The evolution of HCT
Patients today have more treatment options and better outcomes
Hematopoietic cell transplant (HCT) is complex, but treatment options and outcomes have evolved considerably over the last decade. Now the potentially life-saving treatment is possible for more patients than ever before. Explore where transplant is today and who may be a candidate now that might not have been before.
At one time, some clinicians hesitated to refer a patient for a transplant consultation because they believed HCT had poor outcomes. However, HCT outcomes have improved over time and continue to do so today.
Candidacy for transplant has expanded. Transplant centers consider a number of factors beyond age when determining transplant eligibility.
For decades, an 8/8 human leukocyte antigen (HLA) match was required for patients to have the best outcomes. However, not every patient has an 8/8 match on the NMDP RegistrySM or other international registries. This is especially true for patients who are ethnically diverse because registries aren't diverse enough to ensure every patient finds a fully matched donor.
With innovative research into the safe and effective use of mismatched unrelated donors, the need for a fully matched donor is changing. That means there's a suitable donor for virtually all.
Patients do need support after HCT and concerns that a patient won't be able to follow through with their post-transplant care are legitimate. However, many support resources exist to help patients overcome psychosocial and sociodemographic barriers to HCT.
For example, the NMDPSM Patient Support Center offers free support and services to help patients navigate the transplant experience. We also provide patient financial assistance to help patients with costs before and after HCT such as:
Timing does matter in HCT and the road to HCT is complex. But early action by hematology/oncology practices and coordinated care with the transplant center can facilitate idea care before and after transplant.
At NMDP, we strive to provide hematology/oncology practices with essential information and resources to support the unique needs of patients who need HCT or another cell therapy.
Explore the services and support available for your practice.
Patient outcomes are improving across all transplantable diseases
At one time, some clinicians hesitated to refer a patient for a transplant consultation because they believed HCT had poor outcomes. However, HCT outcomes have improved over time and continue to do so today.
- Survival rates: At day 200, overall mortality reduced by 34% from 2007 to 2017. [1]
- GVHD: PTCy and other prevention strategies have expanded matching options and reduced GVHD.
- Quality of life: More than 60% of patients report no major functional limitations one to two years after transplant. [2]
More patients are eligible for transplant
Candidacy for transplant has expanded. Transplant centers consider a number of factors beyond age when determining transplant eligibility.
- Age: Many transplant centers no longer have a chronological age limit, focusing on functional age or performance status instead.
- Reduced-intensity conditioning: Less toxic, lower doses of pre-transplant chemotherapy are safe and effective for older patients. [3]
- Reduced comorbidities: Using the HCT comorbidity index, transplant centers have new tools to assess and address pre-transplant status.
- Precision medicine: A greater understanding of measurable residual disease (MRD) status helps identify patients who can benefit most from transplant. [4]
There's a suitable donor for virtually every patient who needs HCT
For decades, an 8/8 human leukocyte antigen (HLA) match was required for patients to have the best outcomes. However, not every patient has an 8/8 match on the NMDP RegistrySM or other international registries. This is especially true for patients who are ethnically diverse because registries aren't diverse enough to ensure every patient finds a fully matched donor.
With innovative research into the safe and effective use of mismatched unrelated donors, the need for a fully matched donor is changing. That means there's a suitable donor for virtually all.
Support resources can help more patients thrive after HCT
Patients do need support after HCT and concerns that a patient won't be able to follow through with their post-transplant care are legitimate. However, many support resources exist to help patients overcome psychosocial and sociodemographic barriers to HCT.
For example, the NMDPSM Patient Support Center offers free support and services to help patients navigate the transplant experience. We also provide patient financial assistance to help patients with costs before and after HCT such as:
- Unexpected financial burdens like unemployment or costs related to extended hospital stays
- Medical and non-medical out-of-pocket costs
- Travel costs related to clinical trials
- An emergency or crisis event impacting access to HCT or care after HCT
Early action and coordinated care give patients the best chance for positive outcomes after HCT
Timing does matter in HCT and the road to HCT is complex. But early action by hematology/oncology practices and coordinated care with the transplant center can facilitate idea care before and after transplant.
- Early HLA typing: HLA typing and cytogenetic texting at the hematology/oncology practice at the time of diagnosis is a critical first step in removing barriers to HCT, and our NMDP HLA Today program can remove barriers to HLA typing at hematology/oncology practices.
- Shared care: Coordinating with transplant centers can improve access to treatment and has the potential to become a new standard of care for safe and effective follow-up after HCT. [5]
Partnering with you to advance patient care
At NMDP, we strive to provide hematology/oncology practices with essential information and resources to support the unique needs of patients who need HCT or another cell therapy.
Explore the services and support available for your practice.
References
- McDonald GB, Sandmaier BM, Mielcarek M, et al. Survival, non-relapse mortality, and relapse-related mortality after allogeneic hematopoietic cell transplantation: Comparing 2003–2007 versus 2013–2017 cohorts. Annals of Internal Medicine. 2020;172(4):229–239. doi: 10.7326/M19-2936.
- Pidala J, Anasetti C, Jim H. Quality of life after allogeneic hematopoietic cell transplantation. Blood. 2009;114(1):7–19. doi: 10.1182/blood 2008-10-182592.
- Nakamura R, Saber W, Martens MJ, et al. Biologic assignment trial of reduced-intensity hematopoietic cell transplantation based on donor availability in patients 50-75 years of age with advanced myelodysplastic syndrome. Journal of Clinical Oncology. 2021;39(30):3328–3339. doi: 10.1200/jco.20.03380.
- Dillon LW, Gui G, Page KM, et al. DNA sequencing to detect residual disease in adults with acute myeloid leukemia prior to hematopoietic cell transplant. JAMA. 2023;329(9):745–755. doi: 10.1001/jama.2023.1363.
- Abel GA, Kim HT, Zackon I, et al. Non-relapse mortality and quality of life with shared care after allogeneic hematopoietic cell transplantation: A randomized control trial. Blood. 2022;140(Supplement 1):2135–2136. doi: 10.1182/blood-2022-166996.