Abstract
In 2013, recommendations for a standardized practice in the prophylaxis and treatment of GvHD were adopted and published by the European Society for Blood and Marrow Transplantation and the European LeukemiaNet. One year later, all 341 European Society for Blood and Marrow Transplantation centres performing allogeneic haematopoietic stem cell transplantation were contacted for a change-control analysis and asked to fill in a questionnaire; 111 centres (33%) responded. Of these, 83% had been aware of the recommendations. Paediatric centres (P=0.004), centres with shorter programme duration (P=0.049), not JACIE (the Joint Accreditation Committee of the International Society for Cellular Therapy and the European Society for Blood and Marrow Transplantation)-accredited centres (P=0.010) and centres from middle-income countries (P=0.033) were more likely to be unaware of the recommendations. Thirty-eight per cent of the centres regarded the recommendations as relevant guidelines affecting their policies, 61% as interesting information. Thirty per cent had decided to make changes in their institutional protocols based on the recommendations. More than 80% were willing to use the recommendations for a control arm in randomized studies. This survey shows that the published recommendations had some, though insufficient, impact on the strategies and methods of allogeneic haematopoietic stem cell transplantation applied by the centres. It also identified some of the weaknesses to be addressed when releasing recommendations in the future.
References
Ferrara JL, Levine JE, Reddy P, Holler E . Graft-versus-host disease. Lancet 2009; 373: 1550–1561.
Socié G, Ritz J . Current issues in chronic graft-versus-host disease. Blood 2014; 124: 374–384.
Goldman JM, Gale RP, Horowitz MM, Biggs JC, Champlin RE, Gluckman E et al. Bone marrow transplantation for chronic myelogenous leukemia in chronic phase. Increased risk for relapse associated with T-cell depletion. Ann Intern Med 1988; 108: 806–812.
Keever CA, Small TN, Flomenberg N, Heller G, Pekle K, Black P et al. Immune reconstitution following bone marrow transplantation: comparison of recipients of T-cell depleted marrow with recipients of conventional marrow grafts. Blood 1989; 73: 1340–1350.
Ruutu T, van Biezen A, Hertenstein B, Henseler A, Garderet L, Passweg J et al. Prophylaxis and treatment of graft versus host disease after haematopoietic stem cell transplantation: a survey of centre strategies by the European Group for Blood and Marrow Transplantation. Bone Marrow Transplant 2012; 47: 1459–1464.
Ruutu T, Gratwohl A, de Witte T, Afanasyev B, Apperley J, Bacigalupo A et al. Prophylaxis and treatment of GvHD: EBMT-ELN working group recommendations for a standardized practice. Bone Marrow Transplant 2014; 49: 168–173.
Passweg JR, Baldomero H, Bader P, Bonini C, Cesaro S, Dreger P et al. Hematopoietic SCT in Europe 2013: recent trends in the use of alternative donors showing more haploidentical donors but fewer cord blood transplants. Bone Marrow Transplant 2015; 50: 476–482.
Dignan F, Clark A, Amrolia P, Cornish J, Jackson G, Mahendra P et al. Diagnosis and management of acute graft-versus-host disease. Br J Haematol 2012; 158: 30–45.
Dignan F, Amrolia P, Clark A, Cornish J, Jackson G, Mahendra P et al. Diagnosis and management of chronic graft-versus-host disease. Br J Haematol 2012; 158: 46–61.
Baskerville NB, Liddy C, Hogg W . Systematic review and meta-analysis of practice facilitation within primary care settings. Ann Fam Med 2012; 10: 63–74.
Coory M, White VM, Johnson KS, Hill DJ, Jefford M, Harrison S et al. Systematic review of quality improvement interventions directed at cancer specialists. J Clin Oncol 2013; 31: 1583–1591.
Grumbach K, Bainbridge E, Bodenheimer T . Facilitating improvement in primary care: the promise of practice coaching. Issue Brief (Commonw Fund) 2012; 15: 1–14.
