Evolution of the Florida Pediatric Bone Marrow Transplant and Cell Therapy Consortium (FPBCC): A Statewide Initiative Toward Improving Transplant Outcomes

TL;DR

A Florida pediatric bone marrow transplant consortium improved patient survival by collaborating and sharing data, achieving results comparable to larger centers.

Contribution

The paper demonstrates that collaboration among small pediatric transplant centers can significantly improve survival rates, matching those of larger centers.

Findings

FPBCC centers improved 1-year survival from 77.5% to 89.5% after forming the consortium.

Other small centers improved survival slightly, but large centers remained stable.

Collaboration led to a 12% survival improvement in FPBCC centers, unmatched by other programs.

Abstract

Florida Pediatric Bone Marrow Transplant and Cell Therapy Consortium (FPBCC) was formed in 2018 by five pediatric transplant programs in Florida. The key objectives of the consortium are to improve outcomes for children undergoing HSCT through collaboration among centers, data sharing, implementation of best practices, QI projects, and prospective clinical trials. The first step in that process was to analyze HSCT outcomes from all participating centers and identify areas for improvement. In this report, we describe the effectiveness of the activities of this consortium, focused on improving patients' outcomes.

A retrospective data review of allogeneic transplant 1‐year survival, obtained from the annual CIBMTR report, from the five FPBCC centers was compared to survival from 38 other pediatric centers in the country over two periods: preconsortium establishment, from 2016 to 2018, and postconsortium establishment, from 2019 to 2021. Of the 38 other pediatric centers, 22 were defined as small, similar to consortium centers by number of transplants (20–70 first allogeneic transplants per center in a 3‐year period) and 16 were larger centers (> 71 first allogeneic transplants per center in a 3‐year period).

The 1‐year posttransplant survival for the FPBCC centers significantly improved from 77.5% (2016–2018) to 89.5% (2019–2021; p = 0.0313). During the same respective time periods, other small centers improved from 82.4% to 87.9% (p = 0.0059), and large centers maintained stable survival at 85.6%–85.4% (p = 0.2676).

There was a substantial improvement in the 1‐year survival of allogeneic transplant recipients treated in FPBCC centers, achieved after the initiation of consortium activities. Within a 3‐year period, consortium centers, which had a lower starting point, reached 1‐year survival comparable to that of other small and large centers. A significant improvement in survival, although a lesser percentage of change, was seen in other programs of similar size across the country, but not in larger programs. We consider that the magnitude of improvement in survival (12% points or 4% per year), which was not seen among other programs, attests to the effectiveness of consortium activities. A blueprint for improvement in outcomes established by the FPBCC can be shared with other programs around the world that strive to improve posttransplant survival.

Survival after allogeneic hematopoietic stem cell transplants (aHSCTs) in the state of Florida since the creation of a state pediatric HSCT consortium has improved. This is significant because it demonstrates that small‐sized pediatric HSCT centers can work together in a consortium to improve outcomes similar to larger centers.

Figures