Since 2015, FACT Standards have required transplant programs to evaluate one-year survival in comparison to national or international data and submit a corrective action plan (CAP) when survival does not meet the expected range. Allogeneic transplant programs in the U.S. must utilize the annual CIBMTR Transplant Center-Specific Analysis (CSA) report as its comparative data. The FACT Clinical Outcomes Improvement Committee evaluates CAPs against defined guidelines using an established policy. Updates to this policy were announced in 2022.
Sharma et. al. recently published an article titled, Impact of Public Reporting of Center-Specific Survival Analysis Scores on Patient Volumes at Hematopoietic Cell Transplant Centers.1 The authors evaluated the impact of public reporting of survival on allogeneic transplant volumes. Data show that public reporting is associated with changes in volume, including lower volume at programs that do not meet expected one-year survival as reported in the CSA. There is a plethora of reasons for why this may be the case, and some are briefly listed in the article.
As part of FACT’s process for evaluating CAPs intended to improve one-year survival, the FACT Outcomes Committee generally does not accept refusal to transplant high-risk patients as a blanket corrective action.2 The committee is mindful of how its reviews should not impact patient access to transplant. Furthermore, refusal to treat high-risk patients may not improve outcomes: The CSA uses risk-adjusted methodology, meaning that the expected range of one-year survival already accounts for the level of risk. Attempts to improve outcomes simply by refusing to treat high-risk patients will be ineffective. The program’s level of risk would simply be lower, causing a higher expected range of one-year survival in subsequent reports.
To improve survival, the committee encourages transplant programs to focus on the cause of death. Perhaps preparative regimens are too aggressive or not aggressive enough, certain comorbidities need to be managed, socioeconomic barriers require greater social support to ensure medication compliance, or patients are being referred to the program too late. Addressing these root causes may improve survival while giving patients a treatment option.
Finally, research involving high-risk patients advances the field. If transplant programs were to only transplant the easy cases, no improvements would be made. This is a research-oriented field, and the greatest challenges will improve transplant and make it an option for more patients, not less.
1 Sharma et. al. Impact of Public Reporting of Center-Specific Survival Analysis Scores on Patient Volumes at Hematopoietic Cell Transplant Centers. Transplantation and Cellular Therapy, 29, 8 (2023). https://doi.org/10.1016/j.jtct.2023.05.013.
2LeMaistre et. al. Integration of Publicly Reported Center Outcomes into Standards and Accreditation: The FACT Model. Transplantation and Cellular Therapy, 25, 11 (2019). https://doi.org/10.1016/j.bbmt.2019.06.035