Duarte RF, Greinix H, Rabin B, Mitchell SA, Basak G, Wolff D et al. Uptake and use of recommendations for the diagnosis, severity scoring and management of chronic GvHD: an international survey of the EBMT-NCI Chronic GvHD Task Force. Bone Marrow Transplant 2014; 49: 49–54.
Schoemans H, Goris K, Durm RV, Vanhoof J, Wolff D, Greinix H et al. Development, preliminary usability and accuracy testing of the EBMT ‘eGvHD App’ to support GvHD assessment according to NIH criteria – a proof of concept. Bone Marrow Transplant 2016; 51: 1062–1065.
Author information
Authors and Affiliations
Consortia
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Additional information
Supplementary Information accompanies this paper on Bone Marrow Transplantation website
Supplementary information
Appendix
Appendix
Participating centres
Algeria, Centre Pierre et Marie Curie, Alger (703)
Austria, Medizinische Universitaet Wien, Vienna (227)
Austria, Elisabethinen-Hospital, Linz (594)
Belgium, Institut Jules Bordet, Brussels (215)
Belgium, Universitair Ziekenhuis Brussel, Brussels (234)
Croatia, University Hospital Center Zagreb (302)
Czech Republic, University Hospital Motol, Prague (452)
Czech Republic, University Hospital, Olomouc (574)
Czech Republic, Institute of Hematology and Blood Transfusion, Prague (656)
Czech Republic, Charles University Hospital, Pilsen (718)
Denmark, Rigshospitalet, Copenhagen (206)
Finland, Turku University Hospital, Turku (225)
Finland, Helsinki University Hospital, Helsinki (515)
France, CHU Bordeaux, Pessac (267)
France, CHRU de Lille - Hôpital HURIEZ, Lille (277)
France, Hôpital Robert Debre, Paris (631)
France, Gustave Roussy, Villejuif (666)
France, Centre Hospitalier Lyon Sud Pierre Benité, Lyon (671)
France, Hopital Saint-Antoine, Paris (213)
France, CHU Lapeyronie Montpellier (926)
Germany, Universitat Bonn (134)
Germany, Medical Center University of Tübingen (223)
Germany, University Hospital of Essen (259)
Germany, Hannover Medical School, Hannover (295)
Germany, Martin-Luther-Universität Halle-Wittenberg, Halle (338)
Germany, University Hospital Leipzig (389)
Germany, Heinrich Heine Universität, Dusseldorf (390)
Germany, University of Heidelberg (524)
Germany, University Hospital Eppendorf, Hamburg (614)
Germany, Klinikum Nürnberg (625)
Germany, University of Münster (680)
Germany, University of Saarland, Homburg (785)
Germany, University Hospital Erlangen (809)
Germany, University of Freiburg (810)
Greece, Patras University Medical School, Patras (281)
Greece, Evangelismos Hospital, Athens (622)
Greece, St.Savvas Oncology Hospital, Athens (751)
Israel, Chaim Sheba Medical Center, Tel-Hashomer (754)
Israel, Schneider Children's Medical Center of Israel, Petach-Tikva (755)
Italy, Institute G. Gaslini, Genova (274)
Italy, Centro Trapianti di Midollo Osseo - Ospedale San Gerardo, Monza (279)
Italy, Fondazione IRCCS Policlinico San Matteo, Pavia (286)
Italy, Ospedale S. Camillo-Forlanini, Rome (287)
Italy, Hospital San Maurizio, Bolzano (299)
Italy, Ospedale di Careggi, Florence (304)
Italy, Universita Cattolica S. Cuore – Gemelli, Rome (307)
Italy, Istituto Clinico Humanitas, Rozzano (354)
Italy, Ospedale V. Cervello, Palermo (392)
Italy, Centro Unico Regionate Trapianti Cellule Staminali e Terapie Cellulari, Reggio_Calabria (587)
Italy, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo (658)
Italy, Ospedale La Maddalena - Dpt. Oncologico, Palermo (692)
Italy, Azienda Ospedaliero Universitaria di Udine (705)
Italy, Azienda Ospedali Riuniti di Ancona (788)
Italy, Ospedale A. Businco Cagliari (791)
