System-level Redesign of an Allogeneic Hematopoietic Cell Transplantation Program Associated With High One-year...

Practice variation in allogeneic hematopoietic cell transplantation may contribute to preventable toxicity, nonrelapse mortality, and excess cost. We evaluated outcomes occurring with the implementation of a program-wide standardization initiative in a medium-sized program. We conducted a single-center retrospective cohort study of consecutive patients undergoing first allogeneic hematopoietic cell transplantation in 2024 during implementation of a system-level redesign. The intervention emphasized high-reliability operations through concise standard operating procedures, formal quality management, standardized recipient and donor selection, a limited conditioning regimen formulary, fluid-sparing conditioning and graft infusion practices, post-transplant cyclophosphamide-based graft-versus-host disease prophylaxis, and an early-discharge outpatient care model. The primary endpoint was 1-year overall survival. Secondary endpoints included graft-versus-host disease-free, relapse-free survival, nonrelapse mortality, acute and chronic graft-versus-host disease, length of stay, and pharmaceutical cost. Ninety-four patients underwent a first allogeneic hematopoietic cell transplantation in 2024. One-year overall survival was 92.6%, graft-versus-host disease-free, relapse-free survival was 56%, and nonrelapse mortality was 1%. The cumulative incidence of grade II to IV acute graft-versus-host disease was 32%, with grade III to IV acute graft-versus-host disease in 5%, and chronic graft-versus-host disease requiring systemic therapy in 18% at 1 year. Median hospital length of stay was 19 days overall and 14 days among adults. Average pharmaceutical cost per patient decreased from $88,810 across the preceding 3 fiscal years to $39,019 under the redesigned care model. In this single-center cohort, implementation of a standardized, high-reliability allogeneic hematopoietic cell transplantation care model was associated with excellent 1-year survival, low nonrelapse mortality, and lower pharmaceutical cost. These findings support the potential value of disciplined operational standardization as a complement to contemporary transplant platforms.