Latest / Becker’s Healthcare - Clinical Leadership Podcast / Transforming Transplantation: Innovations in Blood and Marrow Research with Dr. Steven Devine

Transcript

Transforming Transplantation: Innovations in Blood and Marrow Research with Dr. Steven Devine · Becker’s Healthcare - Clinical Leadership Podcast

• 0:00
  Welcome everyone to the Becker's Healthcare podcast series.
• 0:02
  I'm Mariah Muhammad, writer and moderator with Becker's
• 0:05
  Healthcare. And I'm thrilled to have with me
• 0:07
  today doctor Steven Devine, chief medical officer of
• 0:10
  the National Marrow Donor Program and executive lead
• 0:13
  and senior
• 0:15
  scientific
• 0:15
  director at the Center for International Blood and
• 0:18
  Marrow Transplant Research. Doctor, welcome to the podcast.
• 0:21
  We're very excited to have you join us
• 0:23
  today. To get us started, could you share
• 0:25
  some of the most promising
• 0:27
  discoveries in blood cancer and disorder research that
• 0:30
  you believe will, improve patient outcomes in 2025
• 0:33
  significantly?
• 0:35
  Yes.
• 0:36
  First,
• 0:37
  Brian, thanks for inviting me.
• 0:40
  Yes. Things are really exciting.
• 0:42
  Now, I'm going to focus
• 0:45
  mostly on
• 0:46
  blood cancer and
• 0:48
  blood or marrow transplantation
• 0:50
  because that's really our focus.
• 0:53
  I think
• 0:55
  in 2025,
• 0:57
  the most exciting,
• 0:59
  finding is really that
• 1:01
  virtually everyone has a donor now where,
• 1:05
  you know, a decade ago, you couldn't say
• 1:08
  that. So now we are able to find
• 1:10
  donors for virtually
• 1:12
  every patient,
• 1:14
  in need
• 1:15
  of a life saving,
• 1:17
  transplant
• 1:18
  regardless
• 1:19
  of their
• 1:21
  racial or ethnic background. So that's a big
• 1:24
  change and I think that's
• 1:26
  moving forward.
• 1:29
  And because of that,
• 1:30
  traditionally,
• 1:32
  the practice has been to sort of
• 1:35
  wait or try to identify for many patients
• 1:39
  that
• 1:40
  sort of perfect
• 1:41
  donor or even that needle in a haystack.
• 1:44
  The message now is,
• 1:48
  don't do that.
• 1:49
  Go forward transplant
• 1:51
  when the patient
• 1:53
  needs to go forward,
• 1:55
  and,
• 1:55
  there are lots of different suitable
• 1:58
  donor options available now.
• 2:02
  Yeah. Absolutely. Thank you so much for giving
• 2:04
  us that that information.
• 2:05
  How are advance,
• 2:07
  advancements in donor selection,
• 2:09
  such as the use of donor scores helping
• 2:11
  to streamline the transplant process,
• 2:14
  and kind of avoid the delays caused by,
• 2:16
  searching for a perfectly matched donor?
• 2:19
  Yeah. Well, so I think for that,
• 2:22
  for the answer to that question,
• 2:24
  it's best to go to,
• 2:26
  a recent
• 2:28
  study that was funded by
• 2:31
  the National Institutes of Health, so sort of
• 2:33
  a partnership between
• 2:35
  the federal government and the academic
• 2:38
  community that was run through one of the
• 2:40
  NIH
• 2:42
  or National Institutes of Health
• 2:44
  networks.
• 2:46
  And in that study,
• 2:49
  we
• 2:49
  basically said,
• 2:51
  if you're lucky enough
• 2:53
  to have to identify
• 2:55
  a
• 2:56
  matched donor
• 2:58
  in the registry and they need a transplant,
• 3:00
  go forward with that matched donor. But if
• 3:03
  you're
• 3:04
  predicted to be unlikely
• 3:07
  to have
• 3:08
  a matched donor,
• 3:10
  They'll go forward, but go forward with your
• 3:14
  best alternative
• 3:16
  donor that it would be a mismatched donor,
• 3:19
  and that could be a mismatched
• 3:21
  family member.
• 3:23
  It could be,
• 3:24
  our focus, which is mismatched
• 3:27
  unrelated donors or even umbilical cord blood transplants.
• 3:31
  And what that study showed that using that
• 3:34
  strategy, which was
• 3:36
  use the match donor if you can identify
• 3:39
  it, but go with a good alternative
• 3:41
  otherwise,
• 3:42
  the results of that the outcomes are the
• 3:44
  same with that strategy. So it seems like
• 3:48
  the timing is more the issue than the
• 3:50
  exact type of donor.
• 3:52
  And, again, that's a that's a real change.
