Abstract and Introduction
The European Society for Blood and Marrow Transplantation was established in 1974 to enable scientists and physicians involved in clinical bone marrow transplantation to share their experience and develop cooperative studies. The organization celebrated its 40th anniversary with a meeting that considered hematopoietic stem cell transplantation not as a standalone procedure, but as part of a complex therapeutic program managed by a multidisciplinary professional team. The role of antifungal prophylaxis, emerging resistance in Aspergillus, the management of mucormycosis and new guidelines on antifungal therapy were among the topics discussed by the physicians, nurses, allied health professionals and scientists attending the 40th Annual Meeting of the European Society for Blood and Marrow Transplantation.
As a scientific society, the European Society for Blood and Marrow Transplantation (EBMT) has grown in parallel with use of hematopoietic stem cell transplantation (HSCT) – the millionth bone marrow transplant was reported in early 2013 – and now has members in over 500 centers worldwide. This global expansion of EBMT has been built on a foundation of basic and clinical research, including both randomized clinical trials and observational studies. According to Catherine Cordonnier (Créteil, France), observational or noninterventional studies do not replace gold standard, prospective clinical trials: "Knowing what people do does not tell us what we ought to do."
Observational studies can, however, complement clinical trials if they are well designed and have a clearly stated plan for statistical analysis. In particular, observational studies are often the only credible approach for rare diseases. These studies may also identify epidemiological trends and other important issues that may in turn help to improve management in the clinic and provide hypotheses for future clinical trials. As examples, Cordonnier cited the emergence of invasive aspergillosis in patients with chronic lymphoproliferative disorders identified by the Surveillance des Aspergilloses Invasives en France (SAIF) network and the variability in the incidence and species distribution of candidemia seen in the seven countries included in the Latin American Invasive Mycosis Network.
Most HSCT continue to be performed in Europe and the Americas, with the east Mediterranean/Africa region representing less than 2% of global HSCT. During EMBT 2014, an observational study from the Nigerian Group for Blood and Marrow Transplant reported outcomes of their first three successful HSCTs, all in patients with sickle cell disease.
The first transplant was performed in September 2011 for a 7-year-old patient with a cerebrovascular accident, followed in August 2012 by HSCT in a 12-year old with recurrent vaso-occlusive crisis, who received a re-transplant in May 2013. The third HSCT in July 2013 was for a 15-year patient with recurrent vaso-occlusive crisis. All three patients had allogeneic HSCT from identical siblings. There was no recorded acute or chronic graft-versus-host disease. Chimerism for the first HSCT patient was 95% at 2 years post-HSCT, 0% for the second patient after the retransplant and 57% at day 27+ after HSCT for the third patient.
The Nigerian Group for Blood and Marrow Transplant was established in 2013 to coordinate and regulate HSCT in Nigeria. Other recent developments in that country include a bone marrow registry at the University of Nigeria Teaching Hospital (Enugu, Nigeria) to increase the potential for unrelated HSCT, and an HLA laboratory at the Obafemi Awolowo University Teaching Hospital (Ile-Ife, Nigeria).
Future Microbiol. 2014;9(10):1117-1121. © 2014 Future Medicine Ltd.