• 2,300 women
    women were determined to be at high risk for breast cancer by the High Risk Screening Program in Ontario in 2015
  • 86%
    of cancer patients saw a registered dietitian at a regional cancer centre within 14 days of referral in 2016
  • 71%
    of stage III colon cancer patients received chemotherapy within 60 days of after surgery in 2014
  • 86%
    of all cancer surgery patients received their consult within the recommended wait time in 2016, and 87% received their surgery within the recommend wait time
  • Over 43,000
    patients were discussed at comprehensive multidisciplinary cancer conferences (MCCs) in fiscal year 2016/2017
  • About 13%
    of patients who undergo lung, prostate and colorectal surgery have an unplanned hospital visit following surgery
  • 79%
    of breast cancer patients had a guideline-recommended mammogram in the first follow-up year
  • 74%
    of colorectal cancer patients diagnosed in 2013 had a surveillance colonoscopy within 18 months of surgery
  • Over 100
    patient and family advisors, who vary by their type of cancer and experiences, represent diverse regions and work with Cancer Care Ontario to ensure a person-centred cancer system
  • 383,023
    unique patients were screened for symptom severity using Your Symptoms Matter – General Symptoms (YSM-General) in 2016
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Safety and Access to Hematopoietic Cell Transplant

 

Key findings

The 100 day mortality rate after hematopoietic cell transplant in 2015 is low and within published standards. Among patients receiving an allogeneic hematopoietic cell transplant from unrelated donors, 15% died within 100 days, while 9% of patients with related donors died within 100 days of transplant. Two percent (2%) of patients died within 100 days of an autologous hematopoietic cell transplant. These results are the same as those reported by large international registries.

In fiscal year (FY) 2015/16, 46% of multiple myeloma patients had an autologous hematopoietic cell transplant within the wait time target of 21 days from last apheresis, while 46% of relapsed lymphoma patients had an autologous hematopoietic cell transplant within 21 days of the last apheresis. More work is required to ensure a larger portion of patients have their transplant within the target of 21 days, an interval agreed upon by provincial transplant experts.

Measure Desired DirectionAs of this Report
Percentage of cases with death date within 100 days after hematopoietic cell transplantBlack Arrow LevelYellow Arrow Level
Percentage of patients receiving hematopoietic cell transplant within 21-day target following apheresisBlack Arrow UpYellow Arrow Level
See Methodology and Approach to find out how the ratings are calculated.

What is hematopoietic cell transplantation?

  • Hematopoietic cell transplantation (HCT) is an essential treatment component for selected patients with hematologic malignancies (including lymphoma, leukemia, myeloma and other disorders)1. HCT replaces a patient’s blood or marrow cells.
  • HCTs are commonly referred to as blood or marrow transplants or stem cell transplants, although many different types of stem cells exist.
  • The two main types of HCT are autologous and allogeneic. Whether a patient requires an autologous versus an allogeneic transplant is based on the type of blood cancer or illness for which the patient is being treated.
  • For autologous (auto) transplants, patients are administered high doses of chemotherapy, with or without radiation, to destroy the patient’s diseased cancer cells—a treatment that also destroys the patient’s own bone marrow. Reinfusion of the patient's own previously collected and stored hematopoietic cells allows the bone marrow to regrow, resulting in recovery of blood counts.
  • For allogeneic (allo) transplants, the patient also receives chemotherapy, with or without radiation, but the intent is to prepare the patient's body to accept cells from a tissue-matched donor. The donated hematopoietic cells again regrow the bone marrow and a new immune system.
  • Cancer Care Ontario funds 6 centres to perform HCTs: Hamilton Health Sciences Centre, Health Sciences North/Horizon Santé Nord, Kingston General Hospital, London Health Sciences Centre, The Ottawa Hospital and University Health Network (see Figure 1).
Figure 1. Hematopoietic cell transplant centres
LHIN Toronto Central Champlain Hamilton Niagara Haldimand Brant South West South East North East
Centre University Health Network - Princess Margaret Hospital The Ottawa Hospital General Campus Hamilton Health Sciences Centre - Juravinski Hospital London Health Sciences Centre - Victoria Hospital Kingston General Hospital Health Science North/ Horizon Sante Nord
Address 610 University Ave Toronto M5G 2M9 501 Smyth Road Ottawa K1H8L6 711 Concession St Hamilton L8V 1C3 800 Commissioners Road East London N6A 5W9 76 Stuart St Kingston K7L 2V7 41 Ramsey Lake Rd Sudbury P3E 5J1

What is apheresis?

  • Apheresis is an umbrella term for removing a blood component1.
  • Apheresis includes plasmapheresis (removing plasma), cytapheresis (removing blood cells) and leukapheresis (removing white bloods cells that contain the hematopoietic cells)2.

What is myeloma?

  • Myeloma and multiple myeloma both refer to a cancer of the plasma cells.
  • Normal plasma cells are a cell in our immune system that make antibodies to protect us from infections.
  • Plasma cells are found in the bone marrow, which is why myeloma is referred to as hematologic, blood or bone marrow cancer.
  • The term “multiple myeloma” is used because the malignant cells tend to affect multiple areas of the bone marrow3.

What is lymphoma?

  • Lymphoma is the most common form of blood cancer that affects the immune or lymphatic system. The lymphatic system carries lymph fluid, which contains lymphocytes and other white blood cells, across the entire body and helps fight infections4.
  • Lymphomas are broadly classified into two types:
    1. Hodgkin lymphoma; and
    2. Non-Hodgkin lymphoma.
click to close graph
Close Graph

What do the results show?

The majority of hematopoietic cell transplants are autologous (Figure 2).

