Increasing Access to Transplantation through Telemedicine and Patient Navigation

Hematopoietic cell transplantation (HCT) is a promising treatment for hematological diseases, yet access barriers like cost and limited transplant centers persist. Telemedicine-based patient navigation has emerged as a solution. This study presents a cost-free patient navigation telemedicine clinic in collaboration with the National Marrow Donor Program, assessing its impact on HCT access. In this single-center cohort study, patients of all ages and diagnoses referred for HCT participated. Two transplant physician-navigators established patient relationships via video calls, collecting medical history, offering HCT education, and recommending pretransplant tests. The analysis involved descriptive statistics and intent-to-transplant survival assessment. One hundred and three patients were included of whom n=78 were referred for allogeneic HCT, with a median age of 28 years. The median time from initial contact to the first consult was 5 days. Cumulative incidence of transplantation was 50% at 6 months and 61% at 12 months, with varying outcomes based on HCT type. Notably, 49 patients were not transplanted, primarily due to refractory disease, progression, or relapse (57.1%). AutoHCT candidates and physician referrals were correlated with higher transplant success compared to alloHCT candidates and patients who were not referred by a physician. In conclusion, our pre-transplant telemedicine clinic was feasible, facilitating access to HCT. Disease relapse posed a significant barrier. Enhancing timely physician referrals should be a focus for future efforts.