High-Risk Centers and the Benefits for Lower-Risk Transplants

Objectives: Allogeneic hematopoietic cell transplantation (HCT) is the transplantation of stem cells from a donor and an effective treatment for many hematologic malignancies. We sought to compare allogeneic HCT survival outcomes and hazard of death among US centers that treat higher-risk patients versus those in centers that do not perform lower-risk HCT procedures. Study Design: We utilized 2008 to 2010 Center for International Blood and Marrow Transplant Research data. We categorized patients into 4 risk categories that align with factors shown in the literature to be associated with HCT survival. We stratified centers into those that do and do not conduct high-risk pre-transplant HCT. Methods: To further evaluate the association between pre-trans- plant mortality risk and HCT survival by transplant center, we examined the association between risk category score and hazard of death using Cox proportional hazard modeling. Results: There were 12,436 HCT recipients at 147 transplant centers. Of the 147 centers, 74 performed HCT for patients rang- ing from the lowest risk category to the highest category, and 73 centers performed only lower-risk HCT. Adjusting for all other factors, lower-risk patients that underwent transplants in lower- or higher-risk centers had a similar relative hazard of death (P ≤.05). Conclusions: Low-risk patients had similar survival outcomes irrespective of whether they underwent transplant at higher- or lower-risk centers. Patient and payer policy implications could in- clude initiatives that reduce travel for low-risk patients. Similarly, HCT center administrators and providers that manage higher-risk patients need not expect commensurate benefits in survival for lower-risk patients.