Insights of pediatric bone marrow transplantation in Brazil - A registry-based study (2018–2024)

Background: Hematopoietic cell transplantation (HCT) is established as a curative strategy for several severe pediatric hematological and immunological disorders. However, despite Brazil’s extensive public transplant infrastructure, national data on pediatric HCT trends remain insufficiently characterized. Objective: To analyze temporal trends, regional distribution, and modality characteristics of pediatric HCT in Brazil from 2018 to 2024, including the impact of the COVID-19 pandemic. Methods: This retrospective descriptive study used data from the Brazilian Transplant Registry (RBT/ABTO). Descriptive statistics were used and transplant modalities were compared across pre-pandemic (2018–2019), pandemic (2020–2022), and post-pandemic (2023–2024) periods using Pearson’s chi-square test. Results: A total of 3,592 pediatric BMT procedures were reported. Allogeneic transplantation predominated throughout the study period (68.3%–87.5%), while the proportion of autologous procedures increased significantly during the pandemic (p < 0.001). S.o Paulo concentrated more than half of all procedures, indicating substantial regional concentration. The lowest annual volume occurred in 2024 (n = 377), potentially reflecting incomplete or revised registry data. Conclusion: The data showed temporal variations, pandemic associated changes in transplantation modalities, and persistent regional disparities. These findings highlight the complexity of pediatric transplant care in Brazil and the need for standardized data collection and policies to reduce access inequities.