Improving Transplant and Cellular Therapy Outcomes

Cincinnati Children's launched a new learning health network this year focused on bone marrow transplant and cellular therapy—making it the first such collaborative of its kind.

ENGRAFT is one of 13 learning health networks initiated by Cincinnati Children’s. Other networks focus on areas including pediatric cardiology, epilepsy, cystic fibrosis, autism, rheumatology, and prenatal and perinatal health.

Led by the Cancer and Blood Diseases Institute at Cincinnati Children’s, ENGRAFT brings together medical centers, researchers, patients and families to identify challenges in the transplant and cellular therapy space, share best practices and, ultimately, improve patient outcomes.

“We want to make sure we’re doing the right thing for the right patient at the right time,” says Christopher Dandoy, MD, MSc, pediatric hematologist-oncologist and member of the Division of Bone Marrow Transplantation and Immune Deficiency at Cincinnati Children’s. “In stem cell transplant, there’s a lot of heterogeneity in practice, similar to surgery, so outcomes are very different from center to center. And we’re not always very good at learning from each other.”

The goal of learning health networks is to change that. “We pull in our industry partners, we pull in people from multiple centers, and we pull in our patients and their families, so we can identify which outcomes are most important to them,” Dandoy says.

A Hub for Streamlining Best Practices

For transplant and cellular therapy, ENGRAFT identified survival, long-term follow-up, chronic graft-versus-host disease, and quality of life as the most important outcomes.

“Now that we’ve identified them, we’re targeting those outcome measures with different processes,” Dandoy says. “When there are gaps in evidence, we conduct research to try to figure out those gaps and then try to break them down.”

In the meantime, the group collects data as patients go through the transplant process and into survivorship. Patients and their families also provide insights on barriers to care they may face, such as obstacles to follow-up and medication adherence.

“That way, we’re able to learn, in real time, what some of the differences are between centers, and which practices are associated with improved outcomes,” Dandoy says. “Then, of course, we work to streamline those best practices.”

One of ENGRAFT’s long-term goals is to integrate tools into Epic that will promote algorithms for network providers. These tools can help guide decisions and make it easier to apply complex guidelines, ensuring providers know which steps to take and for which specific patients, according to Dandoy.

Similar to other learning health networks, ENGRAFT also provides a platform where providers, patients and families in the network can learn from one another.

First Learning Health Network for Both Adult and Pediatric Centers

In addition to being the first learning health network dedicated to transplant and cellular therapy, ENGRAFT is the first to include both pediatric and adult center participants.

“We’re the first network that, from the jump, has wanted to include adults,” Dandoy says, adding that’s because both sides have learnings to offer the other.

For example, one of the initial outcomes ENGRAFT has identified as an area to improve is the time from transplant to central line removal. At Cincinnati Children’s alone, Dandoy says, that metric can range from 100 days to 400 days, depending on the attending physician. In adults, however, the average is 50 days.

“When you’re able to remove the central line, it’s a transition to a little bit more normalcy,” Dandoy says. “It’s the same treatment, same conditioning, same everything [between adult and pediatric patients]. So I think we can benefit from learning what the adult centers do in this area, and they can benefit from learning what we do in areas like assessments and long-term, follow-up care.”

Building a Foundation for Improving Patient Outcomes

Including Cincinnati Children’s, 12 centers are participating in ENGRAFT. The other pediatric centers are Akron Children’s Hospital, Boston Children’s Hospital, Children’s Healthcare of Atlanta, Children’s of Alabama, Cleveland Clinic Children’s, Nicklaus Children’s Hospital, Texas Children’s Hospital and The Sydney Children’s Hospitals Network. The adult centers are Medical College of Wisconsin, University of Minnesota Health and The James — The Ohio State University Comprehensive Cancer Center.

Each participating center pays between $5,000 and $8,000 annually to help build and support the network’s infrastructure. Funding also comes from nonprofit and National Institutes of Health grants.

ENGRAFT’s first two meetings were held in January and July of 2024.

“We’re going to continue our work on timely central line removal and then start our transition to long-term follow-up,” Dandoy says. “Then each time we meet, we’re going to come up with a new project—and work on building an infrastructure for that—until we have a full portfolio.”

(Published July 2024)