Why do many patients not receive a transplant?

Why do many patients not receive a transplant? So 60 to 80 percent of patients get in remission so they can go to transplant, but the vast majority of patients don't have a transplant. There are a variety of different reasons for that. I mean, one is that there certainly are, you know, not the majority, but there are some patients that have a relatively high rate of being cured with chemotherapy alone. And so there's really not a compelling reason for them to have a bone marrow transplant, which has side effects and toxicities. And then I think the other, you know, the other major reason is again the age of leukemia patients. And so if you look at it, the average leukemia patient again being in their late 60s, a lot of people think that bone marrow transplant is something that really can't be done for patients that are in that age range. It turns out nowadays we really think that people that are up to the age of 75 and even some patients that are up to the age of 80 who are healthy are certainly candidates for bone marrow transplant. But it turns out that a lot of patients also that have AML are not healthy enough or too elderly and frail to have a bone marrow transplant. And so with intensive therapy, people that are healthy enough to get intensive therapy, we can get most people in remission. And now with less intensive therapy, even people that aren't healthy enough to get intensive therapy, we can probably get the majority of those patients in remission. It doesn't mean that everybody can get a bone marrow transplant. There's also this referral bias, which is to say that, you know, there's especially patients that are getting treated by community oncologists that don't have a lot of experience with bone marrow transplant. They're a lot less likely to refer a patient to a referral center if they're able to get that patient in remission and things are going well. If they don't have familiarity with bone marrow transplant, they're less likely to refer a patient to have a bone marrow transplant.