MYELOID-LEUKEMIA IN 10 COUNTRIES

Background. Allogeneic bone marrow transplantation, a sophisticated an d expensive procedure, is the only curative therapy for chronic myeloi d leukemia (CML). We examined the availability and appropriateness of allogeneic bone marrow transplantation for CML in 10 economically adva nced countries with diverse health care systems. For each country we o btained data on the likelihood of transplantation to treat CML in pati ents under the age of 55 years, the length of time from diagnosis to t ransplantation, and the stage of disease at the time of transplantatio n. Methods. Data were collected on 9873 allogeneic bone marrow transpl antations performed at 208 centers in 10 countries from 1989 th rough 1991. Data were acquired from transplantation registries and by means of a mailed survey of all centers and teams that did not contribute da ta to registries. Data on the incidence of disease were drawn from nat ional and regional cancer registries. Results. Among the 10 countries there was a twofold difference between the lowest and highest rates of transplantation to treat CML (0.26 to 0.54 per 100,000 population per year); Swedish patients were the most likely to receive a transplant, and German patients the least likely. The median length of time from diagnosis to transplantation ranged from 6.8 to 15.4 months. In all co untries, most transplantations were performed in the chronic phase of the disease, but as many as a third of patients received transplants i n the less favorable accelerated or blast phase. The values for the Un ited States fell near the middle of those for the 10 countries on all measures. Conclusions. Our findings challenge the assumption that the United States is unique in providing broad access to high-technology t reatments. On no measure of the availability or appropriateness of tra nsplantation for CML did it surpass the other nine countries studied.