Transcript New Approaches for Transplant Patients

New Approaches for Transplant Patients
Linda J Burns, MD
Medical Director, Health Services Research Program
National Marrow Donor Program (NMDP)/Be the Match
May 21, 2016
Leukemia Research Foundation
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Learn About
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Be The Match
Types of transplants
When to consider an unrelated donor transplant
Finding an unrelated donor
How Be The Match can assist you
A look to the future
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Be The Match: Dedicated to Patients
Be The Match: People Helping People
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Types of Transplants and Cell Sources
• There are two types of transplant – autologous and allogeneic
• There are three sources of stem cells for transplantation: bone
marrow, peripheral blood stem cells (PBSC), and cord blood
Operated by the National Marrow Donor Program®.
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Total Number of Transplants
Pasquini MC, Zhu X. Current uses and outcomes of hematopoietic stem cell transplantation:
CIBMTR Summary Slides, 2015.
Reasons for Transplant
Pasquini MC, Zhu X. Current uses and outcomes of hematopoietic stem cell transplantation:
CIBMTR Summary Slides, 2015.
The Transplant Process
Operated by the National Marrow Donor Program®.
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Reduced-intensity Regimen
(non-myeloablative or “mini”)
• Lower doses of chemotherapy with or without radiation
– Main goal: suppressing the recipient immune system to
allow donor cells to engraft
• Works for patients with:
– Slower growing diseases
– Who are less likely to tolerate the side effects of a high
dose transplant
• Primary benefit of this type of transplant is the immune
effect: Graft vs. Leukemia/Lymphoma
Operated by the National Marrow Donor Program®.
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Standard-intensity Regimen
(myeloablative)
• Higher doses of radiation/chemotherapy administered
with goal of killing ALL of the patient’s stem cells and
diseased cells
• Works for patients with:
– More aggressive diseases
– Who are younger and overall healthy
• Usually causes more side effects
Operated by the National Marrow Donor Program®.
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Allogeneic Transplant
• Family donor
• Unrelated donor
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When to Consider an
Unrelated Donor Transplant
• When you need an allogeneic transplant and a
family member is not able to donate for you
• Outcomes comparable to family donor for many
diseases
– Advances in HLA typing to identify the “best” match
– New preparative regimens
– Improved supportive care
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How an Unrelated Donor or
Cord Blood Unit Is Found
• Your transplant center is
responsible for searching for a
donor or cord blood unit(s)
• Be The Match Registry
– Includes 12.5 million donors
and 209,000 cord blood units
– Has access to 25 million
potential donors and more
than 622,000 cord blood units
on U.S. and global registries
Operated by the National Marrow Donor Program®.
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HLA: Genetic Identity
• Human Leukocyte Antigens (HLA) are proteins found on
the surface of most cells in the body
• The immune system uses HLA to verify that a given cell
is part of the body and not foreign
• Finding a suitably-matched donor is important to reduce
the risk of post-transplant complications
• There are many different variations of the HLA molecules
(HLA-A, -B, -C, -DRB1, -DQ, -DP)
Operated by the National Marrow Donor Program®.
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HLA Haplotypes
• Possible sets of HLA
combinations, termed
“haplotypes,” are in the
billions
– Similar to a set of lottery
numbers
– Everyone gets one haplotype
from each parent
• Haplotypes often follow
ethnicity (but not always)
Operated by the National Marrow Donor Program®.
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Diversity of Be The Match Registry
DIVERSITY OF OUR ADULT
DONORS
White
Minority
Unknown, Other or Declined
0%
White
Minority
Unknown, Other or Declined
Other0%
10%
Other
13%
Minority
27%
DIVERSITY OF CORD
BLOOD UNITS
White
60%
Operated by the National Marrow Donor Program®.
White
45%
Minority
45%
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NMDP: How We Can Assist You
• Confidential one-on-one
support and navigation
• Tailored educational
materials
• Financial resources
• Fundraising information
• Insurance appeals
• Peer-to-peer connection
• Caregiver support
Operated by the National Marrow Donor Program®.
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Pre-Transplant Patient Materials
• Booklets:
– Transplant Basics
– Allogeneic Transplant: How to plan and
what to expect
• Fact sheets:
– Basics of Blood or Marrow Transplant
– Allogeneic Transplant Process
– Autologous Transplant Process
– Preparing for Transplant
– Being a Transplant Caregiver
• Videos:
– Basics of Blood and Marrow Transplant
Post-Transplant Patient Materials
• Fact sheets on chronic GVHD
– Eyes, lungs, mouth, skin & connective
tissues
– Available summer 2016: GI tract,
genitals
– Developed with experts from the
Chronic GVHD Consortium
• Living Now newsletter series
– Magazine series with 6 issues plus
special caregiver issue
– Mailed automatically to patients who
receive an NMDP facilitated transplant
– Available to order for others
Post-Transplant Guidelines
• Mobile app
–Customizable 6-month, 12-month and 2+ year
checkup guidelines
–Chronic GVHD symptom checker
–Set reminders (appointments, medications,
etc.)
–Search “transplant guidelines” in app stores
to download
• Also available online and print at
BeTheMatch.org/patient-after
Operated by the National Marrow Donor Program ®.
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Free Webcasts for Patients and Families
• Living Now:
– Taking Care of Yourself
– Your Role in Managing Your Chronic GvHD
– Staying Healthy After Transplant
– Your Journey Ahead
– Making Meaning and Moving Forward
Visit: BeTheMatch.org/careguide
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Look to the Future
Research will enable:
• Every patient who needs a transplant to
receive one when they need it
• More patients to be cured of their disease
• Us to understand and improve outcomes that
matter most to patients
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Take Home Points
• Be The Match helps transplant centers identify unrelated
stem cells (donor or umbilical blood) for their patients in
need of a transplant
• Survival following an unrelated transplant is similar to a
transplant using a family member as a donor
• Be The Match has many programs to help you and your
family through the transplant journey
• The future is bright for patients needing a transplant
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