OBJECTIVES: Hematopoietic cell transplantation (HCT) is a widely used procedure for acquired and congenital hematologic malignancies. Given the life-saving role of HCT but high morbidity due to complications, this research explores the patient burden of HCT in the United States.

METHODS: Ten private and institutional payers in the United States were interviewed in 2022.

RESULTS: According to the interviewed payers, in 2021, approximately 28,400 HCT procedures were done in the United States, of which 41.5% were allogeneic HCT (11,786) and 58.5% were autologous HCT (16,614). About half of the allogeneic HCTs were performed in patients aged between 40-60 years and the most common indications belonged to leukemias. 55% of the allogeneic HCTs were performed using unrelated donors. Within allogeneic HCTs, peripheral blood cells were used in 70%, bone marrow in 22%, and cord blood cells in 8% procedures. Peripheral blood cells were more commonly utilized in adults; however, bone marrow and cord blood cells were more common in pediatrics (<18 years). Of the total deaths 100 days post allogeneic HCT, 42% were due to the primary disease or infections. About 10% of deaths in the first 100 days as well as after 100 days post-HCT were due to Graft-versus-host disease (GvHD). On average, 7% of allogeneic HCT cases had poor graft function (PGF) leading to an incomplete recovery; 4% had primary PGF and 3% had secondary PGF.

CONCLUSIONS: In 2021, the transplant rates for overall HCT and allogeneic HCT in the United States were 843 per 10 million and 350 per 10 million population, respectively. The high incidence of unrelated donors suggests that patients often rely on unrelated donor registries to find a donor graft source. GvHD and PGF are life-threatening complications post HCT, and primary PGF had a similar incidence as to secondary PGF.