How to develop a Transplant program Which patients are best to choose when you are starting? Or you have a small program 100-day Mortality after HLA-identical Sibling Transplants, 2008-2009 100 Mortality, % 80 60 Early Disease Intermediate Disease Advanced Disease Chronic Phase Accelerated Phase Blast Phase Other 40 20 0 AML ALL CML MDS/MPS Aplastic Anemia Immune Deficiency Slide 16 SUM-WW11_15.ppt 100-day Mortality after Unrelated Donor Transplants, 2008-2009 100 Mortality, % 80 60 Early Disease Intermediate Disease Advanced Disease Chronic Phase Accelerated Phase Blast Phase Other 40 20 0 AML ALL CML MDS/MPS Aplastic Anemia Immune Deficiency Slide 17 SUM-WW11_16.ppt One-year survival after myeloablative conditioning for acute leukemias in any remission phase, CML or MDS, age <50 years, by year of transplant and graft source, 1988-2009 100 HLA-matched sibling Unrelated Donor One-Year Survival, % 80 60 40 20 0 1988- '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 90 Slide 14 SUM11_40.ppt Getting Started • What are the advantages of starting the program with autologous HCT? Getting Started • What are the advantages of starting the program with autologous HCT? – Troubleshoot program components without dealing with most complex immunologic issues • • • • • Pharmacy support Apheresis and cell processing lab Nursing support Infection control Laboratory support Getting Started • What are the advantages and disadvantages of starting the program with allogeneic HCT What are the advantages and disadvantages of starting the program with allogeneic HCT • Greater pool of potential allogeneic recipients • Troubleshoot all program components during the same period of time • Greater risk of early poor outcomes due to “infrastructure” • Loss of confidence of stakeholders – Referring MDs, hospital, local authorities Getting Started • How should the program evaluate the needs of the population when considering the initial strategy? Getting Started • How should the program evaluate the needs of the population when considering the initial strategy? – What is the impact of the transplant center upon health in the region? – Will the impact differ if either autologous or allogeneic HCT are not part of the portfolio – Is regional reputation, based upon outcomes, an important factor of success and sustainability? Getting Started • What consideration should be given to transplant candidate selection in the program’s first few years? Getting Started • What consideration should be given to transplant candidate selection in the program’s first few years? – Which diseases and disease status to focus upon? • Those with best opportunity for cure? • Those with limited alternative treatments? – How to consider recipient risk and comorbidities – What about distance? Getting Started • Does all follow-up of the HCT recipients need to occur at the Transplant center? Getting Started • Does all follow-up of the HCT recipients need to occur at the Transplant center? – After care and support affect the outcomes – Should the availability of good post HCT care affect patient selection? • And, if follow-up of the HCT recipients has to occur at the Transplant center, for how long? Getting Started • Should a center establish cross-center collaboration within a region to capitalize on expertise and efficiencies?