Advancing the pathway to allogeneic hematopoietic stem cell transplantation through a physician–nurse coordinator system in patients with acute leukemia

Abstract

Acute leukemia is an aggressive hematologic malignancy with a historically poor prognosis. The introduction of allogeneic hematopoietic stem cell transplantation (allo-HSCT) has substantially improved patient outcomes, offering the potential for a cure. However, prolonged preparation time for allo-HSCT can increase the risk of disease relapse or complications from consolidation chemotherapy. To address this issue, we established a physician‒nurse coordinator system to streamline and organize the preparation of patients and donors for allo-HSCT. In this single-center study, we combined prospective and historical cohorts. Adult leukemia patients (aged 18 years or older) who underwent allo-HSCT at Siriraj Hospital, Bangkok, Thailand, were enrolled. The primary aim was to compare the timing and rate of transplantation before and after the implementation of the physician‒nurse coordinator system. Between January 1, 2018, and February 1, 2024, 105 patients were enrolled. Patients diagnosed after August 1, 2021, were categorized into the physician–nurse coordinator group, resulting in 61 patients in the conventional group and 44 in the physician‒nurse coordinator group. The median (Q1, Q3) time from diagnosis to transplantation was significantly shorter in the physician‒nurse coordinator group than in the conventional group (9.0 [6.0, 14.0] months vs. 13.0 [7.5, 19.5] months; P = 0.029). Similarly, the time from diagnosis to complete preparation was significantly shorter (7.0 [5.0, 12.8] months vs. 11.0 [6.5, 17.0] months; P = 0.022). However, improvements in the transplantation rate within 6 months, relapse during transplant preparation, and post-transplantation outcomes did not reach statistical significance. Implementing a physician‒nurse coordinator system significantly reduced the time from diagnosis to allo-HSCT in acute leukemia patients. Our findings suggest that such coordinated care models could be valuable in optimizing the management of acute leukemia patients eligible for transplantation.