Hematopoietic stem cell transplantation practice variation among centers in the Eastern Mediterranean Region (EMRO): Eastern Mediterranean Bone Marrow Transplantation (EMBMT) group survey

Walid Rasheed, Ardeshir Ghavamzadeh, Rosemarie Hamladji, Tarek Ben Othman, Amal Alseraihy, Fawzi Abdel-Rahman, Alaa Elhaddad, Abdulaziz Alabdulaaly, David Dennison, Ahmad Ibrahim, Ali Bazarbachi, Mohamed Amine Bekadja, Said Yousuf Mohamed, Salman Naseem Adil, Parvez Ahmed, Said Benchekroun, Mani Ramzi, Mohammad Jarrar, Kamran Alimoghaddam, Fazal HussainAmir Hamidieh, Mahmoud Aljurf

Research output: Contribution to journalArticle

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Abstract

INTRODUCTION: This practice survey is conducted to analyze clinical hematopoietic stem cell transplantation (HSCT) practice variability among centers in the WHO Eastern Mediterranean Region (EMRO), as represented by the Eastern Mediterranean Blood and Marrow Transplantation (EMBMT) group. METHOD: Th is internet based survey was completed by the medical program directors of the EMBMT centers; 17 centers participated. The survey collected data on various clinical aspects of HSCT practice. RESULTS: Consistency in pre HSCT cardiac (100%), pulmonary (82%) and viral screen (100%) was observed. Obtaining informed consent was universal. Pre-HSCT psychological assessment is practiced in 50% of the centers. All centers used single-bedded rooms with HEPA filters. Visitor policy during neutropenic phase and the use of gowns, masks or gloves when examining patients varied among centers. MRSA/VRE screen and use of low bacterial diet were applied in 65% and 82%, respectively. Anti-bacterial prophylaxis is employed in 58% (Auto-SCT) and 60% (Allo-SCT) of the centers. Drug choice varied (cotrimoxazole, ciprofloxacin, levofloxacin, piperacillin-tazobactam); 60% of the centers used penicillin prophylaxis in GVHD patients. PCP prophylaxis is applied in 58% (Auto-SCT) and 87% (Allo-SCT) of the centers; cotrimoxazole is usually used. Anti-viral prophylaxis with acyclovir or, less commonly, valacyclovir is used in 70% (Auto-SCT) and 93% (Allo-SCT) of centers. Anti-fungal prophylaxis is applied in 70% (Auto-SCT), 93% (myeloablative Allo-SCT) and 87% (reduced intensity [RIC] Allo-SCT). Fluconazole is used in all Auto-SCT and majority of Allo-SCT recipients; few centers used other agents (itraconazole, voriconazole, amphotericin B) in Allo-SCT. Prophylactic GCSF use varied among centers: Auto-SCT 77%, myeloablative Allo-SCT 33%, RIC Allo-SCT 27%. Use of ursodeoxycholic acid for venoocclusive disease (VOD) prophylaxis is variable: 60% (Allo-SCT) and 12% (Auto-SCT). Cyclosporine/methotrexate is the most commonly used GVHD prophylaxis in myeloablative Allo-SCT (93%); heterogeneity was seen in RIC SCT. Treatment of steroid refractory acute GVHD varied (ATG 53%, higher steroid dose 40%). CMV monitoring varied between antigenemia (53%) and PCR (40%) techniques. Pre-emptive anti CMV therapy is used in 86% of the centers, while 7% used routine CMV prophylaxis; 7% had no specific CMV management policy. CONCLUSION: Consistency was observed in areas of pre-SCT work up, use of single rooms, HEPA filters and GVHD prophylaxis. Heterogeneity is observed in other practice aspects including other isolation measures, antimicrobial prophylaxis, VOD prophylaxis, growth factor use and treatment of steroid refractory GVHD. Further studies are needed to probe the impact of such practice variations on post-transplant outcome and to ascertain the best clinical practice approach.

Original languageEnglish
Pages (from-to)14-19
Number of pages6
JournalHematology/ Oncology and Stem Cell Therapy
Volume6
Issue number1
DOIs
Publication statusPublished - Mar 2013

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Mediterranean Region
Hematopoietic Stem Cell Transplantation
Bone Marrow Transplantation
valacyclovir
Steroids
Sulfamethoxazole Drug Combination Trimethoprim
Physician Executives
Ursodeoxycholic Acid
Levofloxacin
Itraconazole
Acyclovir
Fluconazole
Amphotericin B
Methicillin-Resistant Staphylococcus aureus
Ciprofloxacin
Masks
Informed Consent
Practice Guidelines
Methotrexate
Penicillins

