For patients with hematologic malignancies such as AML, ALL, MDS, myelofibrosis, and lymphoma, timely access to stem cell transplant can be lifesaving. However, the period between a patient's initial transplant evaluation and the start of transplant can lead to vulnerable delays. These can be referred to as conversion delays, and can create barriers to treatment and negatively impact both patient outcomes and also transplant program efficiencies. Recognizing these challenges, a large academic center launched an APP-led multidisciplinary optimization pilot in June of 2025, with a goal to better understand why delays in conversion failures occur, and to develop strategies that improve the transition from transplant evaluation to treatment.

In order to evaluate transplant delays and conversion failures, along with identifying contributing factors, this project incorporated things such as workflow shadowing, prospective tracking of patients, clinical reviews, and QR code reporting of delays in conversion failures. The initiative brought together a multidisciplinary team of physicians, advanced practice providers, nursing teams, and administrative leadership to help evaluate barriers across the care continuum.

During the study period, 278 patients underwent transplant evaluation. Of those patients, 248, or 89%, successfully moved forward with transplant without delay. However, 30 of those patients experienced significant delays or failed conversion to transplant. When examining regions for conversion failures, disease progression or relapse emerged as the most common barrier, accounting for about 59% of those cases. This highlights the need for timely referral to transplant centers. Comorbidities represented 18% of conversion failures, suggesting that earlier identification and optimization of medical conditions prior to transplant evaluation may help improve transplant candidacy.

The study also identified psychosocial barriers, including challenges related to caregiver support, substance use, and housing instability. These findings reinforce that transplant readiness extends beyond disease management alone. So, what should advanced practice providers take away from this work?

First, early intervention matters. Many barriers can be identified before patients ever arrive at the transplant centers, giving APPs an opportunity to proactively address risks and accelerate necessary evaluations.

Second, transplant readiness is more than about disease control. Psychosocial factors, caregiver availability, housing concerns, and comorbidity management all play a critical role in transplant eligibility and timing.

Third, standardization can improve outcomes. Standardization, such as standardized referral documentation, pre-arrival checklists, earlier supportive care involvement, and formalized communication pathways between referring providers and transplant teams may reduce delays and improve care coordinization. APPs can lead a meaningful system-level change to issues like this. This project demonstrates that advanced practice providers are uniquely positioned to drive operational improvements that directly impact patients' access to potentially curative therapies. Future evaluation of APP-led pre-arrival clinics may provide even more additional models for enhancing transplant readiness and care coordination.