REDMO’SANNUALREPORT 2018

The results presented in this annual report have been compiled thanks to the work carried out by the staff at our donor, collection and transplant centers, umbilical cord blood banks, immunology laboratories and REDMO. All of them collaborated according to the guidelines and procedures established by the Transplant Coordination of each Autonomous Community, the National Transplant Organization and the José Carreras Foundation.

To all of them and to all voluntary donors and their associations, our acknowledgment and gratitude..

Population data Spain: Instituto Nacional de EstadísticaPopulation data by country: WikipediaInternational activity data: World Marrow Donor AssociationIconography: FreepikImages: Pexels

Donors

373 196 available donors, meaning an increase of 16% from the previous year.

37% are male donors, 63% female, with 52%of all donors being under 40 years of age.

Throughout 2018 54 011 new donors joined the Registry, 75% of them under 40 years of age.

We received extended typing requests for 2041donors, processing 171 each month. 50% were completed in a period under 14 days.

We received 1 083 confirmatory typing requests, processing an average of 91requests per month. 80% were shipped in under 14 days.

We received 302 requests for stem-cell collections (25 requests per month), with a total of 201 collections completed, meaning an increase of 36% when compared to the previous year.

3

Donors

Donor distribution by continent

Evolution of available donors worldwide (x1000)

0

5000

10000

15000

20000

25000

30000

35000

40000

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

Available donors

worldwide33 483 824

4

73.562

4.338.459

14.723.026

9.553.612

181.979

4.613.186

Africa Asia Europe North America Oceania South America

Donors

Donor distribution by country

5

776 974 1.311 1.432 3.425 7.124 7.772 10.178 10.579 11.679 12.402 14.060 14.450

18.498 21.781 29.383 34.553 34.679 35.247 46.541 53.179 54.523 58.142

72.786 82.372

100.631 111.262 118.938 125.401 125.432 129.472

161.573 169.274 169.577

202.487 266.845 271.703

290.238 340.425

369.766 373.203

398.616 416.605

454.258 488.184 492.179

1.090.410 1.169.718 1.591.575 1.626.868 4.426.401 8.299.509 9.065.428

NigeriaUruguayBulgaria

MacedoniaSerbia

HungaryRussia

ChileLuxembourg

LithuaniaNew Zealand

MexicoSlovakiaSlovenia

IrelandArmeniaRomania

IranNorwayFinlandCroatia

Arabia SaudiDenmark

South AfricaBelgium

SingaporeCzech Rep.

AustriaGreece

SwedenSwitzerland

ArgentinaCyprus

AustraliaThailand

TurkeyNetherlands

FranceKorea

TaiwanSpain

PortugalItaly

IndiaCanada

JapanChinaIsrael

United KingdomPoland

BrazilGermany

United States

Donors

Donor distribution within Europe

By country Per 1 000 people

6

1.311

1.432

3.425

7.124

7.772

10.579

11.679

14.450

18.498

21.781

34.553

35.247

46.541

53.179

58.142

82.372

111.262

118.938

125.401

125.432

129.472

169.274

266.845

271.703

290.238

373.203

398.616

416.605

Bulgaria

Macedonia

Serbia

Hungary

Russia

Luxembourg

Lithuania

Slovakia

Slovenia

Ireland

Romania

Norway

Finland

Croatia

Denmark

Belgium

Czech Rep.

Austria

Greece

Sweden

Switerzland

Cyprus

Turkey

Netherlands

France

Spain

Portugal

Italy

United Kingdom

Poland

Germany 8.299.509

1.626.868

1.591.575

0

0

0

1

1

2

3

4

4

5

7

7

7

8

8

9

10

10

11

12

13

13

15

16

18

24

33

39

42

100

198

Russia

Bulgaria

Serbia

Macedonia

Hungary

Romania

Slovakia

Lithuania

France

Ireland

Norway

Italy

Belgium

Spain

Finland

Slovenia

Denmark

Czech Rep.

Greece

Sweden

Croatia

Austria

Switzerland

Netherlands

Luxembourg

United Kingdom

Turkey

Portugal

Poland

Germany

Cyprus

Donors

*The number of donors registered by REDMO may not match the numbers provided by the NTO nor the variousRegional Transplant Coordinations. REDMO only considers as valid those donors who report all basic data andhave their HLA typed. On the other hand, the NTO and the Autonomous Communities include within their data alldonors who signed an informed consent, and who also provided a sample for HLA typing at a later point.