ASJC Scopus subject areas

  • Hematology
  • Oncology

Cite this

Hematopoietic stem cell transplantation practice variation among centers in the Eastern Mediterranean Region (EMRO) : Eastern Mediterranean Bone Marrow Transplantation (EMBMT) group survey. / Rasheed, Walid; Ghavamzadeh, Ardeshir; Hamladji, Rosemarie; Othman, Tarek Ben; Alseraihy, Amal; Abdel-Rahman, Fawzi; Elhaddad, Alaa; Alabdulaaly, Abdulaziz; Dennison, David; Ibrahim, Ahmad; Bazarbachi, Ali; Bekadja, Mohamed Amine; Mohamed, Said Yousuf; Adil, Salman Naseem; Ahmed, Parvez; Benchekroun, Said; Ramzi, Mani; Jarrar, Mohammad; Alimoghaddam, Kamran; Hussain, Fazal; Hamidieh, Amir; Aljurf, Mahmoud.

In: Hematology/ Oncology and Stem Cell Therapy, Vol. 6, No. 1, 03.2013, p. 14-19.

Research output: Contribution to journalArticle

Rasheed, W, Ghavamzadeh, A, Hamladji, R, Othman, TB, Alseraihy, A, Abdel-Rahman, F, Elhaddad, A, Alabdulaaly, A, Dennison, D, Ibrahim, A, Bazarbachi, A, Bekadja, MA, Mohamed, SY, Adil, SN, Ahmed, P, Benchekroun, S, Ramzi, M, Jarrar, M, Alimoghaddam, K, Hussain, F, Hamidieh, A & Aljurf, M 2013, 'Hematopoietic stem cell transplantation practice variation among centers in the Eastern Mediterranean Region (EMRO): Eastern Mediterranean Bone Marrow Transplantation (EMBMT) group survey', Hematology/ Oncology and Stem Cell Therapy, vol. 6, no. 1, pp. 14-19. https://doi.org/10.1016/j.hemonc.2013.04.001
Rasheed, Walid ; Ghavamzadeh, Ardeshir ; Hamladji, Rosemarie ; Othman, Tarek Ben ; Alseraihy, Amal ; Abdel-Rahman, Fawzi ; Elhaddad, Alaa ; Alabdulaaly, Abdulaziz ; Dennison, David ; Ibrahim, Ahmad ; Bazarbachi, Ali ; Bekadja, Mohamed Amine ; Mohamed, Said Yousuf ; Adil, Salman Naseem ; Ahmed, Parvez ; Benchekroun, Said ; Ramzi, Mani ; Jarrar, Mohammad ; Alimoghaddam, Kamran ; Hussain, Fazal ; Hamidieh, Amir ; Aljurf, Mahmoud. / Hematopoietic stem cell transplantation practice variation among centers in the Eastern Mediterranean Region (EMRO) : Eastern Mediterranean Bone Marrow Transplantation (EMBMT) group survey. In: Hematology/ Oncology and Stem Cell Therapy. 2013 ; Vol. 6, No. 1. pp. 14-19.
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abstract = "INTRODUCTION: This practice survey is conducted to analyze clinical hematopoietic stem cell transplantation (HSCT) practice variability among centers in the WHO Eastern Mediterranean Region (EMRO), as represented by the Eastern Mediterranean Blood and Marrow Transplantation (EMBMT) group. METHOD: Th is internet based survey was completed by the medical program directors of the EMBMT centers; 17 centers participated. The survey collected data on various clinical aspects of HSCT practice. RESULTS: Consistency in pre HSCT cardiac (100{\%}), pulmonary (82{\%}) and viral screen (100{\%}) was observed. Obtaining informed consent was universal. Pre-HSCT psychological assessment is practiced in 50{\%} of the centers. All centers used single-bedded rooms with HEPA