Transplantation Referral Patterns for Patients with Newly Diagnosed Higher-Risk Myelodysplastic Syndromes and Acute Myeloid Leukemia at Academic and Community Sites in the Connect® Myeloid Disease Registry: Potential Barriers to Care

Authors

Benjamin Tomlinson
Marcos de Lima
Christopher R Cogle
Michael A Thompson
David L Grinblatt
Daniel A Pollyea
Rami S Komrokji
Gail J Roboz
Michael R Savona
Mikkael A Sekeres
Mehrdad Abedi
Guillermo Garcia-Manero
Sandra E Kurtin
Jaroslaw P Maciejewski
Jay L Patel
Dennis A Revicki
Tracy I George
E Dawn Flick
Pavel Kiselev
Chrystal U Louis
Irene S DeGutis
Melissa Nifenecker
Harry P Erba
David P Steensma
Bart L Scott

Publication Date

7-1-2023

Journal

Transplantation and Cellular Therapy

Abstract

Hematopoietic stem cell transplantation (HCT) is indicated for patients with higher-risk (HR) myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML). Age, performance status, patient frailty, comorbidities, and nonclinical factors (eg, cost, distance to site) are all recognized as important clinical factors that can influence HCT referral patterns and patient outcomes; however, the proportion of eligible patients referred for HCT in routine clinical practice is largely unknown. This study aimed to assess patterns of consideration for HCT among patients with HR-MDS and AML enrolled in the Connect® Myeloid Disease Registry at community/government (CO/GOV)- or academic (AC)-based sites, as well as to identify factors associated with rates of transplantation referral. We assessed patterns of consideration for and completion of HCT in patients with HR-MDS and AML enrolled between December 12, 2013, and March 6, 2020, in the Connect Myeloid Disease Registry at 164 CO/GOV and AC sites. Registry sites recorded whether patients were considered for transplantation at baseline and at each follow-up visit. The following answers were possible: "considered potentially eligible," "not considered potentially eligible," or "not assessed." Sites also recorded whether patients subsequently underwent HCT at each follow-up visit. Rates of consideration for HCT between CO/GOV and AC sites were compared using multivariable logistic regression analysis with covariates for age and comorbidity. Among the 778 patients with HR-MDS or AML enrolled in the Connect Myeloid Disease Registry, patients at CO/GOV sites were less likely to be considered potentially eligible for HCT than patients at AC sites (27.9% versus 43.9%; P < .0001). Multivariable logistic regression analysis with factors for age (

Keywords

Humans, Aged, Myelodysplastic Syndromes, Leukemia, Myeloid, Acute, Hematopoietic Stem Cell Transplantation, Registries, Health Services Accessibility, Bone marrow transplantation, Clinical practice, Management and treatment, Hematologic malignancies, Myelodysplastic syndromes, Acute myeloid leukemia

DOI

10.1016/j.jtct.2023.04.011

PMID

37086851

PMCID

PMC11104018

PubMedCentral® Posted Date

6-1-2024

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes