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Improving Survival Outcomes for Hematopoietic Cellular Transplant (HCT) Recipients
S348
Abstracts / Biol Blood Marrow Transplant 23 (2017) S18–S391
was low for the complexity of the recipients that were transplanted. Partnering with Sarah Cannon Blood Cancer Network, a more in-depth audit of TTI data collection and clinical outcomes was performed. This audit revealed that incomplete medical records and data collection contributed to significantly lower comorbidity index scoring as well as lower assignment of staging for disease and disease status at transplant. The following corrective action and process improvement plan was established:
Figure 2.
treatment distress were obtained at baseline, discharge, and day 100. Weekly semi-structured interviews were conducted for qualitative analysis. Results: 20 subjects have enrolled: median age 57 (28–72), 75% male, 90% white, median length of stay 23 days (17– 37), 55% HLA-matched related and 45% HLA-matched unrelated recipients. From admission to day 100, overall mood improved (Profile of Mood States-2 (POMS); p = .015) and depression decreased (POMS-D; p = .023). Trait and state anxiety (State Trait Anxiety Inventory; STAI-T/S) were stable. Cancerrelated treatment distress decreased from admission to discharge, as well as from discharge to day 100 (Cancer and Treatment Distress Scale (CTXD); p = .008 and p = .01, respectively.). Activation increased from admission to discharge (Patient Activation Measure (PAM); p = .032) but remained stable at day 100. At discharge, the PAM correlated with the POMS (total) (p = .03, r = −.55); the POMS-D (p = .01, r = −.62); STAI-T (p = .05, r = −.49); STAI-S (p = .05, r = −.51). Weekly semistructured qualitative interviews were conducted on topics including acceptance of BMT Roadmap, informational needs, and psychosocial burdens. Major themes emerging from content analyses indicated: i) Roadmap usefulness, ease-ofuse, and likeability; ii) focus on importance of laboratory module (Figure 2); iii) desire for more data and expansion into outpatient setting. Conclusions: BMT Roadmap was designed with humancomputer interaction and user-centered design research methods. The resulting app was useful and easy-to-use. Validated PROs indicate that activation and mood increased, cancer-related treatment distress decreased, and trait and state anxiety remained stable across time points.
483 Improving Survival Outcomes for Hematopoietic Cellular Transplant (HCT) Recipients Paul J. Shaughnessy 1, Jose C. Cruz 1, Richard Lex 2, Sherri Shade 2, Kimberlie Ratliff 2. 1 Adult Blood and Marrow Transplant, Texas Transplant Institute, San Antonio, TX; 2 Blood and Marrow Transplant Program, Methodist Hospital, San Antonio, TX Texas Transplant Institute (TTI) performed an audit to review data integrity for reporting each recipient’s risk for transplant to CIBMTR. The audit revealed that comorbidity scoring
Educate all staff including physicians, APPs, and data managers about the importance of obtaining all necessary data possible before transplant. Strive to obtain data “real time” prior to transplant to ensure complete and accurate documentation. Relocate data managers to be physically closer to clinical staff and provide them better access to records. Establish weekly meetings between data managers and clinicians for review and sign-off on clinical data peritransplant, including comorbidities, diagnosis, and stage of disease before transplant. Implement Long Term Follow-up (LTF) Clinic. Track, trend, and report survival outcomes quarterly to the program’s Quality Improvement Committee. Fully implement an internal software platform; input and track HCT recipient and product data, supported with a software compliance solution. Implement a provider documentation template within the electronic medical record. In conclusion, to improve survival outcomes, TTI will continuously track and trend 100-day and 1-year survival outcomes, engraftment outliers, selection criteria, and comorbidity scores to ensure appropriate risk assessment of transplant recipients.
484 Retrospective Comparative Analysis of Spectra Optia® MNC and Cmnc Apheresis Collection Protocols Paul J. Shaughnessy 1, Gayla Nagy 2, Dorothy Stevens 2, Carijo West 3, Mary Kay Nalty 3, Betsy Blunk 4, Joseph Roig 5, Peter McSweeney 6. 1 Adult Blood and Marrow Transplant, Texas Transplant Institute, San Antonio, TX; 2 Apheresis Unit, Methodist Hospital, San Antonio, TX; 3 Apheresis and CTL, Presbyterian/St. Luke’s Medical Center, Denver, CO; 4 Sarah Cannon, Denver, CO; 5 Terumo BCT, Inc, Lakewood, CO; 6 Hematology/Oncology, Colorado Blood Cancer Institute, Denver, CO Background: There are several collection methods utilizing the Spectra Optia®; Continuous Mononuclear Cell (CMNC) and Mononuclear Cell (MNC). With the recent FDA approval of the Spectra Optia® Continuous Mononuclear Cell (CMNC) protocol, 2 centers within the Sarah Cannon Blood Cancer Network (SCBCN), Methodist Hospital and the Colorado Blood Cancer Institute at Presbyterian/St. Luke’s Medical Center, have instituted the new CMNC collection protocol. Following this change, a comparison of collection outcomes was performed. Methods: Retrospective analysis included 30 MNC collections and 36 CMNC collections. These analyses included only autologous patients. While there were multiple data elements evaluated, this study found some key differences in the baseline pre-collection parameters, CD34+ cell collection efficiency (CE2), and product volume. CD34+ cell collection efficiency (CD34 CE2) was defined as [total CD34+ cells in
Abstracts / Biol Blood Marrow Transplant 23 (2017) S18–S391
was low for the complexity of the recipients that were transplanted. Partnering with Sarah Cannon Blood Cancer Network, a more in-depth audit of TTI data collection and clinical outcomes was performed. This audit revealed that incomplete medical records and data collection contributed to significantly lower comorbidity index scoring as well as lower assignment of staging for disease and disease status at transplant. The following corrective action and process improvement plan was established:
Figure 2.
treatment distress were obtained at baseline, discharge, and day 100. Weekly semi-structured interviews were conducted for qualitative analysis. Results: 20 subjects have enrolled: median age 57 (28–72), 75% male, 90% white, median length of stay 23 days (17– 37), 55% HLA-matched related and 45% HLA-matched unrelated recipients. From admission to day 100, overall mood improved (Profile of Mood States-2 (POMS); p = .015) and depression decreased (POMS-D; p = .023). Trait and state anxiety (State Trait Anxiety Inventory; STAI-T/S) were stable. Cancerrelated treatment distress decreased from admission to discharge, as well as from discharge to day 100 (Cancer and Treatment Distress Scale (CTXD); p = .008 and p = .01, respectively.). Activation increased from admission to discharge (Patient Activation Measure (PAM); p = .032) but remained stable at day 100. At discharge, the PAM correlated with the POMS (total) (p = .03, r = −.55); the POMS-D (p = .01, r = −.62); STAI-T (p = .05, r = −.49); STAI-S (p = .05, r = −.51). Weekly semistructured qualitative interviews were conducted on topics including acceptance of BMT Roadmap, informational needs, and psychosocial burdens. Major themes emerging from content analyses indicated: i) Roadmap usefulness, ease-ofuse, and likeability; ii) focus on importance of laboratory module (Figure 2); iii) desire for more data and expansion into outpatient setting. Conclusions: BMT Roadmap was designed with humancomputer interaction and user-centered design research methods. The resulting app was useful and easy-to-use. Validated PROs indicate that activation and mood increased, cancer-related treatment distress decreased, and trait and state anxiety remained stable across time points.
483 Improving Survival Outcomes for Hematopoietic Cellular Transplant (HCT) Recipients Paul J. Shaughnessy 1, Jose C. Cruz 1, Richard Lex 2, Sherri Shade 2, Kimberlie Ratliff 2. 1 Adult Blood and Marrow Transplant, Texas Transplant Institute, San Antonio, TX; 2 Blood and Marrow Transplant Program, Methodist Hospital, San Antonio, TX Texas Transplant Institute (TTI) performed an audit to review data integrity for reporting each recipient’s risk for transplant to CIBMTR. The audit revealed that comorbidity scoring
Educate all staff including physicians, APPs, and data managers about the importance of obtaining all necessary data possible before transplant. Strive to obtain data “real time” prior to transplant to ensure complete and accurate documentation. Relocate data managers to be physically closer to clinical staff and provide them better access to records. Establish weekly meetings between data managers and clinicians for review and sign-off on clinical data peritransplant, including comorbidities, diagnosis, and stage of disease before transplant. Implement Long Term Follow-up (LTF) Clinic. Track, trend, and report survival outcomes quarterly to the program’s Quality Improvement Committee. Fully implement an internal software platform; input and track HCT recipient and product data, supported with a software compliance solution. Implement a provider documentation template within the electronic medical record. In conclusion, to improve survival outcomes, TTI will continuously track and trend 100-day and 1-year survival outcomes, engraftment outliers, selection criteria, and comorbidity scores to ensure appropriate risk assessment of transplant recipients.
484 Retrospective Comparative Analysis of Spectra Optia® MNC and Cmnc Apheresis Collection Protocols Paul J. Shaughnessy 1, Gayla Nagy 2, Dorothy Stevens 2, Carijo West 3, Mary Kay Nalty 3, Betsy Blunk 4, Joseph Roig 5, Peter McSweeney 6. 1 Adult Blood and Marrow Transplant, Texas Transplant Institute, San Antonio, TX; 2 Apheresis Unit, Methodist Hospital, San Antonio, TX; 3 Apheresis and CTL, Presbyterian/St. Luke’s Medical Center, Denver, CO; 4 Sarah Cannon, Denver, CO; 5 Terumo BCT, Inc, Lakewood, CO; 6 Hematology/Oncology, Colorado Blood Cancer Institute, Denver, CO Background: There are several collection methods utilizing the Spectra Optia®; Continuous Mononuclear Cell (CMNC) and Mononuclear Cell (MNC). With the recent FDA approval of the Spectra Optia® Continuous Mononuclear Cell (CMNC) protocol, 2 centers within the Sarah Cannon Blood Cancer Network (SCBCN), Methodist Hospital and the Colorado Blood Cancer Institute at Presbyterian/St. Luke’s Medical Center, have instituted the new CMNC collection protocol. Following this change, a comparison of collection outcomes was performed. Methods: Retrospective analysis included 30 MNC collections and 36 CMNC collections. These analyses included only autologous patients. While there were multiple data elements evaluated, this study found some key differences in the baseline pre-collection parameters, CD34+ cell collection efficiency (CE2), and product volume. CD34+ cell collection efficiency (CD34 CE2) was defined as [total CD34+ cells in