System-level Redesign of an Allogeneic Hematopoietic Cell Transplantation Program Associated With High One-year Survival and Reduced Cost

作者：Shernan G. Holtan, Megan M. Herr, Kanwal Mallhi, Trish Boersch, Jordan Pleskow, Erin Hughes, Lora Yoerg, Molly Aungst, Nataliya P. Buxbaum, Matthew Barth, Meghan Higman, Grant Schofield, Ehsan Malek, Maureen Ross, Philip McCarthy, Renier Brentjens, Marco L. Davila, Brian C. Betts · 发表于：Transplantation and Cellular Therapy · 年份：2026 · DOI：10.1016/j.jtct.2026.06.050 · 研究领域：Hematopoietic Stem Cell Transplantation、Acute Lymphoblastic Leukemia research、Neutropenia and Cancer Infections

Background Practice variation in allogeneic hematopoietic cell transplantation may contribute to preventable toxicity, non-relapse mortality, and excess cost. We evaluated outcomes occurring with the implementation of a program-wide standardization initiative in a medium-sized program. Methods We conducted a single-center retrospective cohort study of consecutive patients undergoing first allogeneic hematopoietic cell transplantation in 2024 during implementation of a system-level redesign. The intervention emphasized high-reliability operations through concise standard operating procedures, formal quality management, standardized recipient and donor selection, a limited conditioning regimen formulary, fluid-sparing conditioning and graft infusion practices, post-transplant cyclophosphamide-based graft-versus-host disease prophylaxis, and an early-discharge outpatient care model. The primary endpoint was 1-year overall survival. Secondary endpoints included graft-versus-host disease-free, relapse-free survival, non-relapse mortality, acute and chronic graft-versus-host disease, length of stay, and pharmaceutical cost. Results Ninety-four patients underwent a first allogeneic hematopoietic cell transplantation in 2024. One-year overall survival was 92.6%, graft-versus-host disease-free, relapse-free survival was 56%, and non-relapse mortality was 1%. The cumulative incidence of grade II-IV acute graft-versus-host disease was 32%, with grade III-IV acute graft-versus-host disea...