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Survival Following HCT


                                                                                    HCT Transplantation: Version 7.0

Survival Following HCT


Patient survival is highly dependent on the underlying disease, its stage, prior treatment, the patient’s age and co-morbidities.  In general, patients undergoing autologous HCT tolerate the procedure fairly well and, following engraftment, their prognosis is that of the underlying disease that has been modified (hopefully) by the treatment.  In contrast, patients undergoing an allogeneic HCT face a whole host of problems related to the toxicities of the procedure, the sequel of receiving stem cells from another donor and the long-term effects of immunosuppression, GVHD, fungal infections, viral infections, post-transplant tumors, etc. These are in addition to the effects of the natural history of the underlying illness that may not have responded to treatment. The overall one-year mortality varies tremendously with diagnosis, stage of the disease, etc. and can vary from as low as 10 percent survival to as high as 90 percent survival. Overall, one-year mortality for patients undergoing allogeneic HCT is approximately 50 percent.

Unfortunately, unlike solid organ transplantations, the number of variables is so large and the number of centers performing HCT is so large that it has been nearly impossible to perform center specific, transplant specific outcomes analyses that have statistical credibility. For this reason, the INTERLINK Health Services Transplant Network does not report comparable center specific outcome results as we do with solid organ programs. The NMDP reports self-reported outcomes by disease for those centers submitting voluntary data, but in the very near future, by congressional mandate, outcomes by center by specific disease will be reported. In the meantime, it is most important to evaluate each program individually and understand the relative strengths and weaknesses of each program when making the best selection for your members. The factors that we feel are important when evaluating HCT programs are:

        •    Tertiary care center recognized as a leading transplant center with a
              regional and/or national reputation. The center will receive referrals
              from other major medical centers in the area because of that expertise.
        •    The center offers autologous, related donor allogeneic and unrelated
              donor allogeneic transplants to adults and children.
        •    The program has been in existence for at least three years with
              substantially the same professional team.
        •    The program director has had at least two years experience as a stem
              cell transplanter and is engaged in HCT full-time.
        •    The center meets ASBMT standards.
        •    The center is FACT accredited.
        •    The center is a member of the NMDP.
        •    The center participates in clinical trials of substantial merit sponsored
              by multi-center organizations such as ECOG, COG, SWOG, NIH, NCI,
              etc. and the results of these trials are published in peer reviewed journals
              that are recognized as authoritative journals in their field.
        •    The center is affiliated with a university and, if it has a post-graduate
              training program, that program meets ASBMT standards.
        •    One or more of the following: participation in NCCN, the NCI Clinical
              Trials Network and designation as a NCI Comprehensive Cancer Center
              or NCI Clinical Cancer Center.
        •    All care is performed under institutionally approved protocols; either
              standard care or an IRB approved clinical trial.
        •    All patients are evaluated within the program and patient selection is
              performed using institutionally approved protocols administered by an
              institutionally based patient selection committee.
        •    The transplant takes place and all subsequent care is rendered within the
              institution where the patient was evaluated.
        •    All pre and post-transplant care is coordinated by full-time employees
              of the institution.
        •    There is close communication with the referring physician and health plan.
        •    Housing in the immediate vicinity of the center is available for families and
              patients and the center staff assists the families with these arrangements.