FastTrack Dramatically Reduces Donor Searches for Blood & Marrow Transplant Patients
BMT recipient Ashlee Ingelsby (center) pictured with her donor Scott Rowland and her transplant doctor Robert Lowsky, MD. Ingelsby and Rowland met at Stanford's 30th Annual Blood & Marrow Transplant Reunion in May 2018.
In a partnership with the National Bone Marrow Donor Program’s Be the Match registry, Stanford Health Care was one of two transplant centers in the nation to pilot the FastTrack Program, starting in September 2016. The program officially launched this past spring at transplant centers across the country.
“Our first patient who went through the official version of FastTrack was transplanted in only six weeks,” said Gary Goldstein, Business Manager, Blood & Marrow Transplant (BMT) Program. “That’s not just the search itself; that’s everything from ruling out potential donors, to getting the actual blood cell product here and our patient getting infused.”
Ashlee Ingelsby was one of the first Stanford Health Care patients to benefit from FastTrack during its pilot phase. At age 30, she was diagnosed with aplastic anemia; her bone marrow had stopped making new blood cells. Her Stanford BMT physician, Robert Lowsky, MD, recommended bone marrow transplantation rather than treatment with long-term immunosuppression medication because of the high success rate with transplantation, her young age and otherwise excellent health.
“We were scared at first. We weren’t sure how soon a donor would be found and I was declining quickly,” said Ashlee. “I was in infusion clinics several times a week getting blood and platelet transfusions.”
Because Ashlee had no full siblings, and she had high-risk severe aplastic anemia, the Stanford team initiated a worldwide, unrelated donor search as part of the pilot FastTrack process with Be the Match. A perfectly matched unrelated donor was found just four weeks later.
“The fact that a donor was found so quickly, we were just amazed,” said Ashlee, who received her bone marrow transplant on Dec. 17, 2016. “We couldn’t have asked for anything more than that.”
Faster searches for the sickest patients
FastTrack is an accelerated donor search process to help quickly identify one or more unrelated donors for high-risk patients awaiting bone marrow transplantation.
“The very first thing we did was create two pathways for a donor search,” said Jennifer McAtee, Unrelated Donor Search Coordinator, adding an ultra-urgent check box for high-speed search requests for our most critically ill patients.
During the FastTrack pilot, every step in the donor search process was analyzed and streamlined. Even before a patient’s first consultation, Stanford requests HLA typing of the patient’s siblings. If a related donor is not found to be a match, the BMT team can immediately put the patient on the Be the Match registry, shaving one to two weeks off the search process. The team also worked with the Stanford Histocompatability Laboratory to decrease turnaround times for HLA typing of both patients and possible donors, from an average of 21 days at the start of the pilot project down to just three or four days.
A major difference in FastTrack searches is the detailed information acquired from possible donors at the beginning of the process. Transplant coordinators share the expected timeline with all possible donors on the front end to ensure that if a donor is found, availability would not be an issue. Potential donors also learn about the type of donation required, peripheral blood stem cells or bone marrow, and their willingness to undergo the requested procedure is confirmed. Medical clearance of the donor’s health is also expedited to reduce delays.
“The underlying idea of FastTrack is greater communication of detail in a more proactive way,” said Goldstein. Bone marrow transplantation relies heavily on the goodwill of voluntary donors who have jobs, children and scheduled vacations. “Having those conversations at the beginning of the search can shave weeks off the search time,” said McAtee. It can also help eliminate the need to restart searches when a perfect match is found, but the donor has a change of heart or is unavailable, she said.
“For a lot of patients requiring an unrelated donor transplant, I no longer really worry about the timing, which is a huge change,” said Lori Muffly, MD, assistant professor of medicine, Blood & Marrow Transplantation. Today, FastTrack searches at Stanford are completed in approximately 17 days, down from 52 days. “We used to tell patients it might take three to four months to find an unrelated donor,” said Muffly. “And now, I am often able to tell them that I think we can comfortably be ready for transplant in six to eight weeks. That’s a pretty big change.”
Fast Track helps alleviate the medical issues that can arise when patients wait months for a donor match. These include additional rounds of chemotherapy, higher risk of infection, more blood transfusions and the risk of relapse. “The difference of two months in a patient like Ashlee is the difference of many transfusions and possible infections,” said Muffly. “The ability to move quickly is really helpful.”
FastTrack takes a lot more manpower, said Goldstein, which is why it is only available to patients when it is clinically necessary. Stanford performs more than 225 allogenic (related and unrelated donor) transplants each year, and just over half are from volunteer donors coordinated through the National Marrow Donor Program’s Be the Match registry. Goldtsein estimates that about one third of these patients will now receive a FastTrack search.
Stanford was eager to pilot this new program, he said, because of its underlying mission. “Stanford is conducting research not just for the benefit of our patients, but for patients at every transplant center in the world.”