ASBMT and CBMTG Release Choosing Wisely BMT Recommendations
ASBMT and the Canadian Blood and Marrow Transplant Group (CBMTG) have partnered with Choosing Wisely and Choosing Wisely Canada to develop the first Choosing Wisely BMT list of five transplantation practices that clinicians should consider.
Choosing Wisely is an initiative of the American Board of Internal Medicine (ABIM) Foundation, developed to spark conversations between providers and patients to ensure the right care is delivered at the right time. Choosing Wisely centers around evidence based recommendations of “Things Providers and Patients Should Question.”
Through the efforts of the Choosing Wisely Task Force, led by Sita Bhella, MD, MEd, FRCPC, and Matthew Seftel, MD MBChB , MPH , MRCP, the ASBMT and CBMTG have jointly released the following recommendations:
- Don't routinely use peripheral blood stem cells for patients with aplastic anemia when a suitable bone marrow donor is available due to a higher risk of graft-versus-host disease.
- Don't use greater than 2 mg/kg/day of methylprednisolone (or equivalent) for the initial treatment of graft-versus-host disease.
- Don't routinely use two cord blood units for standard umbilical cord blood transplantation when a single unit of adequate size is available, recognizing that higher cell doses are preferred when using units with greater HLA mismatch.
- Don't routinely use peripheral blood stem cells for matched unrelated donor transplantation using myeloablative conditioning and standard graft-versus-host disease prevention regimens when a suitable bone marrow donor is available.
- Don't routinely give immunoglobulin replacement to adult hematopoietic cell transplantation recipients in the absence of recurrent infections regardless of the IgG level.
Suggestions for the list were solicited from ASBMT’s Quality Outcomes, Practice Guidelines and Education Committees, CBMTG Program Directors, and Chairs of Center for International Blood and Marrow Transplant Research Scientific Working Committees. The 119 unique suggestions received were ranked, and the final short listed recommendations were subjected to systematic reviews to establish the final five.
“These recommendations were uniformly based on Choosing Wisely’s guiding principles of focusing on tests, treatments or procedures, that may be harmful, wasteful, or for which there is no clinical benefit” said Dr. Bhella. According to Dr. Seftel, “They were written with the intention of facilitating wise decisions about the most appropriate care based on a patient’s individual situation, and will foster discussion among clinicians and between clinicians and patients about these practices.”
The list, with the rationale and key references for each recommendation, is available here. A manuscript detailing the methodology and summary of evidence for each recommendation is online now at ASBMT’s journal – Biology for Blood and Marrow Transplantation.
Other members of the Choosing Wisely BMT Task Force included: Jeffrey Betcher, Christopher Bredeson, Luciano Costa, Andrew Daly, Christopher Dandoy, Zachariah De Filipp, Vi Doan, Alison Gubis, Lisa Hicks, Mark Juckett, Nandita Khera, Amrita Krishnan, Navneet Majhail, George Selby, Nirav Shah, Melisa Stricherz, and Auro Viswabandya.
The American Society for Blood and Marrow Transplantation (ASBMT) is an international professional membership association of physicians, investigators and other healthcare professionals involved in blood and marrow transplantation and novel cellular therapies. The ASBMT represents the interests of transplant clinicians and investigators and the patients they serve in eight broad areas: research, representation, clinical standards, regulation, communications, accreditation, reimbursement, and recruiting and training clinical personnel.