Barriers to Transplant Access and Academic-Community Disparities

Rawan Faramand, MD, addresses the uneven distribution of access to allogeneic transplant and to newer transplant technologies. She observes that effective upfront regimens for acute leukemia, such as a hypomethylating agent with venetoclax, mean that many patients are now treated close to home rather than at large academic centers, so the first step is a strong relationship with community referring physicians. She highlights National Marrow Donor Program resources such as HLA Today, which allow donor HLA typing to begin before a patient reaches a transplant center, and stresses that many community physicians and patients do not recognize that a patient is eligible for a potentially curative transplant, especially now that platforms are safer. Getting patients through the door is the essential first step. Dr Faramand notes that newly approved technologies, as was seen with chimeric antigen receptor T-cell therapy, can unintentionally widen disparities because they require specialized training, coordination with a manufacturing facility, donor collection at a specified time because the cells are fresh, and cell therapy infrastructure that tends to exist only at centers with established transplant or cell therapy programs. She calls for the transplant community to work with community physicians to deliver these therapies closer to home or to provide the resources and financial support that let patients travel for initial treatment and then return home. Because therapies such as Orca-T substantially reduce chronic graft-vs-host disease and infections, she expects that more patients can be followed by their referring oncologist and through telehealth rather than traveling repeatedly to an academic center.