  • Auto transplants account for approximately 71% of all HCTs.
  • Allo-related accounted for 12% of HCTs and 17% were allo-unrelated.

Mortality is low and within acceptable limits (Figure 3).

  • Due to the aggressive nature of the treatment—and often of the underlying disease —some patients will die of complications from the transplant or from disease relapse.
  • Among patients receiving an allo transplant from unrelated donors, 15% died within 100 days; 9% of patients with related donors died within 100 days of the transplant. Two percent (2%) of patients died within 100 days of an auto HCT (Figure 3).
  • One hundred (100) days was chosen as an appropriate measure because the first 3 months after HCT is when a patient is most likely to die from a direct complication, and 100-day mortality is commonly reported in transplant literature. Ultimately, moving towards reporting one-year survival is desirable to align with evolving international reporting standards, as is separating out treatment-related mortality from death due to relapse or persistence of the disease for which the transplant was undertaken.

There is potential to improve on the time it takes to get patients to transplant.

  • In fiscal year (FY) 2015/16, almost half of myeloma and lymphoma patients had an auto transplant within 21 days of last apheresis (Figures 4-6).
  • The wait time target of 21 days was agreed upon by clinical experts as the estimated number of days it would take for a patient to go through the next steps of the cancer journey. Experts estimate that 80% of patients should have received a transplant within 21 days of their last apheresis.
  • Almost half of myeloma (46%) and lymphoma patients (46%) were treated within 21 days in FY 2015/16, which shows work still needs to be done (Figure 4).
  • Figures 5 and 6 show that the median number of days that multiple myeloma and relapsed lymphoma patients were waiting is close to the target of 21 days. In addition, in FY 2015/16, the 75th percentile for multiple myeloma ranged from 28 to 52 days, and for lymphoma ranged from 35 to 46 days (data table for Figures 5 and 6).
  • No statistical difference is present across the patient age groups for the number of days that myeloma or relapsed lymphoma patients had to wait to have an auto HCT (data not shown). Therefore, different age groups are not disadvantaged in relation to treatment.

Why is this important to Ontarians?

  • 100-day mortality is a standard metric reported by transplant programs that reflects the overall quality of care.
  • Wait times and their impact are important to consider because the diagnosis of cancer and uncertainty associated with cancer treatment often result in patient distress and anxiety5.
  • Wait times are a useful tool to assess the health care system. If wait times are too long, work must be undertaken to determine whether appropriate resources are available and whether they are being efficiently utilized.
  • More importantly, long delays in treatment can negatively impact survival.

How does Ontario compare to other jurisdictions?

  • Unlike many countries, patients in Ontario have access to a transplant that is not restricted based on age.
  • A recent study found that the median wait time in Canada is 23 days, which is comparable to the median wait time in Ontario (Figures 5 and 6)6.
  • Ontario’s mortality rate after 100 days of HCT is comparable with other jurisdictions in Canada and internationally7. Studies from Canada and the United States have found 100-day survival ranging from 70 to 98%, depending on the years examined and the specific hematologic disease being considered.8,9,10

Find out more

View Notes

  1. Canadian Cancer Society [Internet]. Toronto: the Canadian Cancer Society; c2016. Types of stem cell transplants; [cited 2015 Mar 11]. Available from: http://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/stem-cell-transplant/types-of-stem-cell-transplants/?region=nl&sc_prof=1.
  2. Canadian Cancer Society [Internet]. Toronto: the Canadian Cancer Society; c2016. Lymphoplasmacytic lymphoma; [cited 2015 Mar 11]. Available from: http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/lymphoplasmacytic-lymphoma/?region=on.
  3. Myeloma Canada [Internet]. Myeloma Canada; c2016. What is myeloma?; [cited 2015 Feb 28). Available from: http://www.myelomacanada.ca/en/whatismyeloma.htm.
  4. National Cancer Institute [Internet]. Bethesda (MD): National Institutes of Health; 2007. Overview: non-Hodgkin Lymphoma; [cited 2015 Jan 12]. Available from: http://www.cancer.gov/cancertopics/types/non-hodgkin.
  5. Cancer Care Ontario. Current state of diagnostic assessment programs: ESRS Phase II report. Toronto: Cancer Care Ontario, 2013.
  6. Skamene T, Jiang W, Meyer R, Crump M, Kuruvilla J, Kouroukis T. et al. Impact of wait times for autologous stem cell transplantation in patients with aggressive non-Hodgkin lymphoma. Poster session presented at American Society of Hematology Annual Meeting. 2016. San Diego, California.
  7. Pasquini MC, Zhu Z. Current uses and outcomes of hematopoietic stem cell transplantation: CIBMTR Summary Slides, 2015. Available at: http://www.cibmtr.org
  8. Hahn T, McCarthy P, Hassebroek A, Bredeson C, Gajewski J, Hale G, et al. Significant improvement in survival after allogeneic hematopoietic cell transplantation during a period of significantly increased use, older recipient age, and use of unrelated donors. J Clin Oncol. 2013; 31(19):2437–49.
  9. McCarthy P, Hahn T, Hassebroek A, Bredeson C, Gajweski J, Hale G, et al. Trends in use of and survival after autologous hematopoietic cell transplantation in North America, 1995–2005: significant improvement in survival for lymphoma and myeloma during a period of increasing recipient age. Biol Blood Marrow Transpl. 2013; 19:1116-1123.
  10. United States Department of Health Resources and Services Administration. Blood cell transplant: patient survival report [Internet]; [cited 2014 Feb 20] Available from: http://bloodcell.transplant.hrsa.gov/research/transplant_data/us_tx_data/survival_data/survival.aspx.