• 3:57
  Yeah. Yeah. Definitely sounds like it. And,
• 4:00
  another change, I guess, with donors trending younger
• 4:03
  and recipients skewing older, how is this demographic
• 4:06
  shift influencing the strategies for donor, recruitment
• 4:10
  and patient management?
• 4:13
  So,
• 4:14
  traditionally,
• 4:16
  when the field of marrow transplantation
• 4:20
  started,
• 4:21
  you look to the family.
• 4:23
  And we would
• 4:24
  identify,
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  if there was any
• 4:28
  brother or sister within the family
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  that,
• 4:31
  was
• 4:32
  matched at these genes that we call HLA.
• 4:36
  And the chance of that are only about
• 4:38
  twenty five to thirty percent, which is really
• 4:40
  why the donor registry
• 4:43
  came about.
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  But
• 4:45
  if you think about it,
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  as our patients are getting older,
• 4:52
  their brothers or sisters are also
• 4:55
  getting older. So for instance, with acute leukemia,
• 5:01
  the the average age at diagnosis is 60.
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  So most of the,
• 5:07
  potential
• 5:09
  brother or sister or sibling donors are also
• 5:12
  in that age range. They could be, you
• 5:14
  know, in their fifties, sixties, even seventies.
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  And so one of the real questions
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  now that's being asked
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  is even if you have a
• 5:24
  matched donor,
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  a brother or sister,
• 5:27
  say, in the family,
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  but if they're older, is it better to
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  go with the older,
• 5:33
  sibling donor
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  or a younger
• 5:36
  donor,
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  say, in their twenties that could be identified
• 5:41
  in the registry.
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  We don't have a definitive answer to that
• 5:45
  today,
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  but a lot of the academic centers
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  are now tending
• 5:51
  to actually go to the registry
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  because the influence of donor age
• 5:56
  may be so significant that they really wanna
• 5:59
  find a younger donor even if it's not
• 6:01
  within the family.
• 6:04
  Yeah. Thank you so much for giving us
• 6:05
  that insight.
• 6:07
  Another question, doctor.
• 6:09
  Novel doc data suggests mismatched unrelated donors are
• 6:12
  expanding access to transplants,
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  especially for diverse populations. Can you elaborate
• 6:18
  a little bit more on this trend,
• 6:20
  and its implications for patient care?
• 6:23
  Yes. So this is a a trend, and
• 6:25
  it's really been, you know, since maybe before
• 6:28
  right before the pandemic
• 6:30
  to the years that have ensued following the
• 6:33
  pandemic.
• 6:35
  And, a lot of,
• 6:37
  the changes in the use of mismatched unrelated
• 6:40
  donor transplants
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  has occurred because of,
• 6:44
  efforts,
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  and resources
• 6:46
  provided
• 6:47
  by the NMDP.
• 6:49
  We've shifted our focus
• 6:51
  towards
• 6:53
  looking at
• 6:54
  less than perfectly matched donors because we saw
• 6:57
  an opportunity
• 6:58
  to be able to provide suitable donors
• 7:01
  for,
• 7:02
  all patients. So the NMDP,
• 7:06
  together with the research group, the CIBMTR
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  that we lead,
• 7:12
  has been, putting forward an initiative called Donor
• 7:15
  For All.
• 7:16
  And basically, what Donor for All is is
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  a set of studies
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  that are defined,
• 7:23
  to,
• 7:24
  really improve outcomes
• 7:27
  using
• 7:28
  mismatched
• 7:29
  unrelated
• 7:30
  donors. What we found is through these studies
• 7:33
  that actually,
• 7:34
  because of new ways to prevent complications
• 7:37
  after transplant,
• 7:39
  the outcomes, even with less than perfectly matched
• 7:42
  donors,
• 7:43
  have been very similar, if not exactly the
• 7:45
  same, as the outcomes we would expect
• 7:48
  using
• 7:49
  fully matched donors. And so to translate to
• 7:52
  what that means for
• 7:54
  patients, again,
• 7:56
  so,
• 7:57
  in the past, if you were racially or
• 7:59
  ethnically diverse, for instance,
• 8:01
  an African American might only have a 29
• 8:04
  to 30 percent chance of identifying
• 8:07
  a fully matched donor on the registry.
• 8:10
  Now more than 80% of them can identify
• 8:14
  a a a seven of eight match, where
• 8:16
  the eight of eights are the full matches.
• 8:19
  And if you go down to the six
• 8:20
  of eight level,
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  virtually a % of people will be able
• 8:24
  to find
• 8:25
  donors. And so that's translated
• 8:27
  into our ability
• 8:29
  to offer a life saving transplant
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  for,
• 8:33
  basically anyone in need of a transplant, regardless
• 8:38
  of their racial or ethnic background. In our
• 8:41
  clinical trials,
• 8:43
  more than half of the patients that have
• 8:45
  been enrolled
• 8:46
  on the NMDP sponsored clinical
• 8:49
  trials have been in fact, racially or ethically
• 8:52
  diverse, which is really,
• 8:54
  unheard of in
• 8:56
  in research and certainly unheard of in the
• 8:59
  transplantation
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  field.
