Authors' objectives:

To review the status of treatment with bone marrow transplantation, with particular reference to the current situation and future needs in Sweden.

Authors' recommendations: Bone marrow transplantation (BMT) is a part of hematologic intensive care. Autologous and allogenic transplantations may be alternatives to other possible treatment methods such as conventional chemotherapy. The indications for BMT today include malignant blood disorders, particularly leukemia, certain rare genetic diseases and solid tumours (under clinical trial). By 1990, about 60 allogenic and 80 autologous bone marrow transplantations were performed in Sweden. The future need for BMT in Sweden is guided by improved treatment methods, size of current diagnostic groups, ethical considerations and changing indications. The need is presently estimated at 100 allogenic and 150 autologous transplantations per year. There is scientific evidence that better results are achieved if the number of allogenic transplantations per unit exceeds five per year. Therefore, there is reason to limit the number of hospitals which perform allogenic transplantation to those which have a sufficiently large patient base, and to limit autologous transplantation to those regional hospitals with appropriate resources and technical equipment. The outcome of BMT depends on many factors, making the results of studies difficult to assess. Current studies indicate that survival for more than five years following transplantation is about 50% for leukemia patients. The results are generally better for children than adults, sibling donors than unrelated donors and non malignant blood disorders. There are few studies comparing BMT with conventional chemotherapy or autologous and allogenic bone marrow transplantation. More of these studies are needed. Cost studies of BMT are difficult to perform because the number of patients is small and the individual differences in treatment and disease are large. This report estimates the total direct costs of conventional chemotherapy at 710,000 SEK, allogenic transplantation at 820,000 SEK and autologous transplantation at 780,000 SEK over five years. The cost per year of life saved through BMT is estimated at 40,000-90,000 SEK depending on estimated remaining length of life. The few studies available on quality of life indicate that it is arduous both for patients and families. No studies on quality of life have been done on adults in Sweden but studies on children indicate that sexual development and height are inhibited, medications may be required throughout life, and they may be sterile. Research on new conditioning methods, preventive antibiotic treatment, treatment of viral infections, and improving results with unrelated donors is underway. International cooperation to assess treatment methods is essential and Sweden should continue to actively participate.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.sbu.se/Published

Year Published: 1991

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Sweden

Organisation Name: Swedish Agency for Health Technology Assessment and Assessment of Social Services

Contact Address: P.O. Box 3657, SE-103 59 Stockholm, Sweden. Tel: +46 8 4123200, Fax: +46 8 4113260

Contact Name: registrator@sbu.se

Contact Email: registrator@sbu.se

Copyright: The Swedish Council on Technology Assessment in Health Care