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Welcome everyone to the Becker's Healthcare podcast series.

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I'm Mariah Muhammad, writer and moderator with Becker's

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Healthcare. And I'm thrilled to have with me

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today doctor Steven Devine, chief medical officer of

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the National Marrow Donor Program and executive lead

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and senior

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scientific

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director at the Center for International Blood and

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Marrow Transplant Research. Doctor, welcome to the podcast.

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We're very excited to have you join us

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today. To get us started, could you share

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some of the most promising

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discoveries in blood cancer and disorder research that

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you believe will, improve patient outcomes in 2025

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significantly?

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Yes.

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First,

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Brian, thanks for inviting me.

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Yes. Things are really exciting.

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Now, I'm going to focus

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mostly on

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blood cancer and

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blood or marrow transplantation

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because that's really our focus.

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I think

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in 2025,

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the most exciting,

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finding is really that

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virtually everyone has a donor now where,

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you know, a decade ago, you couldn't say

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that. So now we are able to find

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donors for virtually

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every patient,

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in need

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of a life saving,

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transplant

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regardless

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of their

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racial or ethnic background. So that's a big

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change and I think that's

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moving forward.

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And because of that,

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traditionally,

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the practice has been to sort of

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wait or try to identify for many patients

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that

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sort of perfect

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donor or even that needle in a haystack.

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The message now is,

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don't do that.

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Go forward transplant

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when the patient

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needs to go forward,

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and,

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there are lots of different suitable

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donor options available now.

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Yeah. Absolutely. Thank you so much for giving

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us that that information.

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How are advance,

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advancements in donor selection,

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such as the use of donor scores helping

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to streamline the transplant process,

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and kind of avoid the delays caused by,

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searching for a perfectly matched donor?

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Yeah. Well, so I think for that,

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for the answer to that question,

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it's best to go to,

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a recent

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study that was funded by

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the National Institutes of Health, so sort of

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a partnership between

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the federal government and the academic

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community that was run through one of the

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NIH

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or National Institutes of Health

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networks.

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And in that study,

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we

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basically said,

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if you're lucky enough

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to have to identify

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a

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matched donor

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in the registry and they need a transplant,

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go forward with that matched donor. But if

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you're

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predicted to be unlikely

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to have

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a matched donor,

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They'll go forward, but go forward with your

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best alternative

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donor that it would be a mismatched donor,

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and that could be a mismatched

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family member.

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It could be,

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our focus, which is mismatched

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unrelated donors or even umbilical cord blood transplants.

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And what that study showed that using that

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strategy, which was

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use the match donor if you can identify

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it, but go with a good alternative

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otherwise,

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the results of that the outcomes are the

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same with that strategy. So it seems like

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the timing is more the issue than the

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exact type of donor.

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And, again, that's a that's a real change.

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Yeah. Yeah. Definitely sounds like it. And,

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another change, I guess, with donors trending younger

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and recipients skewing older, how is this demographic

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shift influencing the strategies for donor, recruitment

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and patient management?

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So,

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traditionally,

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when the field of marrow transplantation

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started,

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you look to the family.

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And we would

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identify,

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if there was any

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brother or sister within the family

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that,

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was

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matched at these genes that we call HLA.

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And the chance of that are only about

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twenty five to thirty percent, which is really

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why the donor registry

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came about.

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But

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if you think about it,

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as our patients are getting older,

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their brothers or sisters are also

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getting older. So for instance, with acute leukemia,

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the the average age at diagnosis is 60.

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So most of the,

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potential

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brother or sister or sibling donors are also

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in that age range. They could be, you

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know, in their fifties, sixties, even seventies.

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And so one of the real questions

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now that's being asked

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is even if you have a

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matched donor,

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a brother or sister,

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say, in the family,

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but if they're older, is it better to

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go with the older,

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sibling donor

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or a younger

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donor,

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say, in their twenties that could be identified

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in the registry.

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We don't have a definitive answer to that

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today,

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but a lot of the academic centers

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are now tending

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to actually go to the registry

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because the influence of donor age

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may be so significant that they really wanna

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find a younger donor even if it's not

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within the family.

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Yeah. Thank you so much for giving us

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that insight.

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Another question, doctor.

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Novel doc data suggests mismatched unrelated donors are

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expanding access to transplants,

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especially for diverse populations. Can you elaborate

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a little bit more on this trend,

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and its implications for patient care?

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Yes. So this is a a trend, and

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it's really been, you know, since maybe before

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right before the pandemic

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to the years that have ensued following the

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pandemic.

