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Researchers at the National Marrow Donor Program (NMDP) observed a significant need gap between patients with acute myeloid leukemia (AML) and consultation for hematopoietic cell transplantation (HCT). These findings were presented during the American Society of Hematology (ASH) 62nd Annual Meeting and Exposition.
Hematologists and oncologists (n=302) who treated at least 10 patients with AML and who did not personally perform HCT were recruited to participate in this study. The physicians were assessed for their trends in referrals and knowledge of cytogenic risk factors. Screening criteria and questions were replicated from a study involving 150 hematologists/oncologists conducted in 2015.
The physicians indicated they referred 50.7% of their patients for HCT during 2019, which was significantly increased from the level reported in 2015 (40.3%; P =.0001). Most patients were referred during the first complete remission (71.6%), which was also increased from the rate in 2015 (60.3%; P =.001).
Compared with 2015 reports, physicians in 2019 indicated they were comfortable recommending patients with older maximum ages (related HCT: 64.9 years in 2015 vs 67.3 years in 2019; P =.01; unrelated HCT: 61.9 vs 65.2, respectively; P =.0002).
A quarter of the participating physicians (20.9% to 25.5%) were unsure whether a patient should be referred for HCT given 3 poor-risk cytogenic categories, despite current clinical guidelines.
Stratified by years in practice, physicians with more than 20 years of experience referred fewer patients with AML for HCT (42% vs 55%; P =.001), were less likely to refer older patients for an unrelated HCT (maximum age, 64.4 vs 67.1 years; P =.02), and reported more uncertainty about when a patient should be referred for HCT given 6 cytogenic/molecular markers (2 favorable-risk, 1 intermediate-risk, and 3 poor-risk; P <.05), compared with physicians who had been in practice for up to 10 years.
This study was limited by not associating the type of practice or center types of clinicians with referral and knowledge biases.
These data indicated some physicians treating patients with AML required increased education on HCT referrals and risk factors.
To address the need for assistance and education among physicians, Kelley Steffens, the senior market research intelligence manager at the NMDP, and coauthor of the study, stated their organization “has a program called ‘HLA Today’ where we are conducting free HLA tests which provide physicians with a preliminary report about HLA typing, as well as a preliminary donor search for any unrelated donors or cord blood units. We’re hoping to empower the physician and the patient to start that search early and to know their options ahead of time. [The NMDP is] really excited about that program and hoping to see some improved outcomes with earlier referrals to transplant centers.”
Disclosures: An author declared affiliation with industry. Please refer to the original abstract for a full list of disclosures.
Steffens KA, Yoo DS, Banerjee P, Le T, Devine SM. Understanding barriers to hematopoietic cell transplantation among patients with acute myeloid leukemia. Presented at: American Society of Hematology (ASH) 62nd Annual Meeting and Exposition; December 5-8, 2020. Abstr 432.