“Vast discrepancies” exist in transplantation and cellular therapy training around the world, reflecting inequalities in access to such treatments, an international survey has revealed.

On behalf of the European Society for Blood and Marrow Transplantation (EBMT)’s Trainee Committee, UK researchers surveyed trainees from 32 different countries on their experiences in these fields.

Data from 145 trainees were included in the analysis, of whom 39% were from low-middle-income (LMI) or upper-middle-income countries (UMIC) and 61% from high-income countries (HIC).

The results, published in The Lancet Haematology, revealed that the majority of responding trainees (42%) first became aware of transplantation and cellular therapy in medical school, followed by during rotational residency (32%), fellowship (25%) and in research (1%). Regarding patient settings, 61% were exposed to adult-only, 6% to paediatric, and 33% to combined settings, the authors noted.

Data showed that 53% of clinical centres offered a transplantation and cellular therapy fellowship, but that there was a difference depending on country income status, with a fellowship offered to 61% trainees in HICs and just 41% of those in LMI or UMICs.

Also, if a fellowship was offered, training periods were longer in HICs versus LMI or UMICs; for example, more than 24 months’ training was offered to 7% of HIC trainees vs zero of the LMI or UMIC trainees, while 13–24 months was offered to 22% and 4%, respectively. The research also highlighted that more fellowships in HICs were paid versus those in LMI or UMICs (76% vs 43%).

The number of annual allogeneic and autologous haematopoietic stem-cell transplantations (HSCTs) were also found to vary according to income: 27% of HIC trainees were exposed to 51–75 allogeneic HSCTs per year, whereas 38% of LMI or UMICs were exposed to 20 or fewer. Also, for autologous HSCTs, 19% of HIC trainees compared to just 2% of LMI or UMIC trainees said that their centre undertook more than 100 transplantations per year.

A similar picture of economic divide was seen for CAR T-cell therapy: while 73% of HIC centres delivered such therapy, just 7% of LMI or UMIC centres did so. Also, 34% of those in HICs undertook more than 30 CAR T-cell therapy procedures per year, compared to five or fewer for all LMI or UMIC centres.

The researchers concluded that their findings depict significant discrepancies in transplantation and cellular therapy training globally, “particularly when stratifying by country income”, and that this, in turn, has affected the number of trained physicians, a key factor in the provision of cell-based therapies.

“These results are particularly relevant in the current era of global networking and collaboration, and we should acknowledge that as new therapies become available and costs continue to escalate, the current discrepancies might be further increased,” they noted.