A Word from President Helen Heslop, MD
How do you feel about the forecast that the number of unrelated donor transplants could triple in the next few years?

Last year, there were about 3,500 transplants performed in the United States. The new strategic plan of the National Marrow Donor Program anticipates 10,000 by 2015.

This prediction, calculated in several different ways, would be a continuation of the trends of the past eight years. Since 1999, there have been dramatic increases in the number of transplants for AML, ALL, NHL and MDS, as illustrated in an NMDP bar chart.

Indications for transplant, of course, can change rapidly with the introduction of alternative therapies or the results of large late-phase clinical trials. The same NMDP bar chart shows a decline in the number of unrelated donor transplants for CML, no doubt the result of the introduction of Imatinib and other tyrosine kinase inhibitors.

Another example of a rapid change is the number of transplants for breast cancer, plummeting from 1,864 transplants at 162 centers in 1999, to only 11 transplants at six centers in 2006. (See CIBMTR table.)

Unforeseen developments in research and clinical studies can skew the growth that is predicted through 2015. But assuming that trends continue and that the NMDP is successful in expanding the number of donors to attain 10/10 matches for more patients, we need to ask whether our transplant facilities are up to the challenge. Can we deliver three times the number of unrelated donor transplants that are performed today?

That question is posed in this month’s interactive reader poll in the adjacent left-hand column. You are encouraged to use it to give us your thoughts about how an expanding demand might affect your program. Next month, we’ll tally and report your aggregate answer.

The NMDP projections, presented at the BMT Tandem Meetings in San Diego, raise a number of issues and concerns, such as:
• lengthening waiting lists caused by physical plant limitations
• medical and nursing staff needs and recruitment
• adequacy of reimbursement by third-party payers

The ASBMT Board of Directors will be considering these issues at a planning retreat in June. Before that meeting, our Committee on Indications and Resources, chaired by Jeff Schriber, will be sending a brief survey to transplant centers to gather information on staffing and capacity.

In the meantime, though, we’d like to hear your comments using the interactive reader poll.

– Helen