I have a confession to share – I enjoy being on "service!" I always look forward to my two-week rotation on our inpatient BMT unit. I get to spend more time with our patients. Each patient room provides a glimpse into their lives – the photo of their favorite pet, the book they are reading, the guardian teddy bear from their grandchild, the rosary they clutch when I enter the room, and the progress they have made on a puzzle that tells me how their previous 24 hours have transpired.
Equally informative are the bare walls and empty window shelves for some patients, with no get well soon cards and no scribbles on the whiteboard. I get to see our awesome team in action as they provide compassionate care to our patients. At the end of the day, it is a very grounding experience and is a good reminder of why we do what we do and that we need to keep getting better.
At the peril of sounding like a broken record, I am going to make a comment about CAR-T reimbursement again this month. CMS released the FY2020 Inpatient Prospective Payment System (IPPS) proposed rule in April, and unless you are a health policy wonk like me, you probably ignored it. However, among other things, there are provisions that are going to be very impactful for CAR-T reimbursement.
While the society remains appreciative of CMS’s attempts at trying to figure out a way to pay for CAR-T therapies, the current and proposed reimbursement remains woefully inadequate and continues to be a threat to patient access (read ASTCT’s response here). In my opinion, these therapies are exorbitantly priced considering the data for their efficacy is primarily based on phase 2 studies and we have not established their “value” for our older lymphoma patients. However, Yescarta and Kymriah are the harbingers of other cell and gene therapies that are in the pipeline and it is really important that we get their payment mechanisms right. ASTCT will continue to advocate for this at several levels. To be effective, we need help from our members – please do advocate at your institutions, share what the ASTCT is doing with your government affairs department, and please do volunteer to get involved with the society in this area.
What were some of the really fun things I did on behalf of the ASTCT in April? I had the privilege of attending two BMT and cell therapy meetings – one organized by the iNDUS BMT Group in Chennai, India, and the second by Turkish Bone Marrow Transplantation Foundation in Istanbul, Turkey.
Both events reinforced the global nature of our field. There are unique issues and challenges everywhere, including here in the US, but the essence of what we do is the same. The curiosity and enthusiasm of trainees, the passion to do the best for our patients, the culture of innovation, and the desire to collaborate are universal themes that cut across boundaries, language, and culture.
There is a significant focus this year on strengthening our collaboration with sister societies in other countries and I have to call out Dr. Damiano Rondelli from the University of Illinois at Chicago for leading our International Partnerships committee. The ASTCT has already signed memorandums of understanding with the Asia Pacific Blood and Marrow Transplantation Group (APBMT) and the Brazilian Society of Bone Marrow Transplantation (SBTMO) and we are exploring similar opportunities with other organizations. This will allow us to offer more educational offerings to our colleagues and trainees in other countries and enhance exchange of ideas.
As I write this column, I am en route to our HQ in Chicago to attend our inaugural ASTCT Leadership Course. I am really looking forward to and excited about this course – but you will need to wait for next month’s column to learn more about it. Till then, enjoy spring!!