Inequalities in the career pathway for paediatric HSCT and cellular therapy physicians

Pioneering advances in the field of paediatric haematopoietic stem-cell transplantation (HSCT) and cellular therapy over the past few decades have transformed the lives of countless children across the globe dealing with otherwise incurable conditions. Currently, around 5000 paediatric patients undergo HSCT in the centres belonging to the European Society for Blood and Marrow Transplantation (EBMT) registry every year. The majority of such procedures are allograft (>4000 per year), while autologous transplantations reach approximately 1000 per year. The main indications for allogeneic transplantations are represented by acute leukaemias and bone marrow failure syndromes, whereas solid tumours and lymphomas constitute the most common diagnoses for autologous procedures. Importantly, there has been a substantial increase in the use of allogeneic HSCT for the treatment of immune deficiencies, immune dysregulation conditions, and metabolic disorders, which are unique to the paediatric population. Furthermore, there is a continuous, steady increase in HSCTs over time, with an overall increase of 5·5% in 2021 (an increase of 6·9% for allogeneic HSCTs and 1·6% for autologous HSCTs) in Europe when compared to previous years. Among the 690 actively transplanting EBMT centres, 121 perform transplantations on both adult and paediatric patients, whereas 125 are dedicated to the paediatric population only.