[A medical-pharmaceutical partnership model as a contributor to the success in conditioning regimen for allogenic hematopoietic stem cell transplantation in adults: a cross-reflection on our organizations].
Allogeneic hematopoietic stem-cell transplant (allo-SCT) remains the only cure for many hematological malignancies and some benign and congenital diseases. Busulfan, proposed in its injectable form, has quickly become a mainstay of pharmacological and myeloablative (or non-myeloablative) conditioning. This is following the outbreak in 2010 of a multicenter international clinical phase II trial, we tested the robustness and reliability of our organization in a complex model of organization and multifactorial partnership. In this type "BuCy2" protocol based on a classical treatment duration of 4 consecutive days, the administration of IV busulfan is given in one single daily infusion instead of the conventional 16 infusions, while keeping the same total dose. Under these conditions, the treatment is totally secured using a therapeutic drug monitoring of busulfan, applied in real-time. The process is technically complex and requires the very close cooperation of the teams involved. A strength, weakness, opportunity and threat (SWOT) analysis has been constructed; it fully supports continuous quality improvement to the triple benefit of the nursing chain, the patients and their environment. Several critical points were identified and corrected. The experiment strongly contributes to the safety and security of the medication circuit at the hospital and, improves the performance of allo-SCT. It also contributes to the protection of all actors in the health field and their working environment via a well-functioning quality management system.
Groupe hospitalier Necker-Enfants malades, service de pharmacie clinique, 149, rue de Sèvres, 75743 Paris Cedex 15, France. philippe.bourget@nck.aphp.fr
Philippe
P
Bourget
Ludivine
L
Falaschi
Felipe
F
Suarez
Valérie
V
Galland
Dominique
D
Blot
Caroline
C
Trompette
David
D
Sibon
Flore Sicre de
FS
Fontbrune
Christophe
C
Merlette
Fabrice
F
Vidal
Odile
O
Corriol
Bérénice
B
Giraud
Christine
C
Broissand
Rozenn
R
Clement
Olivier
O
Hermine
D000328:Adult; D002066:Busulfan / Q000008:administration & dosage* / Q000276:immunology; D017322:Clinical Trials, Phase II as Topic; D018380:Hematopoietic Stem Cell Transplantation / Q000592:standards; D006801:Humans; D007262:Infusions, Intravenous / Q000379:methods; D007373:Interinstitutional Relations; D017146:Models, Organizational; D015337:Multicenter Studies as Topic; D019653:Myeloablative Agonists / Q000008:administration & dosage* / Q000276:immunology; D058996:Quality Improvement; D019172:Transplantation Conditioning / Q000379:methods* / Q000592:standards; D014184:Transplantation, Homologous / Q000592:standards
D019653:Myeloablative Agonists; D002066:Busulfan