Educational Needs in Hematopoietic Stem Cell Transplant: Eligibility Criteria, Transplant Benefits, and Risks

Educational gap in knowledge of eligibility criteria for hematopoietic stem cell transplant and transplant risks/benefits.

When patients with hematological malignancies do not receive referrals for hematopoietic stem cell transplant (HSCT), they may face a risk of poorer outcomes. Common reasons behind this lack of referrals include provider confusion over eligibility criteria for HSCT, overestimation of the risks associated with transplant, and confusion regarding the benefit of HSCT. This educational gap regarding the uses and risks of HSCT was identified in the baseline data collected from i3 Health’s continuing medical education (CME)/nursing continuing professional development (NCPD)–approved visiting faculty meeting series titled Current Challenges and New Opportunities in Hematopoietic Stem Cell Transplant, led by Miguel-Angel Perales, MD, Chief of the Adult Bone Marrow Transplantation Service at Memorial Sloan Kettering Cancer Center, along with Amin M. Alousi, MD, Professor of Medicine at MD Anderson Cancer Center, Corey S. Cutler, MD, MPH, Medical Director of the Adult Stem Cell Transplantation Program at Dana Farber Cancer Institute, Mark A. Schroeder, MD, Associate Professor of Medicine at Washington University School of Medicine, Michael Scordo, MD, Assistant Attending Adult Bone Marrow Transplant Service at Memorial Sloan Kettering Cancer Center, and Daniel Weisdorf, MD, Deputy Director of the University of Minnesota Clinical and Translational Science Institute.

A total of 1,246 learners engaged in the activity, and 791 completed the activity for credit. The activity was presented at 10 live meetings held between July 15, 2019, and April 30, 2020, and the content was available online from July 26, 2019, to July 25, 2020. The majority of 227 learners at the live meetings were physicians (51%), followed by individuals who selected “other” for their profession (17%), registered nurses (14%), nurse practitioners (10%), pharmacists (6%), and physician assistants (2%). Participants in the live meetings had been in practice for an average of 20 years and saw an average of seven patients a month who had received an HSCT. The 1,041 online learners were mostly registered nurses (90%), followed by nurse practitioners (4%), individuals who selected “other” for their profession (3%), physicians (2%), seven physician assistants, three advanced practice nurses, and two pharmacists. Online participants had a wide range of practice experience, from less than five years to over 20 years, and they saw a monthly average of 14 patients who had received an HSCT. Learners were given a pretest prior to beginning the activity and a posttest consisting of the same questions following the activity’s conclusion.

The baseline assessment demonstrated a significant shortfall in knowledge of uses and risks of HSCT: only 25% of learners correctly determined the risk of a patient undergoing HSCT; only 26% knew the efficacy of ruxolitinib therapy; only 29% of learners could identify the most likely adverse event of HSCT; and only 38% of learners could identify the efficacy of cyclophosphamide. However, a higher proportion (63%) of learners recognized the efficacy of anti-thymocyte globulin (ATG).

Significant learning took place during the activity with respect to all topics, as revealed by the learners’ performance on the posttest. Nearly 90% of learners, a learning gain of 65%, could now correctly score a patient with acute myeloid leukemia and prior malignancy as high risk (group 3) according to the Hematopoietic Cell Transplantation Comorbidity Index. Learners also demonstrated a learning gain of 65% (91% vs 26% ) in choosing ruxolitinib as the appropriate treatment for a 46-year-old woman with relapsed acute lymphoblastic leukemia who developed acute graft-versus-host disease (GVHD) that is refractory to steroids after undergoing her second allogeneic HSCT, following myeloablative conditioning and total body irradiation; and a learning gain of 64% (92% vs 29%) in identifying late phase, phase III, as the phase in which a 62-year-old patient that has developed chronic GVHD after a HSCT for acute myeloid leukemia would be susceptible to developing varicella-zoster virus.

There was a learning gain of 51% (88% vs 37%) in knowledge that a patient with myelodysplastic syndrome who received a conditioning regimen of cyclophosphamide/total body irradiation before HSCT would not experience improved overall survival compared with fludarabine/melphalan conditioning. More than 95% of learners, a knowledge gain of 32%, knew that the addition of ATG to standard GVHD prophylaxis in the myeloablative conditioning regimen before HSCT has been shown to decrease the risk for chronic GVHD, that the addition of ATG to the regimen would not improve overall survival or progression free-survival, and that it would not decrease the risk for relapse of a patient with multiple myeloma who underwent allogeneic HSCT.

Learners’ performance on the pre- and post-activity assessment suggested that their competence improved regarding the uses and risks of HSCT. Therefore, i3 Health has determined that the multidisciplinary team may benefit from future CME/NCPD–approved activities that provide further and updated HSCT education.

Upon completion of the activity, 91% of participants felt more confident in treating their patients with HSCT, and 91% felt that the material presented would be used to improve the outcomes of their patients.  

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