Hematopoietic stem cell transplantation practice variation among centers in the Eastern Mediterranean Region (EMRO)
Rattachement africain : sa, ir, jo, Égypte, om, lb, Algérie, pk, Maroc. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
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: This 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, anti-microbial 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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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Hematopoietic stem cell transplantation practice variation among centers in the Eastern Mediterranean Region (EMRO)
- Date Crossref
- 01/01/2013
- Éditeur
- Ovid Technologies (Wolters Kluwer Health)
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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King Faisal Specialist Hospital & Research Centre pays non établi dans la noticeÉtablissement de santé
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Tehran University of Medical Sciences pays non établi dans la noticeUniversité ou école supérieure
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King Hussein Cancer Center pays non établi dans la noticeOrganisation à but non lucratif
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Cairo University National Cancer Institute Cairo University, Égypte (code pays fourni par la source)Université ou école supérieure
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Riyadh Armed Forces Hospital pays non établi dans la noticeÉtablissement de santé
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Sultan Qaboos University Hospital pays non établi dans la noticeÉtablissement de santé
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Makassed General Hospital pays non établi dans la noticeÉtablissement de santé
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American University of Beirut Medical Center pays non établi dans la noticeÉtablissement de santé
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University Hospital of Oran University Hospital of Oran, Algérie (code pays fourni par la source)Établissement de santé
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Aga Khan University Hospital pays non établi dans la noticeÉtablissement de santé
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Hôpital 20 Août Maroc (code pays fourni par la source)Établissement de santé
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Shiraz University of Medical Sciences pays non établi dans la noticeUniversité ou école supérieure
King Faisal Specialist Hospital & Research Centre, Tehran University of Medical Sciences et King Hussein Cancer Center, avec 9 autres affiliations. Pays d’affiliation : Égypte, Algérie, Maroc.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.