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Integrated Care, Wider Donor Sources Can Boost Transplant Access for Patients With AL, MDS

June 20, 2023

July 2023

Thomas R. Collins

Thomas R. Collins is a medical journalist based in West Palm Beach, Florida.

Integrating hematopoietic cell transplantation (HCT) care and non-transplant care, as well as using haploidentical donors and other donor types, can boost access to transplantation and reduce racial disparities for people living with non-favorable risk acute leukemia (AL) and myelodysplastic syndromes (MDS), researchers reported in Blood Advances.

Reviewing data for patients 75 or younger who received care at Northside Hospital in Atlanta between 2016 and 2021, researchers found that 147 of 256 patients (57%) proceeded to HCT. Researchers noted this was an improvement from previously studied time periods, although there is still opportunity to improve access and racial disparities.

“In 2023, no patient should really be denied an allogeneic HCT because of lack of donors,” said Asad Bashey, MD, PhD, of the Blood and Marrow Transplant Program at Northside. “The patients who don’t have haploidentical donors may be able to receive a MUD [matched unrelated donor] transplant, which has emerged as another viable option when using post-transplant cyclophosphamide.”

Northside employs several strategies to increase transplant rates. The same physicians perform non-transplant-related care as well as transplant care, which eliminates the need for a referral to a transplant physician. Human leukocyte antigen (HLA) typing, an assessment of potential donors, and a preliminary unrelated donor search are performed routinely when treatment begins, helping reduce unnecessary delays. Northside was one of the first centers to use haploidentical donors for patients who don’t have easy access to HLA-matched donors.

In the present study, the median patient age was 58. Those who proceeded to transplantation did so at a median of 118 days from initial treatment, which was similar for Black and white patients (112 days vs. 122 days; p=0.80). Patients received a graft from a haploidentical donor in 44% of transplants, from a matched related donor in 32% of cases, and from a MUD in 24% of cases. The proportion moving to HCT was higher in patients younger than 60 (70% vs. 44%; p<0.001) but was not significantly different between self-identified Black and white patients (48% vs. 59%; p=0.13).

Researchers found speed to be important: patients who proceeded to HCT within six months of initial treatment had superior three-year survival compared to those who did not (70% vs. 52%; p=0.004).

Dr. Bashey said that, in theory, there is no reason prompt advancement to HCT cannot be performed, but that integration of the transplant and non-transplant teams is crucial.

“These teams should be combined, or if that is not possible, should work much more closely to ensure newly diagnosed and treated patients have immediate commencement of donor search services with streamlined progression to transplant in suitable patients,” he said.

For patients ages 60 to 75 compared to patients 59 and younger, the main reasons for not proceeding to HCT were comorbidities (49% vs. 15%; p<0.001) and poor Karnofsky performance status scores (25% vs. 10%; p=0.06). Lack of caregiver support was more commonly found to be a reason for Black patients not to proceed to HCT when compared to white patients (37% vs. 11%; p=0.002).

Transplant centers can also help overcome socioeconomic hurdles, including caregiver support, Dr. Bashey noted.

“The specific issue of caregiver needs and support to undergo allogeneic transplant should be addressed at the earliest opportunity in order to allow such services to be provided in patients where they may not immediately be available,” he said. “We found that lack of caregiver support represents a significant barrier, particularly for patients from minority backgrounds. This issue will need to be addressed if … equity in transplant services is to be provided.”

Any conflicts of interest declared by the authors can be found in the original article.

Reference

Bashey A, Zhang X, Morris LE, et al. Improved access to HCT with reduced racial disparities through integration with leukemia care and haploidentical donors [published online ahead of print, 2023 Mar 24]. Blood Adv. doi: 10.1182/bloodadvances.2023009765. 

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