Total Number of Transplants since 2005:

539

Average length of stay in the Hospital for Autos/Allos:
Auto 2006: 20.5 Allo 2006: 26.7
Auto 2007: 18.2 Allo 2007: 38.4
Auto 2008: 22.5 Allo 2008: 45.75
Auto 2009: 26.8 Allo 2009: 29.45
Auto 2010: 20.1 Allo 2010: 32.88
Auto 2011: 19.7 Allo 2011: 25.46
Auto 2012: 17.2 Allo 2012: 25.8
Auto 2013: 15.96 Allo 2013: 18.5
The average length of stay for transplant is decreasing overall.

We plan to move towards outpatient Auto Transplants in the next few years.

Our day 100 patient survival rates:
Survival = 93%

Overall Survival rates beyond day 100:
(2005 11/19/13)
Overall Survival = 70%

Lost to follow up (2005 11/19/13) = 22 pts This should = 0!!

# of post-transplant patients currently being followed by the transplant coordinators:
362

Since 2005 we have seen a huge growth in our program. Just this last year alone we had a 59%
increase in new patient referrals. This has translated into a 72% increase in actual transplants for
this last year.

#of new patient Visits:
2012 fiscal year: 244
2013 fiscal year: 415

#of transplants:
2012 fiscal year: 68
2013 fiscal year: 95

According to the National Marrow Donor Program, survival rates are greatly influenced by recognizing
post-transplant complications early, establishing long-term post-transplant screening and preventative
practices, vaccinations and screening for GVHD. Complications from Bone Marrow Transplant can
develop long after a patient leaves UCH and returns to a PCP or local oncologist. It is important that we
dedicate a substantial amount of time and energy to this part of the patients care. As our patient
numbers have increased, this is one area of care that is not getting the attention that is needs. It is vital
to our patients and their survival that we invest as much dedication, attention and time into their post-
transplant care as we do into their pre-transplant care. Also when we move to outpatient Auto
transplants there will be a huge shift in the workload for these patients from the inpatient units to the
outpatient unit and staff. Also, patients anxiety and stress often increase during times of treatment
transition. There is a huge need and a lot of potential for a Bone Marrow Transplant Survivorship
Coordinator. The goal of this position would be to provide an individual who could assist in coordinating
the complex care that post-transplant patients require. Thereby increasing the patients quality of life,
decreasing the patients stress and anxiety, improving their overall satisfaction and ultimately improving
their long-term survival.

Post-Transplant Survivorship Coordinator
- Survivorship Coordinator will begin to care for the patients starting at transplant admission.
- Care starting at Day 0:
o Attend inpatient rounds 2x week
o Hold discharge education classes 2x per week. This class will be open to all caregivers
and patients.
It must be attended 2x before discharge.
o Ensure all post-transplant care is set up prior to discharge. (BIC appointments, MD and
NP appointments, home infusions, medications, lodging, transportation etc.).
This would significantly decrease the overall discharge timewhich would significantly
help the 11
th
floor with bed availability, and improve patient satisfaction.
o Ensure all Insurance issues are resolved for all medications prior to discharge: Fragmin,
Anti-rejection medications, home IV medications, antifungals, heparin, ganciclovir etc.
- Care Starting at Discharge through 1 year post transplant:
o Ensure patients are receiving the appropriate f/u post-transplant (daily-3x week),
working closely with the BIC staff, practitioners and patients.
o Coordinate the patients day 100 and day 365 post-transplant evaluation at UCH.
Return visit with Psychologist, nutritionist, reproductive medicine (if needed)
and attending MD
Labs
PET/CT
ECHO
MUGA
CXR
Procedures (Bone Marrow Biopsy, Lumbar Puncture etc.)
o Laboratory monitoring:
CMV weekly for MUDS and MRDs. Coords 2x week
LFTs at every BIC appointment
Tacrolimus 2 x week thru day 100 / Sirolimus 1 x week thru day 100 /
Cyclosporin 2 x week thru day 100
Cr at every BIC appointment
Lipid panel every 30 days thru day 100 and yearly
AFP/Beta HCG 1 x month for Germ Cell Tumor
o Regularly communicate with the patients referring Oncologist regarding the patients
status.
Once the patient is ready to return home:
Coordinator the transfer of care to the referring oncologist.
Ensure the patient is set up for the appropriate appointments.
Send all appropriate transplant records to the referring oncologist.
o Work with patients to increase compliance with PCP prophylaxis for 6 months post-
transplant.
o Work with patients to increase compliance with antimicrobial/PCP prophylaxis for the
duration of immunosuppressive therapy.
o Assist with Medication Refills.
o Coordinate post-transplant dental care at 6 months post-transplant.
Screening for Sicca Syndrome, Caries, Periodontal disease and oral cancer
Set up prophylactic antibiotics according to the American Heart Association
Guidelines.
o Help the patient to re-establish care with a PCP at 6 months post-transplant.
Fax or mail all the appropriate records to the PCP.
Communicate the needs of the post-transplant patient to the PCP:
Vaccines (see attachment)
Referral for ophthalmologic exam
Screenings/Referrals: pap smear, Mammogram, Colonoscopy,
Dermatology referral, osteopenia/osteoporosis, etc.
- Day 100 and beyond follow up care:
o Survivorship Coordinator will continually follow up with the patient and referring
oncologist/PCP:
Ensure the patient is seen appropriately
Fax results of Day 100 and Day 365 post-transplant evaluation test results and
clinic notes.
Ensure that the referring oncologist is included in the overall plan and
management of care
Ensure the patient is not lost to follow up.
Encourage yearly follow up with PCP.
o Coordinate follow up/communication between donors and patients, if needed, at 1 year
post transplant.
o Ensure that the patient gets a Treatment Summary/Survivorship care plan.
- Psychosocial/Educational Follow Up:
o Set up the appropriate referrals to help with the following: (manage expectations, long-
term psychosocial effects, depression, anxiety, living with uncertainty, returning to
work, intimacy etc.)
BMT Psychologist
Integrative medicine.
WIN Clinic. (What is Next Survivorship Clinic)
Physical Therapy
o Establish a peer- peer program for patients.