For patients who could benefit from a hematopoietic cell transplant (bone marrow, PBSC, or cord blood transplant — BMT), a timely referral to a transplant center for consultation can increase the likelihood of a favorable outcome if transplant is needed. A transplant physician can work in partnership with the patient's treating physician to:
- Determine whether an autologous or allogeneic transplant may be a treatment option
- Incorporate potential transplant into the patient's treatment plan
- Plan the appropriate time to consider transplant based on the patient's diagnosis and prognostic factors — see Recommended Timing for Transplant Consultation
Considerations for a successful referral
After their initial transplant consultation, most patients return to the care of the physician who referred them. To develop an effective partnership between the referring physician and the transplant physician in treating the patient, timing and communication are critical.
- Prior to the patient's first visit, the transplant center should be provided with patient records:
- Diagnostic slides and pathology reports
- Records of chemotherapy and radiation therapy and the patient's response
- Recent X-rays, CT scans or MRIs
- If tissue typing has been done, HLA typing of patient and family members
- For allogeneic transplants, HLA typing of the patient and family members and the search for an unrelated donor or cord blood unit are initiated at the appropriate time. A referring physician can submit a Preliminary Search Request Form to start a preliminary search of the Be The Match Registry® operated by the National Marrow Donor Program® (NMDP).
- Changes in patient status are communicated promptly between treating physicians.
- The patient is kept informed of treatment plans and who to contact with questions.
Patient referral process
The treating physician identifies a transplant center and contacts the transplant center's patient scheduler or coordinator. The time from referral to patient appointment varies depending on the transplant center, the patient's diagnosis and risk factors, and, in some cases, financial issues.
For patients with acute leukemia or other urgent diagnoses, it can be beneficial for the treating physician to contact a transplant center physician directly.
The transplant center:
- Confirms diagnosis
- Reviews records for prior therapies and responses, disease status and co-morbidity issues
- Evaluates whether the patient is a candidate for transplant
- Discusses the role of transplant (autologous or allogeneic), risks of transplant-related mortality and percentage of successful transplants for the patient's diagnosis with the patient and with the referring physician
- If allogeneic transplant is indicated, plans HLA typing and, if a related donor is not available, initiates the search for an unrelated donor or cord blood unit
- Discusses financial resources with patient
- Communicates with the referring physician, patient and patient's family about planning and decision-making
Patient care after referral
After the initial evaluation at the transplant center, most patients return to the care of the physician who referred them until the transplant takes place. During this time, communication between the treating physician and the transplant center is crucial to successful treatment.
- The treating physician updates the transplant center on changes in the patient's disease status.
- Physicians discuss any treatment changes to avoid therapies likely to increase a patient's transplant complications.
- If an unrelated donor transplant is planned, the transplant center updates the treating physician on search progress and any delays.