Access to Hematopoietic Cell Transplant

Key findings

From 2017 to 2018, the median time from remission to allogeneic transplant for people with acute myeloid leukemia decreased from 78 days to 69 days. The interquartile range (middle 50% of values) for the time from second-line chemotherapy to autologous transplant for patients with diffuse large B-cell lymphoma has fluctuated between 2014 and 2018. More progress is needed to achieve the provincial target of transplant within 84 days. The median number of days from first systemic treatment to autologous transplant for people with multiple myeloma decreased from 171 days in 2014 to 160 days in 2018.

Why is this important to Ontarians?

Hematopoietic cell therapy (HCT), commonly referred to as stem cell transplant or bone marrow transplant, is an essential component of treatment for many people with hematologic malignancies and other blood disorders.
There are 2 types of hematopoietic cell therapy – autologous (auto) transplant, which uses the patient’s own previously stored stem cells, and allogeneic (allo) transplant, in which stems cells are donated by another person.
Which type of transplant a person requires depends on the type of blood cancer or disorder they are being treated for.
In an autologous transplant the stem cells promote recovery of the blood counts damaged by the high doses of chemotherapy given to eradicate the cancer.
In an allogeneic transplant, the stem cells both promote recovery of the blood counts, and help fight the underlying disease.
Treatment pathways for people needing HCT are complex and highly dependent on disease type, progression and donor availability.
Long delays in accessing HCT can negatively affect clinical outcomes, including survival.
The time-to-transplant indicator shows the timeliness of access to HCT services in Ontario and is a gauge of system capacity and efficiency.
These time intervals can be used to assess how well the cancer system is working. They provide valuable insight into how to distribute existing resources and plan services.

See Time from Remission to Allogeneic Transplant – Acute Myeloid Leukemia – Methodology for technical information.

Report date: August 2020
Data sources: Ontario Cancer Registry (OCR), Specialized Service Oversight Information System (SSOIS), Registered Persons Database (RPDB)
Prepared by: Quality Measurement and Evaluation (QME), Ontario Health (Cancer Care Ontario)

See Time from Second Line Chemotherapy to Autologous Transplant – Diffuse Large B-Cell Lymphoma – Methodology for technical information.

See Time from First Systemic Treatment to Autologous Transplant – Multiple Myeloma – Methodology for technical information.

Data Table 1. Time (in days) from remission to allogeneic transplant for acute myeloid leukemia, 2017 to 2018
Year of Transplant	Number of Patients Transplanted	25th percentile	median	75th percentile	90th percentile
2017	110	58	77.5	104	145
2018	162	50	69	92	129

Data Table 2. Time (in days) from second-line chemotherapy to date of transplant for diffuse large B-cell lymphoma, 2014 to 2018
Year of Transplant	Target	Number of Patients Transplanted	Wait Time 25th percentile	Wait Time median	Wait Time 75th percentile	Wait Time 90th percentile
2014	84	57	76	91	107	145
2015	84	66	80	97.5	120	149
2016	84	64	78	96.5	131.5	185
2017	84	62	78	92	115	176
2018	84	78	77	92.5	119	165

Figure 3: Time (in days) from first systemic treatment to autologous transplant for multiple myeloma, 2014 to 2018
Year of Transplant	Target	Number of Patients Transplanted	Wait Time 25th percentile	Wait Time median	Wait Time 75th percentile	Wait Time 90th percentile
2014	161	259	154	171	197	225
2015	161	298	149	168	194	236
2016	161	313	147	158	187	237
2017	161	313	146	162	189	225
2018	161	384	146.5	160	191	232

Data Table 1: Time (in days) from remission to allogeneic transplant for acute myeloid leukemia, 2017 to 2018

Data Table 2: Time (in days) from second-line chemotherapy to autologous transplant for diffuse large B-cell lymphoma, 2014 to 2018

Data Table 3: Time (in days) from first systemic treatment to autologous transplant for multiple myeloma, 2014 to 2018

Results

The number of transplants completed increased over the reported periods for all disease sites included in this indicator: acute myeloid leukemia, diffuse large B-cell lymphoma and multiple myeloma.
The median time from remission to allogeneic transplant for people with acute myeloid leukemia decreased from 78 days in 2017 to 69 days in 2018.
The median time in days from second-line chemotherapy to transplant for people with diffuse large B-cell lymphoma has ranged from 91 to 98 days from 2014 through 2018. Therefore, more progress is needed to reach the provincial target of 84 days in 80% of patients.
The median number of days from first systemic treatment to autologous transplant for people with multiple myeloma decreased from 171 days in 2014 to 160 days in 2018, despite a significant increase in the number of patients requiring transplant.
Although a little over half of people with multiple myeloma received transplants within the provincial target in 2018, more work is needed to meet the desired goal of 80% of patients receiving transplants within 161 days of their first treatment.
The wait time targets were agreed upon by clinical experts as the number of days required for a patient to complete the steps necessary to get to transplant. Wait times are influenced by a number of factors, including access to testing, disease-related factors, toxicity of treatment and the ability to collect stem cells.

Opportunities

Some progress has been made in reducing the time from remission to allogeneic transplant for people with acute leukemia, while not negatively affecting time intervals in other disease sites. Despite increases in autologous transplant volumes, the wait times have remained stable and have not adversely influenced allogeneic transplant wait times for people with leukemia.
Time to transplant will vary depending on the person’s disease, response to treatment, ability to identify a donor and clinical circumstances.
More data are needed to identify the optimal time intervals for best clinical outcomes.