Steps: Deciding to Transplant
When a hematopoietic cell transplant is being considered as a treatment option, the risks and benefits are discussed between the physician and patient, as well as between the insurer’s medical director and clinical staff.
Making an early decision for a hematopoietic cell transplant is important to allow time to search for well-matched hematopoietic cells. The following steps can be completed concurrently.
1. Assess the disease status and patient’s healthThe patient’s physician (usually a transplanting physician, oncologist, hematologist) often collaborates with colleagues to determine a comprehensive treatment plan. When the treatment plan includes an immediate or potential hematopoietic cell transplant, timing is critical. Generally, better outcomes are observed when transplants are performed:
- When the disease is in remission and responds to chemotherapy or the tumor is small
- When the patient’s main organs and systems are functioning well, including the patient's heart, lungs, liver and kidneys
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2. Tissue type the patient and the patient’s immediate biological family
Human leukocyte antigen (HLA) typing at A, B, C, and DRB1 are performed for the patient and the patient’s family. HLA typing the patient and family members helps the transplant physician:
- Determine or confirm the type of transplant needed
- Autologous (patient’s own cells)
- Related allogeneic (a family member’s cells)
- Unrelated allogeneic (cells from an unrelated donor or cord blood unit)
- Develop a search strategy if an unrelated donor or cord blood unit is needed
Search strategy for unrelated hematopoietic cells
Approximately 70% of patients will need an unrelated donor or cord blood unit. By comparing the patient’s HLA to family members, genetic information (haplotypes) can be observed. Knowing the patient's haplotypes helps refine the search process to quickly identify an unrelated donor or cord blood unit.
After a patient is tissue typed, the physician requests a preliminary search to help assess the challenges of identifying an unrelated donor or cord blood unit.
3. Identify a caregiverMost transplant centers require that a caregiver be identified before a formal search can be activated. An attentive caregiver can strongly influence patient survival.
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4. Refer the patient to a transplant center Unrelated allogeneic transplants are performed at transplant centers within the National Marrow Donor Program (NMDP) Network.
NMDP transplant centers must:
- Meet NMDP guidelines designed to ensure the safety of patients receiving an unrelated allogeneic transplant
- Renew their NMDP Network status annually
NMDP transplant centers have:
- Physicians experienced with hematopoietic cell transplantation
- Nurses who are trained and experienced in caring for patients who have received a hematopoietic cell transplant
- A coordinator and patient advocate (often a social worker) who are familiar with hematopoietic cell transplantation issues
- Experienced labs that meet the high standards set by professional laboratory organizations
Although a transplant center may be chosen based on the insurance provider's network, the transplant center’s level of expertise or experience in treating a particular disease are factors considered by the referring physician and the patient. A transplant center must be selected to move from a preliminary to a formal search. A delay in determining a transplant center will delay the search for an unrelated donor or cord blood unit.
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