Blood and Marrow Transplantation Long Term Management. Группа авторов. Читать онлайн. Newlib. NEWLIB.NET

Автор: Группа авторов
Издательство: John Wiley & Sons Limited
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Жанр произведения: Медицина
Год издания: 0
isbn: 9781119612735
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to perform studies, assess epidemiologic trends, and ultimately improve patient outcome.

      The EBMT is a voluntary organization comprising more than 600 transplant centers mainly from Europe. Status as a member center requires submission of minimal essential data (MED‐A form) from all consecutive patients to a central registry in which patients may be identified by the diagnosis of underlying disease and type of transplantation.

      Data collection

      Completeness of data registration is checked at regular intervals in centers with accreditation by the Joint Accreditation Committee ISCT‐Europe (JACIE) & EBMT, Europe’s official accreditation body in the field of hematopoietic stem cell transplantation (HSCT) and cellular therapy, promoting high‐quality patient care and medical and laboratory practice through a profession‐led, voluntary accreditation scheme. Over 330 centers have been accredited at some point in time. Accreditation has been shown to be associated with improved outcome [32].

      Informed consent for transplantation and data collection is obtained locally according to current regulations. Since 2003, all transplant centers are required to obtain written informed consent prior to data registration with the EBMT following the 1975 Helsinki Declaration.

      In addition to the registry, the EBMT annual activity survey [35] compiles trends of the use of transplant technology in Europe and neighboring countries. This provides data on transplant indications in a timely manner for member centers of the EBMT and nonmember centers. At the same time, activity survey data collected independently provides a source for checking completeness of reporting into the EBMT database. Information on almost 800,000 transplants has been accrued since 1990.

      Benchmarking studies [36] are used to qualify the completeness of patient follow‐up across centers and to compare outcomes such as mortality among centers as a measure of patient selection and treatment quality.

      Data from the registry are obviously among other things of major interest to describe outcomes of rare diseases [37] and even rare complications of rare diseases [38] and on impact of certain risk factors on early and long‐term outcome [39]. Data obtained through the registry provide a base to formulate guidelines and recommendations [40].

      The Registry contains patient clinical data, including aspects of the diagnosis and disease, first‐line treatments, HSCT‐ or cell‐therapy‐associated procedures, transplant type, donor type, stem‐cell source, complications and outcome. Patients are followed up indefinitely. Basic donor information is included with these procedures and donor follow‐up data are entered. All Registry studies are performed under the supervision of one of the EBMT Working Parties.

      Late effects specific data collection

      The Transplant Complications Working Party (TCWP) leads efforts focused on complications and long‐term survivorship. The aim of the Transplant Complications Working Party is to conduct research as well as to provide education and expertise on the subject of non‐infectious complications after HCT. The major fields of interest of the TCWP include the following:

      Early complications e.g. graft failure, VOD/SOS, transplant‐associated microangiopathy (TAM), other endothelial syndromes, impact of co‐morbidities, toxicity of conditioning regimen and supportive care; Acute and cGVHD – all aspects from risk factors through diagnosis to treatment; Late effects – e.g. infertility, sexual dysfunction, secondary cancers, organ‐specific late complications, quality of life. Variables on late effects such as fertility and secondary cancers are collected in the MED‐B forms, while the MED‐A form contains a restricted set of variables. Cause of death is obviously recorded for every patients.

      Issues of long‐term survivorship data collection are many. Obviously data quality depends on the quality of education for data managers, a task taken seriously by the EBMT where data managers take part at annual education conferences to facilitate quality collection. Follow‐up at each center also poses a challenge, especially in a continent with many different countries and types of healthcare systems.

      Future areas of focus for the EBMT include specific description and analysis of long‐term complications associated with GVHD, description of quality of life, including in comparison with other treatment approaches, and more precise definition of late toxicities and secondary tumors in patients treated by HCT.

      Minako Iida, Yoshiko Atsuta, and Shinichiro Okamoto

      Introduction of the registry

      Asia‐Pacific Blood and Marrow Transplantation Group (APBMT) was initiated by transplant physicians from Australia, China, Hong Kong, India, Japan, Republic of Korea, Malaysia, and Taiwan in 1990 to share the information regarding hematopoietic cell transplantation (HCT) and promote collaborative basic and clinical studies. As of August 2019, APBMT comprised 22 countries/regions (Australia, Bangladesh, Cambodia, China, Hong Kong, India, Indonesia, Iran, Japan, Korea, Malaysia, Mongolia, Myanmar, Nepal, New Zealand, Pakistan, the Philippines, Singapore, Sri Lanka, Taiwan, Thailand, and Vietnam) and are leading a variety of issues regarding HCT in the Asia‐Pacific region.

      APBMT established the Asian Blood and Marrow Transplantation registry (Asian BMT registry) at the 11th Annual Congress of APBMT in Nagoya, Japan in 2006.

      Data collection

      APBMT Data Center launched the APBMT Outcome Registry in 2009, and are collecting individual patient data using the Least Minimum Dataset (LMD). When data collection started, data were submitted on Excel spreadsheets in PDF (hard copy). The collection rate remained at approximately 40% of HCTs reported through the annual APBMT Activity Survey as of 2018. The APBMT Outcome Registry accepts data registered through national registries. The countries/regions with active national registries submitting data to the APBMT Outcome Registry include Australia/New