Geographic distance is not associated with inferior outcome when using long-term transplant clinic strategy.

Ragon BK, Clifton C, Chen H, Savani BN, Engelhardt BG, Kassim AA, Vaughan LA, Lucid C, Jagasia M
Biol Blood Marrow Transplant. 2014 20 (1): 53-7

PMID: 24120525 · DOI:10.1016/j.bbmt.2013.10.004

The optimal healthcare model for follow-up of allogeneic hematopoietic stem cell transplantation (HSCT) recipients after day 100 is not clear. We previously demonstrated that longitudinal follow-up at the transplant center using a multidisciplinary approach is associated with superior survival. Recent data suggest that increased distance from the transplant center is associated with inferior survival. A dedicated long-term transplant clinic (LTTC) was established in 2006 at our center. We hypothesized that geographic distance would not be associated with inferior outcome if patients are followed in the LTTC. We studied 299 consecutive patients who underwent HSCT and established care in an LTTC. The median distance from the transplant center was 118 miles (range, 1 to 1591). The 75th percentile (170 miles) was used as the cut-off to analyze the impact of distance from the center on outcome (219 patients ≤ 75th percentile; 80 patients >75th percentile). The 2 groups were balanced for pretransplant characteristics. In multivariate analyses adjusted for donor type, Center for International Blood and Marrow Transplant Research risk, and transplant regimen intensity, distance from transplant center did not impact outcome. Our study suggests that geographic distance from the transplant center is not associated with inferior outcome when follow-up care is delivered via a dedicated LTTC incorporating well-coordinated multidisciplinary care.

Published by Elsevier Inc.

MeSH Terms (15)

Adult Aged Female Graft vs Host Disease Health Services Accessibility Hematologic Neoplasms Hematopoietic Stem Cell Transplantation Humans Long-Term Care Male Middle Aged Proportional Hazards Models Survival Analysis Transplantation, Homologous Treatment Outcome

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