Italy, Azienda Policlinico Vittorio Emanuele, Catania (792)
Italy, Ospedale San Raffaele s.r.l., Milano (813)
Italy, H SS. Antonio e Biagio, Alessandria (825)
Lebanon, American University of Beirut Medical Center, Beirut (369)
Lithuania, Children's Hospital, Vilnius University Hospital Santariskiu Klinikos, Vilnius (508)
Lithuania, Vilnius University Hospital Santariskiu Klinikos, Vilnius (644)
Netherlands, Leiden University Medical Center, Leiden (203)
Norway, Haukeland University Hospital, Bergen (197)
Poland, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice (428)
Poland, University Children's Hospital in Krakow (507)
Poland, Lower Silesian Center for Cellular Transplantations, Wroclaw (538)
Poland, Institute of Hematology and Transfusion Medicine, Warsaw (693)
Poland, University Hospital, Collegium Medicum UMK, Bydgoszcz (764)
Poland, Central Clinical Hospital, Medical University of Warsaw (954)
Russia, National Research Center for Hematology, Moscow (930)
Saudi Arabia, King Faisal Specialist Hospital & Research Centre, Riyadh (397)
Serbia, Mother and Child Health Care Institute of Serbia 'Dr Vukan Cupic', Belgrade (358)
Spain, Hospital Clinic Barcelona (214)
Spain, Hospital Reina Sofia, Cordoba (238)
Spain, Hospital Clínico Universitario, Valencia (282)
Spain, Fundación Jiménez Díaz, Madrid (309)
Spain, Hospital Universitario Virgen de la Arrixaca, Murcia (323)
Spain, Complexo Hospitalario Universitario de Vigo (421)
Spain, Hospital de Gran Canaria 'Dr Negrin', Las Palmas (537)
Spain, ICO – Hospital Universitari Germans Trias i Pujol, Barcelona (613)
Spain, Hospital Clínico de Salamanca (727)
Spain, Clinica Puerta de Hierro, Madrid (728)
Spain, Niño Jesus Children's Hospital, Madrid (732)
Spain, ICO – Hospital Duran i Reynals, Barcelona (759)
Sweden, Karolinska University Hospital, Stockholm (212)
Sweden, Akademiska Sjukhuset, Uppsala (266)
Sweden, Skanes University Hospital, Lund (283)
Sweden, Sahlgrenska University Hospital, Goteborg (289)
Sweden, Umea University Hospital, Umea (731)
Sweden, University Hospital Linköping (740)
Switzerland, University Hospital Basel (202)
Tunisia, Centre National de Greffe de Moelle, Tunis (183)
Turkey, Hacettepe University, Ankara (168)
Turkey, Gazi University School of Medicine, Ankara (182)
Turkey, Hacettepe University Children's Hospital, Ankara (399)
Turkey, Ankara Bayindir Hospital (412)
Turkey, Erciyes University Hospital, Kayseri (627)
Turkey, Medical Park Antalya Hospital (911)
Turkey, Medical Park Goztepe Hospital, Istanbul (929)
Turkey, Florence Nightingale Sisli Hospital, Istanbul (994)
United Kingdom, Hammersmith Hospital, London (205)
United Kingdom, University College London Hospital, London (224)
United Kingdom, Beatson West of Scotland Cancer Centre, Glasgow (244)
United Kingdom, University Hospital Birmingham NHS Trust (387)
United Kingdom, Manchester Royal Infirmary (601)
United Kingdom, Southampton General Hospital (704)
United Kingdom, Nottingham University Hospital (717)
United Kingdom, St. Bartholomew's and The Royal London NHS Trust, London (768)
United Kingdom, Christie NHS Trust Hospital, Manchester (780)
United Kingdom, Plymouth Hospitals NHS Trust, Plymouth (823)
Rights and permissions
About this article
Cite this article
Ruutu, T., Gratwohl, A., Niederwieser, D. et al. The EBMT–ELN working group recommendations on the prophylaxis and treatment of GvHD: a change-control analysis. Bone Marrow Transplant 52, 357–362 (2017). https://doi.org/10.1038/bmt.2016.298
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/bmt.2016.298
- Springer Nature Limited