National Bone Marrow Plan meets targets one year ahead of schedule, with 207,572 donors at close of 2015

The National Bone Marrow Donation Plan has met its targets one year ahead of schedule, with a total of 207,572 donors at the close of 2015. Figures show that Spain registered 100 new bone marrow donors per day in the last three years; in other words, an increase of 3,000 per month.

The figures were announced by the Director of the Spanish National Transplant Organisation, Rafael Matesanz, at a press briefing where he presented the results from the 2015 National Bone Marrow Plan at which he was accompanied by José María Moraleda, Chairman of the Spanish Association of Haematology and Haemotherapy (Spanish acronym: SEHH).

In his speech, Rafael Matesanz highlighted the "great involvement from Spanish society, patient associations, the professionals who make up the bone marrow donation network and the Carreras Foundation", who have once again demonstrated their ability to overcome difficulty with a monthly rate of growth that has far exceeded initial expectations during a time of enormous economic and social hardship. The plan was co-financed by the Ministry of Health, Social Services and Equality and the regional governments. The Ministry of Health allocated almost 2.7 million euros for its development over the last three financial years.

As you will recall, the Spanish National Transplant Organisation worked with the regional governments to first implement the National Bone Marrow Plan in January of 2013 with a view to doubling the number of donors in four years to a total of 200,000 by the end of 2016. The design of this plan also involved such entities as the Spanish Register of Bone Marrow Donors (Spanish acronym: REDMO), the corresponding scientific societies and patient associations.

José María Moraleda, SEHH Chairman, expressed his satisfaction with the "excellent results" from the National Bone Marrow Plan. "The fact we have met the initially proposed targets one year ahead of schedule reflects well on the motivation and professional nature with which we haematologists face our challenges to improve patient care", he said. This opinion was shared by José Luis Díez, who highlighted the assistance provided by haematologists in designing and developing the Bone Marrow Plan.

Activity in 2015

The results from the National Bone Marrow Donation Plan in 2015 show a total of 37,617 new donors (compared with 25,000 set as the target). This is 50% more than planned (12,617). (See Results from the National Bone Marrow Donation Plan).
Specifically, the total number of donors last year rose from 169,955 at 1 January 2015, to a total of 207,572 at 1 January 2016, an increase of 22%. 11 autonomous regions equal or exceed this increase.

In percentage terms, the autonomous regions posting the highest growth last year were the City of Melilla (up 58%), Aragón (up 39%), Galicia (up 32%), Asturias and Castile-La Mancha (each up 28%), Andalusia, the City of Ceuta and Madrid (up 25%).

In absolute numbers, Andalusia, Catalonia, Madrid, the Region of Valencia and the Basque Country are the autonomous regions posting the highest growth in the number of donors.

Donation and HPT data

• In Spain, 91.2% of cases find a compatible bone marrow or umbilical cord donor within an average of 36 days. For the remaining 8.8%, haematologists resort to haploidentical transplants (a relative who is 50% compatible with the recipient).
• In 2015, a total of 81 donors on the Spanish Register of Bone Marrow Donors made effective donations (47 for Spanish patients and 34 for foreign citizens). The United States, Germany, France, the Netherlands and the United Kingdom are the main destination countries.
• According to the 2014 figures, a total of 3,013 haematopoietic stem cell transplants were performed that year: 1,844 were autologous, 721 were allogenic related (a related donor) and 447 were allogenic unrelated (an unrelated donor).
• In 2014, transplants from unrelated donors (447) accounted for 14% of the total. Of those, 282 were for peripheral blood, 85 for umbilical cord blood and 81 for bone marrow.

Bone marrow and umbilical cord blood transplant coordinator

Rafael Matesanz also explained the recent agreement reached between the Spanish National Transplant Organisation and the regional governments at the last meeting of the Inter-regional Transplant Commission of the Inter-regional Health Council, under which the figure of Hospital Coordinator for Bone Marrow and Umbilical Cord Blood Transplants (transplants from haematopoietic progenitors or HPT) at those centres with allogenic HPT programmes from unrelated donors. This type of transplant is performed at hospitals in 12 autonomous regions.

The creation of this figure has been a historic goal for the Spanish Association of Haematology and Haemotherapy, which has worked in conjunction with the Spanish National Transplant Organisation to create it and design its duties.

Rafael Matesanz and Jose María Moraleda said that the complexity of haematopoietic stem cell transplantation (or haematopoietic progenitor transplants) makes the existence of a haematology expert with similar duties to those of an organ transplant coordinator advisable.

In this regard, José María Moraleda welcomed the creation of a key figure for the development and optimisation of bone marrow and umbilical cord blood transplants in Spain. "Constant progress is being made in terms of these therapeutic techniques that allow us to cure patients with leukaemia and other cancers for a larger number of patients of all ages, but the creation of this figure of coordinator was fundamental to achieve this effectively".

• The following are some of the goals sought by creating this new figure:
• To maximise the chance for patients to access the type of HPT required by their disease
• To ensure that the patient and their families receive the best available information on the advantages and disadvantages of the various types of HPT and, as appropriate, the status of the selection process for the most suitable transplant option
• To channel all the information between the centre that will perform the transplant and the Spanish Register of Bone Marrow Donors (REDMO) and, whenever deemed necessary, coordinate the regional transplant body and the ONT Committee of Experts regarding the selection process for the transplant alternative required
• To ensure that the doctor responsible for treating the patient receives regular information on the status of the selection process for the most suitable transplant option

Duties

According to the document approved, the HPT Coordinator will have the following duties:

• Advice and information to patients and relatives
• Assessment of candidates for receiving an HPT
• Assessment of allogenic PT donors and participation in choosing the most suitable donor in each case
• Maintenance of an up-to-date list of patients accepted for HPT. Regular and systematic monitoring of the clinical status of the patient and the search for a donor will also need to be conducted, changing the type of HPT to be performed depending on progress in the search for donors
• Scheduling of HPT and associated procedures
• Collaboration with the Spanish National Transplant Organisation and the Regional Coordination Office
• The HPT Coordinator will assume responsibility for seeking an unrelated donor in accepted cases
• Furthermore, the HPT Coordinator will have to channel and refer patients to other centres whenever necessary
  

Each autonomous region will establish the organisational mechanisms it deems appropriate for recognising the figure of Haematopoietic Progenitor Transplant Coordinator.

According to data from the Spanish National Transplant Organisation, a total of 448 HPT were performed in Spain last year (haematopoietic stem cell transplants) from unrelated donors, accounting for 14.8% of the 3,013 performed in total.

Partnership agreement

Rafael Matesanz also referred to the recent signing of a partnership agreement between the ONT, the SEHH and the Spanish Haematopoietic Progenitor Transplant Group (Spanish acronym: GETH) with a view to enhancing the training given to haematologists, fostering research in this field and accrediting the quality of care provided in this area. This agreement formalises the close relations maintained between these entities for some time, which was strengthened under the National Bone Marrow Plan.

José María Moraleda believes that this agreement "is the logical consequence of so many years of close collaboration" between these entities. "Research and training are two basic pillars for making progress in the specialised field of haematology and haemotherapy", he said. In turn, José Luis Díez, GETH Chairman, stressed that "the agreement between the ONT, as the national authority, and haematologists will represent an important boost for research in the field of haematological disorders".