filters. Visitor policy during neutropenic phase and the use of gowns, masks or gloves when examining patients varied among centers. MRSA/VRE screen and use of low bacterial diet were applied in 65{\%} and 82{\%}, respectively. Anti-bacterial prophylaxis is employed in 58{\%} (Auto-SCT) and 60{\%} (Allo-SCT) of the centers. Drug choice varied (cotrimoxazole, ciprofloxacin, levofloxacin, piperacillin-tazobactam); 60{\%} of the centers used penicillin prophylaxis in GVHD patients. PCP prophylaxis is applied in 58{\%} (Auto-SCT) and 87{\%} (Allo-SCT) of the centers; cotrimoxazole is usually used. Anti-viral prophylaxis with acyclovir or, less commonly, valacyclovir is used in 70{\%} (Auto-SCT) and 93{\%} (Allo-SCT) of centers. Anti-fungal prophylaxis is applied in 70{\%} (Auto-SCT), 93{\%} (myeloablative Allo-SCT) and 87{\%} (reduced intensity [RIC] Allo-SCT). Fluconazole is used in all Auto-SCT and majority of Allo-SCT recipients; few centers used other agents (itraconazole, voriconazole, amphotericin B) in Allo-SCT. Prophylactic GCSF use varied among centers: Auto-SCT 77{\%}, myeloablative Allo-SCT 33{\%}, RIC Allo-SCT 27{\%}. Use of ursodeoxycholic acid for venoocclusive disease (VOD) prophylaxis is variable: 60{\%} (Allo-SCT) and 12{\%} (Auto-SCT). Cyclosporine/methotrexate is the most commonly used GVHD prophylaxis in myeloablative Allo-SCT (93{\%}); heterogeneity was seen in RIC SCT. Treatment of steroid refractory acute GVHD varied (ATG 53{\%}, higher steroid dose 40{\%}). CMV monitoring varied between antigenemia (53{\%}) and PCR (40{\%}) techniques. Pre-emptive anti CMV therapy is used in 86{\%} of the centers, while 7{\%} used routine CMV prophylaxis; 7{\%} had no specific CMV management policy. CONCLUSION: Consistency was observed in areas of pre-SCT work up, use of single rooms, HEPA filters and GVHD prophylaxis. Heterogeneity is observed in other practice aspects including other isolation measures, antimicrobial prophylaxis, VOD prophylaxis, growth factor use and treatment of steroid refractory GVHD. Further studies are needed to probe the impact of such practice variations on post-transplant outcome and to ascertain the best clinical practice approach.",
author = "Walid Rasheed and Ardeshir Ghavamzadeh and Rosemarie Hamladji and Othman, {Tarek Ben} and Amal Alseraihy and Fawzi Abdel-Rahman and Alaa Elhaddad and Abdulaziz Alabdulaaly and David Dennison and Ahmad Ibrahim and Ali Bazarbachi and Bekadja, {Mohamed Amine} and Mohamed, {Said Yousuf} and Adil, {Salman Naseem} and Parvez Ahmed and Said Benchekroun and Mani Ramzi and Mohammad Jarrar and Kamran Alimoghaddam and Fazal Hussain and Amir Hamidieh and Mahmoud Aljurf",
year = "2013",
month = "3",
doi = "10.1016/j.hemonc.2013.04.001",
language = "English",
volume = "6",
pages = "14--19",
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issn = "1658-3876",
publisher = "King Faisal Specialist Hospital and Research Centre",
number = "1",

