Canterbury DHB

Administration

Haematopoietic Stem Cell Transplant Committee

The members of the Haematopoietic Stem Cell Transplant Committee (HSCT) are as follows:

Other individuals receive electronic copies of Committee correspondence. These include:

• Haematology Registrars.
• Clinical Director, Oncology Service.
• Chief Technologist, Bone Marrow Processing Lab NZBS.
• Tissue Typing Lab, NZ Blood Service.
• Chief Technologist, High Volume Lab.
• Pharmacist, Haematology Service.
• Haematology Trial Co-ordinator.
• Radiographer, Oncology Department (Planning).
• Clinical Charge Nurse Apheresis Service NZ Blood Service.
• Consultants at Otago District Health Board.

The Bone Marrow Transplant (BMT) Coordinator prepares the planning list for each meeting and the Chair will write letters documenting the decisions made on newly referred patients. These are regarded as the minutes. The Committee deals with policy issues and principles of individual patient selection and management.

Transplant planning of patients accepted for transplant takes place in a separate weekly meeting on Thursdays at 8 am in the B6 Meeting Room. This meeting involves:

• Chair.
• Transplant Registrar.
• BMT Coordinator.
• Processing Lab NZBS.
• New Zealand Blood Service staff.
• B6 Charge Nurse Manager.
• Blood Bank.

Only in urgent circumstances will decisions on patient selection and management be made outside of the HSCT Committee. In these circumstances, the Committee Chair and referring Consultant will consult other Committee members before reaching a decision.

Referral of Patients for Stem Cell Grafts

All patients referred for consideration of HSCT will be reviewed by the Christchurch Hospital Haematopoietic Stem Cell Transplant Committee, which meets every two weeks on Mondays at 1-2 pm in the B6 Meeting Room.

Referral letters should be emailed to HSCTcommittee@cdhb.health.nz or posted to Dr Butler, HSCT Committee Chair, Christchurch Hospital, Haematology Service, PO Box 4710, Christchurch 8140.

Attach supporting documentation where necessary. Send to the Committee Chair in time to circulate to other Committee members prior to the meeting, in general by the previous Wednesday.

The minimum desirable information for referral includes:

• Patient and clinician details.
• Diagnosis and current disease status, i.e. relapse, primary refractory, remission.
• Disease risk score, e.g. NHL (IPI, FLIPI, MIPI), MDS (WHO), AML (cytogenetics, PCR).
• Previous chemotherapy and any adverse reactions.
• Current performance status, e.g. ECOG, WHO or Karnofsky.
• Co-morbidities.
• Relevant laboratory results.
• Relevant imaging, e.g. CT scans to be transferred by PACS to Christchurch.
• Relevant histopathology, e.g. diagnostic and relapse biopsies.
• Relevant supporting material, e.g. guidelines, reviews, trial data.

The Committee will evaluate each referral in relation to the current indications for SCT procedures, and will reach its decision by consensus, taking into account individual patient factors, priority with regard to other patients, and resource availability. No patient should be promised a SCT procedure without prior approval from the Committee. In general, transplantation is recommended only for those patients in whom the chance of survival post SCT is likely to be in the order of 20% or more at 2 years but considerable discussion is given to individual circumstances.

Useful resources when considering whether or not to refer a patient for transplant are:

• Patient eligibility for HCT: https://bethematchclinical.org/Transplant-Indications-and-Outcomes/Eligibility/
• Transplant Referral Timing Guidelines: https://bethematchclinical.org/Transplant-Indications-and-Outcomes/Referral-Timing-Guidelines/
• Disease specific outcomes: https://bethematchclinical.org/Transplant-Indications-and-Outcomes/Disease-Specific-Indications-and-Outcomes/

Stem Cell Accreditation

The rapid advance in many aspects, especially technological, of SCT has led to an increase in the number of transplants performed and a proliferation of centres performing them. There is some variability in procedures and standards between different transplant centres. In view of the risks and costs associated with stem cell transplants, legitimate concerns have been raised about the safety and quality of transplant procedures carried out within individual centres. Measures to accredit transplant centres on a more formal basis to ensure compliance with international guidelines are currently underway.

The clinical service at Christchurch Hospital is registered with the International Bone Marrow Transplant Registry and is subject to on-site audit visits. The Unit is also registered with the NZBMDR and Australian Bone Marrow Donor Registry for involvement with unrelated donor transplants.

The laboratory service for processing and manipulation of haematopoietic stem cells (Canterbury Health Laboratories and the New Zealand Blood Service) is accredited by International Accreditation New Zealand (IANZ) and licensed following annual audit by the New Zealand Ministry of Health (MEDSAFE).

Foundation for Accreditation of Cellular Therapy (FACT)

Founded in 1996, FACT establishes standards for high quality medical and laboratory practice in cellular therapies. FACT is a non-profit corporation co-founded by the International Society for Cellular Therapy (ISCT) and the American Society of Blood and Marrow Transplantation (ASBMT) for the purposes of voluntary inspection and accreditation in the field of cellular therapy.

The first FACT-Quality Coordinator, Meghan Heaphy, was appointed in September 2012.

Karen Cocker was appointed in June 2018.

FACT accreditation was first received on 5th November 2018 and awarded again on 5th November 2018.

Patient Information Websites

The following websites are recommended:

Reference Sources for Stem Cell Grafting Information

Medical Journals

• Online access to medical journals is via the University of Otago online access at http://www.library.otago.ac.nz//index.php
• Haematologists and registrars are given Honorary Lecturer status by the UOC and eligible for E-journal access.

Professional Societies – websites/meetings

Topic Code: 7972