Cancer Res Treat.  2024 Jan;56(1):294-304. 10.4143/crt.2023.598.

Ten-Year Trends of Hematopoietic Stem Cell Transplantation in Korean Pediatric Cancer from the National Health Insurance Claims Data

• Kim H
• Kim HJ
• Jo Y
• Yoon SH
• Koh YK
• Kang S
• Koh KN
• Im HJ

• KMID: 2550344
• DOI: http://doi.org/10.4143/crt.2023.598

Abstract

Purpose
We aimed to determine the current application and survival trends of hematopoietic stem cell transplantation (HSCT) among Korean children and adolescents with cancer.
Materials and Methods
Data of patients aged < 20 years with KCD-10 (Korean Classifications of Diseases, 10th revision) C codes and specific designation codes were collected from the National Health Insurance Service database. Thirty claim codes for HSCT were included, and data from 2009 to 2019 were analyzed.
Results
The operational definition of pediatric cancer yielded an annual average of 2,000, with annual cases decreasing. In 2019, 221 HSCTs were performed, a decrease from the ten-year average of 276. Allografts outnumbered autografts with a ratio of 1.5:1. The source of allograft was bone marrow in 15% of patients in 2009; however, it substantially decreased to 3.3% in 2019. Furthermore, 70.5% of allogeneic HSCT used peripheral blood stem cell (PBSC) grafts, which increased to 89.3% by 2015. Cord blood utilization markedly decreased to 2.7% in 2018. The 5-year overall survival (OS) rate of all patients was 85.1%. Overall mortality decreased among patients who underwent recent HSCT, and they exhibited a higher 5-year OS rate.
Conclusion
In Korea, the number of pediatric patients with cancer is declining; however, the ratio of transplants to all patients remains constant. Patients who recently underwent transplantation showed better survival rates, possibly due to HSCT optimization. Korea showed a substantially greater PBSC utilization in pediatric HSCT. An in-depth examination encompassing donor relations and cause of death with a prospective registry is required in future studies.

Keyword

Biomedical big data; Hematopoietic stem cell transplantation; Mortality; Pediatric cancer; Survival

Figure

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  Fig. 1. Patient selection flow. ICD-10, International Classification of Diseases, 10th revision; KCD-10, Korean Classifications of Diseases, 10th revision; NHIS, Korean National Health Insurance Service.

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  Fig. 2. (A) Annual number of hematopoietic stem cell transplantations (2009-2019), and types of hematopoietic stem cell transplantation (HSCT). (B) Annual number of HSCT according to the type of transplant. (C) Stem cell sources among the allogeneic stem cell transplantations. CBT, cord blood transplantation; BMT, bone marrow transplantation; HSCT, hematopoietic stem cell transplantation; PBSCT, peripheral blood stem cell transplantation.

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  Fig. 3. (A) 5-Year overall survival (OS) rates from the diagnosis of all patients. (B) 5-Year OS rates of patients who underwent hematopoietic stem cell transplantation (HSCT) or not. (C) Based on the analyses of 5-year OS rates at 4-year intervals from 2009 to 2012, 2013 to 2016, and 2017 to 2020, according to the year of diagnosis, patients with more recent diagnoses showed a higher chance of survival. (D) Based on the analyses of 5-year OS rates at 4-year intervals from 2009 to 2012, 2013 to 2016, and 2017 to 2020, according to the year of transplantation, patients with more recent transplants had a higher chance of survival but without significance.

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  Fig. 4. Comparison of the 5-year overall survival (OS) rates based on transplant type and number for each disease. The 5-year OS rates of lymphoid leukemia (A), myeloid leukemia (B), and brain tumors (C) were compared according to the number of autologous HSCT (auto-HSCT): single HSCT, auto (1); tandem HSCT, auto (2); three or more HSCT, auto (3). Allo-BMT, allogeneic bone marrow transplantation; Allo-PBSCT, allogeneic peripheral blood stem cell transplantation; CBT, cord blood transplantation; HSCT, hematopoietic stem cell transplantation.

Reference

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