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TY - JOUR

T1 - Hematopoietic stem cell transplantation practice variation among centers in the Eastern Mediterranean Region (EMRO)

T2 - Eastern Mediterranean Bone Marrow Transplantation (EMBMT) group survey

AU - Rasheed, Walid

AU - Ghavamzadeh, Ardeshir

AU - Hamladji, Rosemarie

AU - Othman, Tarek Ben

AU - Alseraihy, Amal

AU - Abdel-Rahman, Fawzi

AU - Elhaddad, Alaa

AU - Alabdulaaly, Abdulaziz

AU - Dennison, David

AU - Ibrahim, Ahmad

AU - Bazarbachi, Ali

AU - Bekadja, Mohamed Amine

AU - Mohamed, Said Yousuf

AU - Adil, Salman Naseem

AU - Ahmed, Parvez

AU - Benchekroun, Said

AU - Ramzi, Mani

AU - Jarrar, Mohammad

AU - Alimoghaddam, Kamran

AU - Hussain, Fazal

AU - Hamidieh, Amir

AU - Aljurf, Mahmoud

PY - 2013/3

Y1 - 2013/3

N2 - INTRODUCTION: This practice survey is conducted to analyze clinical hematopoietic stem cell transplantation (HSCT) practice variability among centers in the WHO Eastern Mediterranean Region (EMRO), as represented by the Eastern Mediterranean Blood and Marrow Transplantation (EMBMT) group. METHOD: Th is internet based survey was completed by the medical program directors of the EMBMT centers; 17 centers participated. The survey collected data on various clinical aspects of HSCT practice. RESULTS: Consistency in pre HSCT cardiac (100%), pulmonary (82%) and viral screen (100%) was observed. Obtaining informed consent was universal. Pre-HSCT psychological assessment is practiced in 50% of the centers. All centers used single-bedded rooms with HEPA filters. Visitor policy during neutropenic phase and the use of gowns, masks or gloves when examining patients varied among centers. MRSA/VRE screen and use of low bacterial diet were applied in 65% and 82%, respectively. Anti-bacterial prophylaxis is employed in 58% (Auto-SCT) and 60% (Allo-SCT) of the centers. Drug choice varied (cotrimoxazole, ciprofloxacin, levofloxacin, piperacillin-tazobactam); 60% of the centers used penicillin prophylaxis in GVHD patients. PCP prophylaxis is applied in 58% (Auto-SCT) and 87% (Allo-SCT) of the centers; cotrimoxazole is usually used. Anti-viral prophylaxis with acyclovir or, less commonly, valacyclovir is used in 70% (Auto-SCT) and 93% (Allo-SCT) of centers. Anti-fungal prophylaxis is applied in 70% (Auto-SCT), 93% (myeloablative Allo-SCT) and 87% (reduced intensity [RIC] Allo-SCT). Fluconazole is used in all Auto-SCT and majority of Allo-SCT recipients; few centers used other agents (itraconazole, voriconazole, amphotericin B) in Allo-SCT. Prophylactic GCSF use varied among centers: Auto-SCT 77%, myeloablative Allo-SCT 33%, RIC Allo-SCT 27%. Use of ursodeoxycholic acid for venoocclusive disease (VOD) prophylaxis is variable: 60% (Allo-SCT) and 12% (Auto-SCT). Cyclosporine/methotrexate is the most commonly used GVHD prophylaxis in myeloablative Allo-SCT (93%); heterogeneity was seen in RIC SCT. Treatment of steroid refractory acute GVHD varied (ATG 53%, higher steroid dose 40%). CMV monitoring varied between antigenemia (53%) and PCR (40%) techniques. Pre-emptive anti CMV therapy is used in 86% of the centers, while 7% used routine CMV prophylaxis; 7% had no specific CMV management policy. CONCLUSION: Consistency was observed in areas of pre-SCT work up, use of single rooms, HEPA filters and GVHD prophylaxis. Heterogeneity is observed in other practice aspects including other isolation measures, antimicrobial prophylaxis, VOD prophylaxis, growth factor use and treatment of steroid refractory GVHD. Further studies are needed to probe the impact of such practice variations on post-transplant outcome and to ascertain the best clinical practice approach.

AB - INTRODUCTION: This practice survey is conducted to analyze clinical hematopoietic stem cell transplantation (HSCT) practice variability among centers in the WHO Eastern Mediterranean Region (EMRO), as represented by the Eastern Mediterranean Blood and Marrow Transplantation (EMBMT) group. METHOD: Th is internet based survey was completed by the medical program directors of the EMBMT centers; 17 centers participated. The survey collected data on various clinical aspects of HSCT practice. RESULTS: Consistency in pre HSCT cardiac (100%), pulmonary (82%) and viral screen (100%) was observed. Obtaining informed consent was universal. Pre-HSCT psychological assessment is practiced in 50% of the centers. All centers used single-bedded rooms with HEPA filters. Visitor policy during neutropenic phase and the use of gowns, masks or gloves when examining patients varied among centers. MRSA/VRE screen and use of low bacterial diet were applied in 65% and 82%, respectively. Anti-bacterial prophylaxis is employed in 58% (Auto-SCT) and 60% (Allo-SCT) of the centers. Drug choice varied (cotrimoxazole, ciprofloxacin, levofloxacin, piperacillin-tazobactam); 60% of the centers used penicillin prophylaxis in GVHD patients. PCP prophylaxis is applied in 58% (Auto-SCT) and 87% (Allo-SCT) of the centers; cotrimoxazole is usually used. Anti-viral prophylaxis with acyclovir or, less commonly, valacyclovir is used in 70% (Auto-SCT) and 93% (Allo-SCT) of centers. Anti-fungal prophylaxis is applied in 70% (Auto-SCT), 93% (myeloablative Allo-SCT) and 87% (reduced intensity [RIC] Allo-SCT). Fluconazole is used in all Auto-SCT and majority of Allo-SCT recipients; few centers used other agents (itraconazole, voriconazole, amphotericin B) in Allo-SCT. Prophylactic GCSF use varied among centers: Auto-SCT 77%, myeloablative Allo-SCT 33%, RIC Allo-SCT 27%. Use of ursodeoxycholic acid for venoocclusive disease (VOD) prophylaxis is variable: 60% (Allo-SCT) and 12% (Auto-SCT). Cyclosporine/methotrexate is the most commonly used GVHD prophylaxis in myeloablative Allo-SCT (93%); heterogeneity was seen in RIC SCT. Treatment of steroid refractory acute GVHD varied (ATG 53%, higher steroid dose 40%). CMV monitoring varied between antigenemia (53%) and PCR (40%) techniques. Pre-emptive anti CMV therapy is used in 86% of the centers, while 7% used routine CMV prophylaxis; 7% had no specific CMV management policy. CONCLUSION: Consistency was observed in areas of pre-SCT work up, use of single rooms, HEPA filters and GVHD prophylaxis. Heterogeneity is observed in other practice aspects including other isolation measures, antimicrobial prophylaxis, VOD prophylaxis, growth factor use and treatment of steroid refractory GVHD. Further studies are needed to probe the impact of such practice variations on post-transplant outcome and to ascertain the best clinical practice approach.

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