Using GIS Technology to Assess

US Bone Marrow Transplantation

Capacity At Be The Match®

Eric P. Williams

Senior Bioinformatics Scientist

National Marrow Donor ProgramApril 10, 2014

2

What the NMDP does

Our Mission Statement

We save lives through cellular transplantation – science,

service and support.

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History of the Be The Match Registry

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History of the Be The Match Registry

In 1987 the program is launched with

congressional support. Championed

by congressman C.W. Bill Young

and with funding from the U.S. Navy

Admiral E.R. Zumwalt Jr.

10, 000 donors

step forward

and

the program

registry is

started

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History of the Be The Match Registry

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History of the Be The Match Registry

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History of the Be The Match Registry

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In 2004 the International Bone

Marrow Transplant Registry

(IBMTR) at the Medical College of

Wisconsin joined together with the

NMDP and formed the CIBMTR

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History of the Be The Match Registry

In 2006 the RITN

(Radiation Injury

Treatment Network)

is created

History of the Be The Match Registry

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Transplantation

THE NMDP GLOBAL NETWORK OF CARE

Be The Match manages the

largest and most diverse

marrow registry in the world.

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Unrelated Donors and Transplantation

1. On average 70 % of patients don’t find related donors

2. Unrelated hematopoietic stem cell sources

a) PBSC – Peripheral Blood Stem Cell

b) BM – Bone Marrow

c) CB – Cord Blood

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1,000

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6,000

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NMDP Transplants by Cell Source

Bone Marrow Peripheral Blood Stem Cells Cord Blood

Transplantation

The NMDP

• Has facilitated more than 55,000 unrelated transplants

• Facilitates more than 5,800 transplants yearly

• Now linked to Transplant Centers, Donor Centers and Registries

in 41 countries

• There are currently over 10.5 Million possible donors and

180,000 cord blood units (CBU) available

• 626,000 donors signed up to join the registry and 20,800 CBU

were added in 2012

• Through international collaboration, patients have access to over

20.5 Million unrelated donors and 590,000 CBU

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What Has Happened in the Last Decade?

• Related transplants flat

• Unrelated transplants up 3 fold

– Minority transplants up 4.5 fold

– Transplants over 50 up 8 fold

– Transplants over 65 up 12 fold

– Incremental growth in all other decades of life

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SCI Organization and Participants

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Regional Market Potential Analysis

• Concept:

– Determine unmet transplant demand within individual US

geographic markets around transplant center(s)

• Purpose:

– Visualize growth potential within individual markets to assist

program/hospital administration in making informed decisions

regarding BMT program expansion

– Apply socioeconomic variables to identify general market

barriers for strategic planning & initiatives

– Potentially visualize underserved markets within US for

additional consideration

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Adult Allogeneic Transplant Centers

Adult Transplant Center

Market boundary

© 2011 National Marrow Donor ProgramNot for disclosure/distribution/duplication without permission

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Pediatric Transplant Center

Market boundary

© 2011 National Marrow Donor ProgramNot for disclosure/distribution/duplication without permission

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Pediatric Allogeneic Transplant Centers

Regional Market Potential Analyses

• Calculate transplant demand within each individual

market using current Census & SEER data

• Transplant demand – actual transplants =

unmet need (market potential) within geographic market

• Recognize some transplant centers may pull from

outside their geographic markets (secondary markets)

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Notes About the Analysis

• There are 110 Adult transplant centers aggregated into 61 market areas

• U.S. Market Areas were developed using Theissen Polygons. Each Market

Area border is geographically equidistant between two transplant centers or

groups of TCs.

• Not all states have transplant centers, some states have multiple

transplant centers

• Donors will receive treatment at the transplant center nearest to their

home, but we know this is NOT always true.

• Unmet Need Calculations

• Market Area Population * Disease Incidence = Transplant Demand

(Expected number of patients needing a transplant)

• Transplant Demand – 2010 Allogeneic Transplants = Market Potential

(or unmet need)Note: Disease Incidence varies based on age;

For ages 20-54 we expect 5.3 people out of 100,000 people to need a transplant, whereas,

for ages 55-75 we expect 12.2 people to need one.

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TRANSPLANT CENTER

410 TEXAS TRANSPLANT INSTITUTE

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San Antonio20-54

Years

55-75

Years

Population 3,253,919 973,831

Disease Incidence/100,000 Population 5.3 12.2

Transplant Demand = pop x (disease incidence/100,000) 172 119

2010 Allogeneic Transplants (related + unrelated) 39 22

Market Potential = demand - actual 133 97

Market Potential Analyses

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Market Potential Analyses

0

20

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20-54 Years 55-75 Years

San Antonio Market

Unmet Need (Market Potential)

2010 Allogeneic Transplants

Notes About the Analysis

• There are 81 pediatric TCs aggregated into 52 market areas

• U.S. Market Areas were developed using Theissen Polygons. Each Market

Area border is geographically equidistant between two transplant centers or

groups of TCs.

• Not all states have transplant centers, some states have multiple

transplant centers

• Donors will receive treatment at the transplant center nearest to their

home, but we know this is NOT always true.

• Unmet Need Calculations

• Market Area Population * Disease Incidence = Transplant Demand

(Expected number of patients needing a transplant)

• Transplant Demand – 2010 Allogeneic Transplants = Market Potential

(or unmet need)Note: Disease Incidence varies based on age;

For ages 20-54 we expect 5.3 people out of 100,000 people to need a transplant, whereas,

for ages 55-75 we expect 12.2 people to need one.

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TRANSPLANT CENTER

410 TEXAS TRANSPLANT INSTITUTE

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San Antonio pediatrics 0-19 Years

Population 2,096,792

Disease Incidence/100,000 Population 4

Transplant Demand = pop x (disease incidence/100,000) 84

2010 Allogeneic Transplants (related + unrelated) 31

Market Potential = demand - actual 53

Market Potential Analyses

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Market Potential Analyses

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0-19 Years

San Antonio Market

Unmet Need (Market Potential)

2010 Allogeneic Transplants

Outcomes of the Systems Capacity Analysis

• Initially $25 M in funding approved for improvements and

additions to existing facilities.

• Ongoing consultation with existing Hospital, Health Care

network providers and Transplant Center administration

to evaluate potential for transplant needs.

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Next Steps

• We are currently in the process of collecting patient zip

code information to access movement across market

area boundaries.

• Potential to use drive time analysis instead of Thiesen

polygons.

• Factor current facility capacities into determining

potential patient movement across market areas.

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The NMDP Bioinformatics Team

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Mark Albrecht

Kelsey Besse

Catherine Calistro

Stephanie DiPrima

Kathryn Doroshak

John Freeman

Loren Gragert

Michael Halagan

Caleb Kennedy

Abeer Madbouly

Bob Milius

Vanja Paunic

Jane Pollack

David Roe

Joel Schneider

Adarsh Sivasankaran

Debra Turner

Eric Williams

Michael Wright

Martin Maiers - Director