Available donors

373 196*

Increase in 201816% 0

50000100000150000200000250000300000350000400000

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

Evolution of number of available donors

Donors typed in

201854 011

Evolution of donor registration

0

10000

20000

30000

40000

50000

60000

70000

80000

90000

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

7

Donors

Donor profile

Available(n=373 196)

Registered in 2018(n=54 011)

The average age of available donors is 39 (Standard deviation ±9,97)

The average age of registered donors is 34 (Standard deviation ±9,18)

By age and gender

52% of available donors are under 40. 75% of new donors are under 40.

8

2496

6

3864

7

4902

8

2523

9

5799

0

7345

0

7127

8

3259

8

18 to 30 31 to 40 41 to 50 51 to 60

Men Women

Men 37%

Women63%

5949

6853

4190

964

1437

0

1315

9

6938

1588

18 to 30 31 to 40 41 to 50 51 to 60

Men Women

Men33%

Women67%

Donor typing

Number of donors (n=373 196)

% of total

HLA A, B, C and DR typed donors(or HLA A, B, C, DR and DQ)

139 428* 37%

HLA A, B and DR typed donors(or HLA A, B, DR and DQ)

207 352 56%

HLA A and B typed donors(or HLA A, B y C)

26 416 7%

Donors

Distribution of available donors by Autonomous Community

Donors registered in 2018 by Autonomous Community

10

3515872255

4923589776669304994810779122381265913693

1601118955

2214035265

4118351354

97860

MelillaCeuta

La RiojaCantabria

Balearic IslandsAragon

ExtremaduraAsturiasGalicia

Canary IslandsNavarre

Basque CountryCastile La Mancha

Castile LeonMurcia

ValenciaMadrid

CataloniaAndalusia

100123175306417

78686010041074116912411334

21892198

385750265026

873718387

La RiojaMelillaCeuta

CantabriaNavarreAragon

AsturiasBasque Country

GaliciaBalearic Islands

ExtremaduraCanary Islands

MurciaCastile La Mancha

Castile LeonValenciaMadrid

CataloniaAndalusia

Donors

Available donors per 100 000 people (media=798,47)

26%

3%

2%

6%

4%2% 9%

11%

14%2%

5%

3%1%

3%4%3% 1%

Percentage of donors by Autonomous Community

11

1954

,89

1497

,45

1167

,17

967,

47

867,

21

848,

46

789,

96

786,

79

714,

34

710,

46

689,

42

675,

70

626,

06

622,

67

585,

76

575,

18

522,

36

406,

33

398,

96

798,47

Donors

Collection requests for hematopoietic stem cells during 2018

302*(51% international;

49% national)

Requests received

201(18 from 2017

requests)

Collections done

89(includes postponed

processes and 4 2017 requests)

Cancelled prior to collection

Evolution of requests for stem-cell collections

Stem-cell collection requests increased 36% compared to 2017 (and by 521% since the start of our National Plan for Bone Marrow Donation in 2012).

* As of Dec 31st 2018 there were 34 collections in process

15

020406080

100120140160180

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

International National

123

109

56 14

18 to 30 31 to 40 41 to 50 51 to 60

77% under 40.

Men65%

Women35%

Profile of requested donors

Average age of

requested donors

34 years

Donors

Distribution of collections by product

Evolution of stem-cell collections by destination

Collections completed in

2018201

Increase in 201836%

Increase from 2012-2018477%

17

Bone Marrow (n=22)

Peripheral Blood(n=170)Lymphocyte collection(n=9)

25 2922 22 20

37 34

5264

97

2010 12 13

43 43 4755

84

104

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

International

National

Cancelled collection requests

89*

* 4 requests from 2017Includes postponements

*By reason for cancellation (n=89)

Patient 50

Medical reasons 40

TC logistical issues 6

Exitus 2

Personal reasons 2

Donor 39

Medical reasons 22

Voluntary withdrawal 7

Donor’s logistical issues 7

CC’s logistical issues 3

Donors

Distribution of collections by donor’s Autonomous Community

Distribution of collections by country of destination

19

11111111222233334

81213

1616

104

Czech Rep.NorwayCanadaPolandTurkeySerbia

ChileSingaporeArgentinaHungary

AustriaRomaniaAustralia

SwitzerlandBelgiumSweden

NetherlandsUnited Kingdom

ItalyFrance

GermanyUnited States

Spain

111223333

56

81212

3643

60

La RiojaExtremadura

CantabriaAsturiasAragon

Castile LeonBalearic I.

