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

Abstract

Background: 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.

Methods: 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).

Results: 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).

Conclusions: 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.