• 9:01
  Yeah. That definitely makes a lot of sense.
• 9:03
  Thank you for breaking that down.
• 9:05
  Kind of going into the field of collaboration,
• 9:09
  obviously obviously, you know that, you know, collaboration
• 9:12
  among researchers,
• 9:13
  industry, health care providers, and government has been
• 9:16
  very vital in advancing the cell therapies.
• 9:19
  Can you provide examples of how these partnerships
• 9:21
  are breaking the barriers and really accelerate accelerating
• 9:24
  innovation in this, type of arena?
• 9:28
  Yeah. Well, it really does take a village
• 9:32
  in order to, you know, accelerate progress
• 9:36
  for patients. And it it it it it
• 9:39
  can't be done by just any
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  one organization.
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  So
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  NMDP
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  is positioned
• 9:48
  right sort of in the middle of the
• 9:50
  whole
• 9:51
  transplant ecosystem,
• 9:53
  if you will.
• 9:55
  We have a network
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  of,
• 9:58
  transplant centers, almost 200 transplant centers
• 10:02
  in The United States that work with us
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  to find donors
• 10:07
  for their patients. And we've also,
• 10:09
  through the CIBMTR,
• 10:11
  been able to provide a clinical trials
• 10:15
  infrastructure
• 10:16
  and working with those transplant centers together with
• 10:19
  funding
• 10:21
  from
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  the
• 10:22
  National Institutes of Health, the Office of Naval
• 10:26
  Research, and some other
• 10:28
  foundations.
• 10:29
  We work together with the whole community, the
• 10:31
  transplanters,
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  the federal government,
• 10:35
  other foundations, the other registries,
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  to work together to design
• 10:40
  these studies
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  and to try to address
• 10:43
  the most important
• 10:45
  questions. And that's really led to,
• 10:48
  our ability to perform these studies that have
• 10:52
  shown that we don't want to wait to
• 10:55
  find that perfect donor, and now we can
• 10:58
  find suitable donors
• 11:00
  for virtually everyone.
• 11:03
  That's amazing. Thank you, for sharing that. And,
• 11:06
  doctor, before I let you go,
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  the last thing I really wanted to ask
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  you is what are the benefits of closer
• 11:12
  collaboration,
• 11:13
  between hematologists and oncologists, and how is this
• 11:16
  improving access to treatments
• 11:18
  and patient outcomes?
• 11:21
  Well, I I know it sounds,
• 11:24
  kind of funny in 2025,
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  but
• 11:28
  many of the physicians who have been practicing,
• 11:32
  for,
• 11:33
  you know, decades,
• 11:36
  and doing all they can to help their
• 11:38
  patients
• 11:39
  may not necessarily
• 11:41
  be aware
• 11:43
  that,
• 11:45
  for instance, we can find a donor for
• 11:47
  everyone.
• 11:48
  Or they might not be aware
• 11:50
  that patients
• 11:51
  back a decade or two who were felt
• 11:54
  to be too old
• 11:56
  to have a transplant and were transplant candidates
• 12:00
  are actually now potentially good
• 12:03
  candidates for transplant. So we're pushing
• 12:06
  the boundaries,
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  and so age matters a lot less
• 12:11
  today
• 12:12
  than it did ten or twenty
• 12:14
  years ago. And so we want to make
• 12:17
  sure that all the hematologists and oncologists
• 12:20
  who are seeing
• 12:22
  our patients out in the community,
• 12:25
  actually
• 12:26
  are educated and understand how much things have
• 12:29
  changed
• 12:30
  that,
• 12:31
  that some of the patients that they might
• 12:33
  not have ever considered
• 12:35
  for transplantation
• 12:37
  now actually are candidates. And so the idea
• 12:40
  is to get that word out so that,
• 12:43
  they could refer
• 12:45
  their patients, if they don't do transplants at
• 13:00
  community
• 13:01
  that
• 13:03
  transplant might be a good option for their
• 13:06
  patients regardless of their age or regardless of
• 13:09
  their racial or ethnic background. I think NMDP
• 13:12
  has a real role to play there.
• 13:16
  Yeah. Thank you so much for those final
• 13:18
  thoughts, doctor. This has definitely been a very
• 13:20
  informative discussion. So, again, I wanna thank you
• 13:22
  so much for coming on Becker's HealthCare,
• 13:24
  and I look forward to connecting with you
• 13:26
  again soon.
• 13:27
  Thank you very much for having us.