GaliciaCanary I.Navarre

Basque CountryMurcia

ValenciaCastile La Mancha

AndalusiaCatalonia

Madrid

Cords

We received extended typing requests for 119 cord blood units, with results provided in an average time of 6 days.

We received 282 requests for DNA samples for confirmatory typing, which were shipped in an average time of 7 days.

64 526 cord blood units available. Throughout 2018 931 new units were added.

We coordinated shipments for 163 units for transplant, 23 for national patients and 140 for international patients.

26

Cords

Distribution of cord blood units by continent

Evolution of cord blood units available worldwide (x1000)Available cord blood

units worldwide709 308

0

100

200

300

400

500

600

700

800

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

27

-

219.166

13.771

168.253

271.774

36.344

Africa North America South America Asia Europe Oceania

Cords

Distribution of cord blood units by country

28

224 342 382 506 1.190 1.424 1.472 1.515 1.744

3.256 3.318 3.340 3.387 3.849 4.197 4.312 4.321 4.600 4.771 5.714 5.731 7.049 7.515 8.350 8.662

14.357 15.890

21.708 27.972

36.344 36.607 37.241 38.036

54.031 64.526

67.371 204.809

BulgariaSlovenia

MexicoHong Kong

ChileAustriaTurkey

ThailandSlovakia

PolandCyprusFinlandCroatia

ArgentinaCzech Rep.

GreeceSweden

NetherlandsSwitzerland

IndiaRussiaChina

SingaporeBrazil

IranCanada

IsraelBelgim

United KingdomAustralia

FranceItaly

GermanyJoreaSpain

TaiwanUnited States

Cords

Distribution of cord blood units through Europe

By country By 100 000 people

29

224

342

1.424

1.472

1.744

3.256

3.318

3.340

3.387

4.197

4.312

4.321

4.600

4.771

5.731

21.708

27.972

36.607

37.241

38.036

64.526

Bulgaria

Slovenia

Austria

Turkey

Slovakia

Poland

Cyprus

Finland

Croatia

Czech Rep.

Greece

Sweden

Netherlands

Switzerland

Russia

Belgium

United…

France

Italy

Germany

Spain

3

4

8

16

17

18

27

32

38

39

42

42

46

56

56

61

62

81

138

190

388

Bulgaria

Russia

Poland

Austria

Slovenia

Turkey

Netherlands

Slovakia

Greece

Czech Rep.

United Kingdom

Sweden

Germany

France

Switzerland

Finland

Italy

Croatia

Spain

Belgium

Cyprus

Cords

Available cord blood

units64 526

Increase in 20181%

Evolution of number of cord blood units available

0

10000

20000

30000

40000

50000

60000

70000

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

30

Distribution of available cord blood units by cord blood bank

Andalusia; 24160; 37%

Catalonia; 19570; 30%

Madrid; 7722; 12%

Galicia; 6364; 10%

Valencia; 4997; 8%

Basque Country; 1590; 3%Vidacord ; 102; 0%

Ivida ; 21; 0%

Cords

Shipments of cord blood units throughout 2018

Shipments throughout

2018163

Evolution of cord blood shipments

050

100150200250300350400

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Cord blood bank National patients

Internationalpatients

Total

Catalunya 7 (8) 72 (65) 79 (73)

Andalucía 12 (9) 55 (66) 67 (75)

País Vasco 1 (0) 6 (6) 7 (6)

C. Valenciana 1 (2) 4 (9) 5 (11)

Madrid 2 (2) 3 (9) 5 (11)

Galicia - (0) - (1) - (1)

Total 23 (21) 140 (156) 163 (177)

Distribution of cord blood shipments by cord blood bank and patient’s origin

Distribution of cord blood shipments by country of destination

34

11111111

23

713

1623

4546

Czech Rep.PortugalSloveniaCanadaBelgium

ChileAustralia

FinlandGreece

ItalyUnited Kingdom

NetherlandsFranceSpain

United StatesColombia

Patients

We coordinated 494 transplants for Spanish patients, representing an increase of 7% from 2017 data, and of 60% in the last 10 years.

