The Transplantation Ecosystem: A New Concept to Improve Access and Outcomes for Older Allogeneic Hematopoietic Cell Transplantation Patients

Sarah A. Wall, Rebecca Olin, Vijaya Bhatt, Saurabh Chhabra, Pashna Munshi, Eileen Hacker, Shahrukh Hashmi, Hailey Hassel, Dianna Howard, Reena Jayani, Richard Lin, Shannon McCurdy, Asmita Mishra, Hemant Murthy, Uday Popat, William Wood, Ashley E. Rosko, Andrew Artz

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Allogeneic hematopoietic cell transplantation (HCT) is increasingly offered to older adults with hematologic malignancies, even though nonrelapse mortality remains a major concern in older patients owing to more comorbidities and greater frailty compared with their younger counterparts. The importance of patient fitness, a well-matched donor, and disease control to the success of allogeneic HCT have been well documented; however, these factors fail to account for the impact of the complex transplantation ecosystem (TE) that older adult HCT candidates must navigate. We propose a definition of the TE modeled after the social determinants of health. Furthermore, we outline a research agenda aimed at increasing understanding of the roles of individual social determinants of transplantation health in the larger ecosystem and how they may benefit or harm older adult HCT candidates. Herein we define the TE and its individual tenets, the social determinants of transplantation health. We review the available literature while incorporating the expertise of the membership of the American Society for Transplantation and Cellular Therapy (ASTCT) Special Interest Group for Aging. The membership of the ASTCT Special Interest Group for Aging identify knowledge gaps and strategies to address them for each of the described social determinants of transplantation health. The ecosystem is an essential but underappreciated pillar for transplant access and success. We put forth this novel research agenda seeking to gain a better understanding of the complexity of HCT in older adults and develop strategies to improve access to HCT, survival, and quality of life.

Original languageEnglish (US)
Pages (from-to)632.e1-632.e10
JournalTransplantation and Cellular Therapy
Issue number10
StatePublished - Oct 2023


  • Allogeneic hematopoietic cell transplantation
  • Elderly
  • Geriatric
  • Older adults
  • Supportive care
  • Transplantation ecosystem

ASJC Scopus subject areas

  • Immunology and Allergy
  • Molecular Medicine
  • Hematology
  • Cell Biology
  • Transplantation


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