A Fair Chance

During a stem cell transplant, damaged blood stem cells are replaced with new, healthy stem cells from a suitable donor. It’s a bit like getting a blood transfusion – it’s not an operation.

In time, the new stem cells attach to bone marrow in a process called engraftment. After this, the donated stem cells will start to make new blood cells.

A second transplant may use cells from the original stem cell donor or from a different donor. This campaign focuses on second transplants following disease relapse in blood cancer. Repeat transplantation following graft failure in malignant conditions is covered separately by NHS commissioning arrangements.

For some people with blood cancer, the disease returns after their first transplant. Depending on the type of cancer, how it responds to further treatment and the patient’s overall health, a second transplant may offer another opportunity to achieve long-term remission or cure.

Other treatments can include chemotherapy, targeted medicines, reducing immunosuppressive treatment or a donor lymphocyte infusion. The right approach will be different for every patient. A second transplant is not suitable for everyone, but for some patients it may be one of the few remaining treatments with curative potential.

The ‘Second allogeneic haematopoietic stem cell transplant for relapsed disease’ policy currently published by NHS England, reference 16068/P, says that a second transplant following relapse will be routinely funded only where:

• the patient is in complete remission;
• the disease returned more than 12 months after the first transplant; and
• the patient is clinically fit enough to undergo the treatment, as determined by a multidisciplinary team.

The policy says patients whose disease returns within 12 months should not be considered for a routinely commissioned second transplant. It applies to patients in England. The policy also says that a further allogeneic transplant should not be offered if a patient relapses following their second transplant.

The 12-month rule relates to when the disease returns after the first transplant. It does not refer to the date on which the second transplant would take place.
Under the published policy, a patient whose blood cancer returns due to relapse before 12 months is not routinely eligible for a second transplant. A patient whose blood cancer returns after 12 months must still be in complete remission and clinically fit enough to undergo treatment.

The timing of relapse is clinically important. In general, patients whose disease returns earlier have poorer outcomes than those whose disease returns later. The concern is not that timing should be ignored, but that the policy turns one prognostic factor into an automatic pass-or-fail rule.
Modern evidence shows that a patient’s prospects are affected by several connected factors, including disease status, response to treatment, performance status, other health conditions, previous transplant complications and the timing of relapse. The evidence does not establish that 12 months is a validated universal point below which no patient could benefit. Several modern studies instead identify relapse within the first six months as a particularly adverse factor and support assessing risk across a range of clinical characteristics.

No. A second transplant is a major and potentially dangerous treatment, and it will not be appropriate for every patient.
The campaign is asking for every potentially eligible patient to receive a fair, individual assessment. A patient should not be ruled out solely because their blood cancer returned before a fixed date. Specialist clinicians should be able to consider the full clinical picture and decide whether the possible benefit justifies the risks. The campaign is asking for every potentially eligible patient to receive a fair, individual assessment. A patient should not be ruled out solely because their disease blood cancer returned before a fixed date. Specialist clinicians should be able to consider the full clinical picture and decide whether the possible benefit justifies the risks.
Removing the automatic cut-off would not guarantee treatment. It would allow a proper clinical decision to take place.

A risk-stratified assessment looks at the patient’s overall clinical circumstances rather than using one factor as an automatic exclusion.
It would allow specialists to consider several factors together and assess whether the patient has a realistic prospect of benefiting from a second transplant. Patients with particularly high-risk circumstances could receive additional scrutiny through an agreed national expert process, rather than being automatically refused or being assessed inconsistently.
The purpose would be to support careful patient selection, not to make second transplants available without restrictions. Contemporary studies and professional guidance repeatedly identify several factors that influence outcomes and support individual decision-making.

Yes. Earlier relapse is consistently associated with worse outcomes, and it should remain an important part of the decision.
However, a poorer average prognosis is not the same as proving that every patient below a particular threshold has no prospect of benefit. Modern evidence frequently identifies relapse within six months as especially high risk, while patients relapsing later generally do better. The evidence supports treating time as part of a wider risk assessment rather than allowing it to determine the decision on its own.

For someone whose blood cancer has returned, a second transplant can offer more than another course of treatment. For some patients, it offers a genuine chance of long-term remission or cure, and with that the possibility of returning to family life, work, birthdays, holidays and plans for the future.

There is no single international rule, but the information gathered for this campaign suggests that comparable systems generally use either individual clinical assessment, a shorter timing marker or an expert-review process.

Patients should first ask their transplant team to explain whether the decision is to offer a second stem cell transplant based on clinical judgement, the NHS England commissioning criteria or both.
A treating clinician may be able to submit an individual funding request if they believe that the patient’s clinical circumstances are exceptional and that the patient is likely to receive greater clinical benefit than other patients with the same condition who also fall outside the policy. Patients cannot submit an NHS England individual funding request themselves, although they can contribute information through their clinician.
If an individual funding request is refused, the clinician may be able to request a review where they and the patient believe the correct process was not followed. NHS England says that this request must be made within 28 days of notification. A clinician can also submit additional information if the patient’s condition changes or new clinical evidence becomes available.
An individual funding request is not a guaranteed route to treatment. It is designed for clinically exceptional cases and does not resolve the wider problem where a group of patients may be disadvantaged by the same policy rule.
Patients should continue to make treatment decisions with their specialist clinical team and should not delay urgent care while pursuing a funding request.

Patients should first ask their transplant team to explain whether the decision to offer a second stem cell transplant is based on clinical judgement, their NHS commissioning criteria or both.
Each devolved nation will approach guidance slightly differently.
In Scotland, there is more flexibility in time frame between relapse and a patients’ first stem cell transplant. The clinician will make the decision if a second stem cell transplant is right for the patient and their treatment.
In Wales, the guidance aligns closely with NHS England’s policy. There may be an opportunity to submit an individual patient funding request. This must be submitted by a clinician where a patient and NHS clinician have agreed that they would be suitable for treatment but is not eligible in line with the clinical policy criteria.
In Northern Ireland, sometimes patients will be transferred to nearby countries for treatment. In this instance the patients‘ treatment would fall under the NHS service guidance for that country.
Patients should continue to make treatment decisions with their specialist clinical team and should not delay urgent care while pursuing a funding request.

The Fund second stem cell transplants on NHS for relapse within 12 months petition asks the UK Government to provide the funding needed so that patients with blood cancer who relapse within 12 months of their first stem cell transplant are not automatically denied a second transplant when their clinical team believes they could benefit.

It also calls on the Government to fund and enable NHS England to change its current policy, which excludes patients from routine access to a second transplant if their cancer returns within 12 months.

The petition is not asking for every patient to receive a second transplant. The decision would remain with the patient’s specialist clinical team, based on their health, disease and individual circumstances. It is asking for the 12-month rule to stop overriding that clinical judgement and for access to a potentially lifesaving treatment not to depend on whether a patient can afford to .

The most important action is to sign the 'Fund second stem cell transplants on NHS for relapse within 12 months' petition and share it with others who may support a fairer approach to second transplant decisions. 

UK Parliament petitions that receive 10,000 signatures receive a Government response. Petitions that reach 100,000 signatures are considered for debate in Parliament, although a debate is not automatic. 

Supporters can also share the campaign’s patient stories and social media posts.