Trends in Hematology-Oncology Physician Perceptions and Referral Behaviors for Allogeneic Hematopoietic Cell Transplant

Access remains a challenge for patients in need of allogeneic hematopoietic cell transplant (alloHCT). Hematology-oncology (Hem-Onc) physician referral of patients to alloHCT may be negatively influenced by perceptions of risk, awareness of indications, patient age, comorbidities, and other factors. To examine trends in these barriers to alloHCT referral, we conducted surveys of Hem-Onc physicians in 2015 (N=150), 2019 (N=302), and 2024 (N=183). Researchers recruited Hem-Oncs in the U.S. seeing at least 10 hematologic malignancy (AML, ALL, MDS) patients in the last year. Questions covered perceptions of alloHCT, referral practices, and perceived barriers. Reported demographic/practice details were used to segment survey responses: High (>66%), medium (34-65%) and low (<33%) referrers based on patients referred vs. patients seen, and high (>21 years), medium (11-20 years) and low (<10 years) practice duration. Independent t- and z-tests were used to determine statistical significance. Positive trends in alloHCT perceptions were observed, with increases seen in expected alloHCT benefit and alloHCT for older AML patients ( Figure 1 ). Across all heme malignancies in 2024, average maximum referral age limit was 73.5 years. In contrast, for related/unrelated donor alloHCT respectively, average maximum age was lower in 2019 (67.3/65.2 years) and 2015 (64.9/61.9 years). Referral timing for alloHCT (all diagnoses) as well as the proportion of AML patients referred in first complete remission also increased across the survey time periods ( Figure 2 ). Referral for alloHCT also differed by demographics: Physicians trained more recently were higher referrers (43%) than moderate- (36%) and high-experience (34%) physicians. More physicians who were high (44%) or moderate (46%) referrers were aware of NMDP than low (25%) referrers. While reported barriers to alloHCT referral persist ( Figure 3 ), 2024 responses (vs. 2019) had significant reductions in poor likelihood of finding suitable alloHCT donors, concern of adverse post-alloHCT outcomes, patient age, and comorbidities or psychosocial barriers. financial resources for patients (69%), information on post-HCT screening (69%) and vaccination (67%), caregiver support (66%), alloHCT outcome data and education (60%), referral guidelines (58%), and post-alloHCT care plans (58%). We identified positive trends in alloHCT perceptions, referral practices, and barriers over time. Encouragingly, these trends suggest that evidence surrounding alloHCT benefit as well as broadened eligibility for alloHCT are reaching the larger Hem-Onc community, and that this may address some historical barriers to access. Ongoing education and outreach are needed to facilitate additional progress.