| Variation in management of immune suppression after allogeneic hematopoietic cell transplantation. | |
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MedLine Citation:
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PMID: 21440079 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Practice variation in transplant physician management of immune suppression (IS) after allogeneic hematopoietic cell transplantation (HCT) is anticipated to have important consequences, but has not been characterized to date. We conducted a national survey of transplant physician members of the American Society for Blood and Marrow Transplantation to discern variation in IS management, characterize the burden of GVHD emerging in the setting of IS taper, and describe the proportion of HCT recipients who successfully discontinue IS by 2 and 5 years post-HCT. There was marked heterogeneity in IS discontinuation practice, with variation in initiation of taper, sequence of agents tapered, frequency of changes, and strategy utilized. Twenty-five percent reported no consistent strategy in their usual practice. Confidence in therapeutic decision making was limited. The majority indicated that they could not predict who would develop GVHD on taper of IS, and reported a resultant burden of both acute and chronic GVHD emerging or recurring in the setting of IS taper. HCT physicians projected rates of IS discontinuation that increased from 2 to 5 years post-HCT, and differed significantly according to donor relation and stem cell source utilized. The marked variation in practice, burden of GVHD emerging in the setting of IS taper, and limited confidence in therapeutic decision making all highlight shortcomings in an essential component of HCT physicians' scope of practice. These data argue for more rigorous study of IS management post-HCT so that evidence-based practice guidelines can be developed. |
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Authors:
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Joseph Pidala; Stephanie J Lee; Gwen Quinn; Heather Jim; Jongphil Kim; Claudio Anasetti |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-3-23 |
Journal Detail:
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Title: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation Volume: - ISSN: 1523-6536 ISO Abbreviation: - Publication Date: 2011 Mar |
Date Detail:
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Created Date: 2011-3-28 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9600628 Medline TA: Biol Blood Marrow Transplant Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2011. Published by Elsevier Inc. |
Affiliation:
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Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, Fl; Oncologic Sciences, University of South Florida, Tampa, Fl. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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