title: High-risk centers and the benefits for lower-risk transplants.
abstract: OBJECTIVE
  Allogeneic hematopoietic cell transplantation (HCT) is the transplantation of stem cells from a donor and an effective treatment for many hematologic malignancies. We sought to compare allogeneic HCT survival outcomes and hazard of death among US centers that treat higher-risk patients versus those in centers that do not perform lower-risk HCT procedures.
  
  
  METHODS
  We utilized 2008 to 2010 Center for International Blood and Marrow Transplant Research data. We categorized patients into 4 risk categories that align with factors shown in the literature to be associated with HCT survival. We stratified centers into those that do and do not conduct high-risk pre-transplant HCT.
  
  
  METHODS
  To further evaluate the association between pre-transplant mortality risk and HCT survival by transplant center, we examined the association between risk category score and hazard of death using Cox proportional hazard modeling.
  
  
  RESULTS
  There were 12,436 HCT recipients at 147 transplant centers. Of the 147 centers, 74 performed HCT for patients ranging from the lowest risk category to the highest category, and 73 centers performed only lower-risk HCT. Adjusting for all other factors, lower-risk patients that underwent transplants in lower- or higher-risk centers had a similar relative hazard of death (P ≤ .05).
  
  
  CONCLUSIONS
  Low-risk patients had similar survival outcomes irrespective of whether they underwent transplant at higher- or lower-risk centers. Patient and payer policy implications could include initiatives that reduce travel for low-risk patients. Similarly, HCT center administrators and providers that manage higher-risk patients need not expect commensurate benefits in survival for lower-risk patients.
authors.affiliation: University of Minnesota, Department of Surgery, 420 Delaware St SE, MMC 195, Mayo Rm 11-142 PWB, 8195E (campus delivery code), Minneapolis, MN 55455. E-mail: marm0014@umn.edu.
authors.forename: Schelomo
authors.initials: S
authors.lastname: Marmor
authors.forename: James W
authors.initials: JW
authors.lastname: Begun
authors.forename: Jean
authors.initials: J
authors.lastname: Abraham
authors.forename: Beth A
authors.initials: BA
authors.lastname: Virnig
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality*; D006782:Hospitals, Special / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D020379:Risk Adjustment / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D055815:Young Adult