Trends in US Hematology/Oncology Physician Perceptions and Referral Practices for Hematopoietic Cell Transplant: A National Survey Conducted by NMDP

BACKGROUND: To evaluate trends in allogeneic hematopoietic cell transplant (HCT) referral perceptions and practices, we compared surveys of Hematology-Oncology (Hem-Onc) physicians conducted in 2015 (N = 150), 2019 (N = 302), and 2024 (N = 183) and reported changes over time. METHODS: Eligible participants included Hem-Onc physicians in the United States seeing at least 10 hematologic malignancy patients in the last year. Questions covered perceptions of HCT, referral practices, perceived barriers to referral, and endorsement of HCT education and patient support resources. RESULTS: There were positive trends in HCT perceptions, increased expected HCT benefit, and positive outcomes with older AML patients. Overall reported disease-specific referral rates increased over the survey periods. Participants reported earlier HCT referral timing across the survey time periods for all diagnoses, as well as increased referral of AML in first complete remission (vs. later stages of disease). While reported barriers to HCT referral persist, 2024 responses (vs. 2019) had significant reduction in concern over finding a suitable HCT donor, adverse post-HCT outcomes, patient age, and medical comorbidities or psychosocial barriers to HCT. Across all hematologic malignancies in 2024, the average maximum referral age was 73.5 years. Respondents indicated a strong desire for additional physician education and patient-level support. CONCLUSIONS: We identified positive trends in HCT perceptions and referral practices, and reduced barriers. Encouragingly, these trends suggest that evidence surrounding HCT benefit and broadened eligibility for HCT are reaching the larger Hem-Onc community, and this may address historical barriers to access. Ongoing education and outreach are needed to facilitate additional progress.