Impact of Donor and Center Attributes on Outcomes of Hematopoietic Cell Transplantation

Abstract

Hematopoietic stem cell transplantation (HCT) is the transplantation of stem cells or blood from a donor and an effective treatment for many hematologic malignancies. After an initially slow evolution, HCT has seen rapid expansion over the last two decades and major changes in technology use. HCT is a costly procedure ranked as one of the five most expensive medical procedures that generally exceed $140,000 for allogeneic (using stem cells from a donor) HCT and has a median length of stay of 35 days. HCT care provides an important opportunity to identify how center attributes can impact outcomes. Specifically, results can inform how payers, providers and policymakers can achieve high quality outcomes in the context of accreditation, the management of patient case mix and distance to facility. Using data from the Center for International Blood & Marrow Transplant Research (CIBMTR), a registry that collects transplant essential data (TED) data that includes disease type, age, sex, pre-transplant disease stage, date of diagnosis, graft type and cause of death. This research evaluates the current gaps in knowledge by 1) evaluating the mechanism between patient case mix and overall HCT center quality (survival) 2) identifying if centers of excellence and accreditation could explain differences in outcomes overall center quality and patient outcomes for complex HCT 3) understanding the impact of distance on overall survival and further evaluating the impact of distance on complex HLA mismatched patients. Overall, this research provides significant evidence for future recommendations surrounding the relative impact of risk stratification, center accreditation and distance on HCT survival.