Outcomes/Effectiveness

Stem cell transplant centers that have greater physician involvement in patient care have better patient outcomes

High-dose chemotherapy with or without radiotherapy followed by hematopoietic stem cell transplantation (HSCT) is widely used to treat malignant and nonmalignant diseases. However, treatment-related mortality following allogeneic HSCT (stem cells transplanted from genetically similar donors, usually a sibling) ranges from 20 to 50 percent in the first year, when most treatment-related deaths occur, and 5 to 15 percent for autologous HSCT (transplant of one's own previously harvested stem cells). Thus, HCST carries high risks of early morbidity and mortality.

A recent study examined the association between center effects (characteristics of the transplantation center and provider characteristics) and survival after HSCT for hematologic malignancies. The researchers found that patients treated at transplant centers where physicians treat a higher volume of patients and answer calls after hours are less likely to die within 100 days of transplantation. The study was supported in part by the Agency for Healthcare Research and Quality (HS13046).

Fausto R. Loberiza Jr. M.D., M.S., of the University of Nebraska Medical Center, and his colleagues surveyed 163 U.S. transplantation centers. The participating centers performed HLA-identical sibling HSCT for leukemia or autologous HSCT for lymphoma between 1998 and 2000 in patients aged 18 or older and reported to the Center for International Blood and Marrow Transplant Research. Patients who underwent transplantation in centers where physicians cared for more than 20 patients per year were 33 percent less likely to die than those treated in centers with lighter physician case loads.

Patients treated at centers where physicians answered after-office-hours or emergency calls were 28 percent less likely to die than those in centers where calls were answered by nurses or physician assistants. Medical school affiliation was not associated with increased 100-day mortality, except in centers where students/residents were present without fellows. The influence of these factors was greater among allogeneic HSCT patients than autologous HSCT patients and, if adopted by small-volume centers, may improve survival outcomes.

See "Association of transplant center and physician factors on mortality after hematopoietic stem cell transplantation in the United States," by Dr. Loberiza, Mei-Jie Zhang, Ph.D., Stephanie J. Lee, M.D., M.P.H., and others in the April 1, 2005, Blood 105(7), pp. 2979-2987.

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