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And, a lot of,

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the changes in the use of mismatched unrelated

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donor transplants

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has occurred because of,

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efforts,

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and resources

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provided

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by the NMDP.

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We've shifted our focus

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towards

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looking at

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less than perfectly matched donors because we saw

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an opportunity

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to be able to provide suitable donors

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for,

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all patients. So the NMDP,

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together with the research group, the CIBMTR

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that we lead,

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has been, putting forward an initiative called Donor

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For All.

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And basically, what Donor for All is is

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a set of studies

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that are defined,

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to,

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really improve outcomes

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using

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mismatched

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unrelated

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donors. What we found is through these studies

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that actually,

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because of new ways to prevent complications

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after transplant,

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the outcomes, even with less than perfectly matched

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donors,

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have been very similar, if not exactly the

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same, as the outcomes we would expect

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using

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fully matched donors. And so to translate to

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what that means for

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patients, again,

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so,

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in the past, if you were racially or

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ethnically diverse, for instance,

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an African American might only have a 29

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to 30 percent chance of identifying

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a fully matched donor on the registry.

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Now more than 80% of them can identify

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a a a seven of eight match, where

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the eight of eights are the full matches.

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And if you go down to the six

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of eight level,

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virtually a % of people will be able

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to find

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donors. And so that's translated

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into our ability

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to offer a life saving transplant

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for,

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basically anyone in need of a transplant, regardless

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of their racial or ethnic background. In our

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clinical trials,

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more than half of the patients that have

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been enrolled

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on the NMDP sponsored clinical

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trials have been in fact, racially or ethically

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diverse, which is really,

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unheard of in

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in research and certainly unheard of in the

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transplantation

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field.

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Yeah. That definitely makes a lot of sense.

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Thank you for breaking that down.

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Kind of going into the field of collaboration,

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obviously obviously, you know that, you know, collaboration

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among researchers,

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industry, health care providers, and government has been

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very vital in advancing the cell therapies.

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Can you provide examples of how these partnerships

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are breaking the barriers and really accelerate accelerating

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innovation in this, type of arena?

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Yeah. Well, it really does take a village

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in order to, you know, accelerate progress

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for patients. And it it it it it

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can't be done by just any

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one organization.

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So

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NMDP

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is positioned

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right sort of in the middle of the

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whole

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transplant ecosystem,

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if you will.

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We have a network

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of,

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transplant centers, almost 200 transplant centers

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in The United States that work with us

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to find donors

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for their patients. And we've also,

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through the CIBMTR,

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been able to provide a clinical trials

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infrastructure

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and working with those transplant centers together with

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funding

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from

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the

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National Institutes of Health, the Office of Naval

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Research, and some other

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foundations.

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We work together with the whole community, the

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transplanters,

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the federal government,

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other foundations, the other registries,

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to work together to design

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these studies

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and to try to address

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the most important

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questions. And that's really led to,

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our ability to perform these studies that have

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shown that we don't want to wait to

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find that perfect donor, and now we can

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find suitable donors

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for virtually everyone.

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That's amazing. Thank you, for sharing that. And,

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doctor, before I let you go,

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the last thing I really wanted to ask

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you is what are the benefits of closer

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collaboration,

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between hematologists and oncologists, and how is this

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improving access to treatments

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and patient outcomes?

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Well, I I know it sounds,

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kind of funny in 2025,

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but

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many of the physicians who have been practicing,

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for,

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you know, decades,

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and doing all they can to help their

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patients

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may not necessarily

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be aware

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that,

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for instance, we can find a donor for

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everyone.

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Or they might not be aware

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that patients

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back a decade or two who were felt

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to be too old

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to have a transplant and were transplant candidates

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are actually now potentially good

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candidates for transplant. So we're pushing

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the boundaries,

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and so age matters a lot less

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today

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than it did ten or twenty

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years ago. And so we want to make

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sure that all the hematologists and oncologists

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who are seeing

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our patients out in the community,

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actually

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are educated and understand how much things have

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changed

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that,

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that some of the patients that they might

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not have ever considered

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for transplantation

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now actually are candidates. And so the idea

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is to get that word out so that,

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they could refer

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their patients, if they don't do transplants at

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community

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that

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transplant might be a good option for their

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patients regardless of their age or regardless of

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their racial or ethnic background. I think NMDP

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has a real role to play there.

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Yeah. Thank you so much for those final

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thoughts, doctor. This has definitely been a very

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informative discussion. So, again, I wanna thank you

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so much for coming on Becker's HealthCare,

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and I look forward to connecting with you

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again soon.

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Thank you very much for having us.