909 searches for Spanish patients, with 808being first time searches.

1 251 compatible donors located for 677patients.

In the last 10 years we were able to reduce by 36% the average search time, which is now at 30 days. 90% of located donors are found before 60 days.

Transplants with adult donor went up by 11%. Peripheral blood collections represent 83% and those from bone marrow 17%.

Transplants from umbilical cord blood units(33) continue their downward trend, with a cumulative decrease of 78% since 2011.

35

Patients

Search activations

909

Evolution of searches by product

By product

Bone marrow and/or peripheral blood (BM/PB) 629

Umbilical cord blood (CBU) 12

Bone marrow and/or peripheral blood and umbilical cord blood (BM/PB +CBU) 268

By type of search

First time search 808

Second search (or subsequent) 101

45% of second time searches were carried out for a new transplant, 29% to search for a new donor and 25% to proceed with transplant with an already located donor.

36

0100200300400500600700800900

1000

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

BM/PB BM/PB+BCU CBU

Patients

Patients with a located

donor677

386

422

472

514

542

584

608

613

642

676

677

2008 2010 2012 2014 2016 2018

83 7865 57 53 53 58 54 52 51 48 51 46 41 37 33 36 32 30

2000 2002 2004 2006 2008 2010 2012 2014 2016 2018

150182

105118107 94 96 108 98 96 83 87 70 62 59 52 47 43 41

2000 2002 2004 2006 2008 2010 2012 2014 2016 2018

Average search time

41 days

Median time for searches

(in days)30

Time to locate donor BM/PB (n=677)

Before 30 days (51%) 342

Between 31 and 61 days (39%) 265

Between 62 and 90 days 42

Over 3 months 19

Over 6 months 9

Donors located before

2 months90%

53% 56% 58% 60% 59% 56% 61% 72% 77% 78% 83% 85% 90%

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

39

Patients

Actuarial probability of compatible donor

Located donors1 250

0

200

400

600

800

1000

1200

1400

2008 2010 2012 2014 2016 2018

40

This distribution is not based exclusively on HLA compatibility, since many centers require 10/10 donors, rejecting lower compatibilities. For this reason, the search is geared to this type of donors, excluding those with a 9/10 compatibility.

0 30 60 90 120 150 180 210 240 270 300 330 360

Time since the start of search (days)

1

0,8

0,6

0,4

0,2

0

Actuarial probability

57%28% 63% 64% 65%

38% 75% 82% 84% 86% 88%

Probability of donor 10/10 (n= 1518)

Probability of donor 9/10 - 10/10 (n= 2513)

Result of 3150 first international searches started during the period 2015 - 2018

Patients

Distribution of located donors by country of origin (n=1 250)

Back in 2012 only 5% of located donors were Spanish. Since the start of the National Plan for Bone Marrow Donation, the number of fully compatible Spanish donors that have been located increased by 21%.

41

1111111222233334461213181922272933

5757

79170 (14%)

263 (21%)410 (33%)

AustraliaChina

Czech Rep.Armenia

IndiaThailandSlovenia

AustriaNorway

Saudi ArabiaTaiwanTurkeyCyprus

DenmarkFinland

BelgiumGreece

SwedenCanada

SwitzerlandArgentina

NetherlandsPortugal

ItalyFrance

BrazilPoland

IsraelUnited Kingdom

United StatesSpain

Germany

Patients

Hematopoietic transplants

2018496

( 6%)

By product

Bone marrow (BM) 76

Peripheral blood (PB)* 387

Umbilical cord blood (CBU) 33

Lymphocyte collections 21

Note: REDMO’s statistics for transplant activity do not necessarily match those of the NTO. This isdue to the fact that ocassionally TCs cryopreserve parts of a donation with high cellularity. If this partof the donation is used later on, the TC views it as a second transplant, whereas for REDMO there’sonly been one donation. The opposite may also take place, that is, a second and immediatedonation is carried out after a first donation with very low cellularity, and although the TC willconsider it one single transplant, for REDMO it would count as two separate transplants.

