UAB' s Program Offers Cutting-edge Care

UAB's 1-year survival rates for matched unrelated donor bone marrow transplants are the highest among major transplant centers in the region, outranking centers such as M.D. Anderson Cancer Center, Emory University, and Vanderbilt University.

The National Marrow Donor Program (NMDP), which locates almost all donors for matched unrelated bone marrow transplants performed in the United States, analyzes each center’s case mix to produce expected 1-year survival rates and reports the actual outcomes of all transplants it facilitates. For patients undergoing transplant during the last 5-year period analyzed (2000-2004), UAB’s predicted 1-year survival was 51.8%. Actual survival was 57.8%, exceeding the rate of the center with the next highest actual survival rate by more than 5%.

The success of UAB’s Bone Marrow Transplantation and Cell Therapy Program (BMT&CT) is due largely to a single-staff model of care, says Director William P. Vaughan, MD, MBA, who instituted the system when he established UAB’s program in 1991. “Under the single-staff model, a patient is cared for by the same team of physicians and nurses at every visit, whether inpatient or outpatient,” he says. These physicians and nurses deliver inpatient, outpatient, and emergency care in a single location at UAB Hospital, 24 hours a day, 365 days a year. “Patients also benefit from a highly structured set of transplant procedures and a stable faculty and staff, some of whom have been with the program since its inception.”

Allogeneic bone marrow transplantation has curative potential for various leukemias and lymphomas and a number of other malignant and nonmalignant disorders. However, there is only a one in four chance that a sibling will be a good human leukocyte antigen match. Less than 25% of patients needing a transplant will have a suitably matched family member. Although the NMDP has more than 4 million registered volunteer donors, and the BMT&CT can access European registries, Vaughan says that suitable unrelated volunteer donors, particularly those from minority populations, always are in short supply.

Expanded Transplant Eligibility
UAB’s BMT&CT program is at the forefront of research that is expanding transplant eligibility in older patients and individuals with significant comorbidities. UAB research has produced a pharmacokinetic-directed dosing strategy for intravenous busulfan-based preparative regimens for treatment of advanced, aggressive non-Hodgkin’s lymphoma. “This strategy has virtually eliminated busulfan-related mortality without compromising efficacy and has resulted in excellent long-term relapse-free survival [50% at 4 years] in otherwise incurable patients with advanced, aggressive non-Hodgkin’s lymphoma,” he says.

BMT&CT scientists are studying strategies to maximize benefits and minimize risks of allogeneic grafts. Investigators are the first in the nation to receive a Food and Drug Administration investigational device exemption to standardize T-cell content of all graft products. “Lower T-cell content of marrow products results in less graft-versus-host disease. Standardizing content allows us to do rigorous clinical trials to identify the other determinants of good and bad outcome,” Vaughan says.

BMT&CT faculty and staff maintain a close relationship with referring physicians and offer a dedicated line for gathering information and arranging patient evaluations. “Our goal is providing compassionate and uncompromisingly expert care to ensure the best possible outcomes,” he says.

For more information:
1.800.UAB.MIST
mist@uabmc.edu