* Includes 3 CD34+ boosts

42

0

50

100

150

200

250

300

350

400

450

500

PB

BM

CBU

BOOST

Patients

By diagnostic

BM PB Boost CBU Total

Myeloblastic Acute Leukemia 12 136 8 156

Myelodysplastic Syndrome 11 66 4 81

Acute Lymphoblastic Leukemia 11 49 1 10 71

Non-Hodgkin’s Lymphomas 1 47 48

Monoclonal Gammopathies 28 28

Severe Aplastic Anemia 17 4 1 22

Other Leukemias 2 13 3 18

Other Malignant Diseases 1 16 17

Chronic Myeloid Leukemia 3 11 1 15

Congenital Diseases of the Immune System 7 2 3 12

Congenital Metabolical Diseases 6 1 2 9

Hodgkin’s Lymphomas 8 8

Other Non-Malignant Diseases 2 3 1 6

Histiocytosis 2 1 3

Congenital Erithrocyte Diseases 2 2

43

Patients

BM/PB* transplants in

2018463

By country of origin BM/PB

Germany (37%) 170

Spain (22%) 100

United States (11%) 53

United Kingdom 30

Poland 29

Israel 14

Portugal 12

Italy 12

Brazil 11

France 7

Switzerland 3

Canada 3

Netherlands 3

Belgium 3

Sweden 2

Finland 2

Argentina 2

Other 7

* Includes 3 CD34+ Boosts

0%

5%

10%

15%

20%

25%

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Evolution of self-supplyPercentage of Spanish donations

22%

44

Patients

CBU transplant

201833*

By country of origin of CBU (n=34)

Spain 18

United States 12

France 1

United Kingdom 1

Sweden 1

Italy 1

* 1 double cord transplant

45

0

20

40

60

80

100

120

<=15 years >15 years

Patients

0,03 0,05 0,08 0,08 0,24 0,38 0,78

1,85 2,36 3,00 3,29

7,24 7,68 7,89 8,06 8,70

10,02 10,45 10,67 10,82 11,22 11,22 11,57 11,89 11,95

13,00 14,04 14,18 14,30 14,55 14,72 15,51 15,52 15,62 15,67 16,24 16,43

19,09 19,50 20,00 20,20 20,81 20,86

23,62 27,50

29,03

Russia China

Mexico India

Thailand Iran

South Africa Romania Argentina

Bulgaria Serbia

Hungary Singapore

Greece Portugal Slovakia

Spain 2017 Korea

Spain 2018 New Zealand

Croatia Ireland Turkey

Norway Australia Slovenia

Italy Canada Poland Austria

Czech Rep. Taiwan France

United Kigdom United States

Switzerland Lithuania

Finland Brazil

Belgium Sweden

Netherlands Japan

Denmark Cyprus

GermanyAverage of worldwide

transplants by population in

201715,85

48

Global activity REDMO 1991-2019

423 018 Donors

registered in REDMO

DONORS

31 069Extended

typing requests

8 981Blood sample

requests

SPANISH DONATIONS

1 661Transplant requests

1 169Collections completed

SPANISH CORDS

73 695Stored cord blood units

10 914Extended typing and samples requests

3 179CBUs shipped

SPANISH PATIENTS

13 202Searches initiated

14 561Located donors

8 220Collections coordinated

53

Global activity REDMO 1991-2019

Evolution of Spanish donations

Cumulative Spanish donations

54

1 4 11 7 15 12 23 17 29 24 28 35 48 43 39 45 39 34 3563

80 81107

148

201

5 10 19 923 15 15

4675

127153

181

234

342312

289320

246212206

177163

BM/PB/DLI donations CBU shipments

0

500

1000

1500

2000

2500

3000

3500

BM/PB donations (n=1 169) CBU shipments (n=3 179)

Global activity REDMO 1991-2019

Transplants coordinated by REDMO

Donors BM/PB/BOOST/CBU/LYM

Spanish Foreign Total

PatientsSpanish 1 339 5 221 6 560

Foreign 3 050 3 050

Total 4 3 89 5 221 9 610

55

0

500

1000

1500

2000

2500

3000

3500

4000

4500

BM (n=1 626) PB (n=3 714) CBU (n=4 058) DLI (n=212)

Muntaner, 383, 2-208021 BarcelonaTel. +34 93 414 55 66Fax +34 93 414 00 28redmo@fcarreras.eswww.fcarreras.org