title: Hematopoietic stem cell transplantation practice variation among centers in the Eastern Mediterranean Region (EMRO): Eastern Mediterranean Bone Marrow Transplantation (EMBMT) group survey.
abstract: BACKGROUND
  This practice survey is conducted to analyze clinical hematopoietic stem cell transplantation (HSCT) practice variability among centers in the WHO Eastern Mediterranean Region (EMRO), as represented by the Eastern Mediterranean Blood and Marrow Transplantation (EMBMT) group.
  
  
  METHODS
  This internet based survey was completed by the medical program directors of the EMBMT centers; 17 centers participated. The survey collected data on various clinical aspects of HSCT practice.
  
  
  RESULTS
  Consistency in pre HSCT cardiac (100%), pulmonary (82%) and viral screen (100%) was observed. Obtaining informed consent was universal. Pre-HSCT psychological assessment is practiced in 50% of the centers. All centers used single-bedded rooms with HEPA filters. Visitor policy during neutropenic phase and the use of gowns, masks or gloves when examining patients varied among centers. MRSA/VRE screen and use of low bacterial diet were applied in 65% and 82%, respectively. Anti-bacterial prophylaxis is employed in 58% (Auto-SCT) and 60% (Allo-SCT) of the centers. Drug choice varied (cotrimoxazole, ciprofloxacin, levofloxacin, piperacillin-tazobactam); 60% of the centers used penicillin prophylaxis in GVHD patients. PCP prophylaxis is applied in 58% (Auto-SCT) and 87% (Allo-SCT) of the centers; cotrimoxazole is usually used. Anti-viral prophylaxis with acyclovir or, less commonly, valacyclovir is used in 70% (Auto-SCT) and 93% (Allo-SCT) of centers. Anti-fungal prophylaxis is applied in 70% (Auto-SCT), 93% (myeloablative Allo-SCT) and 87% (reduced intensity [RIC] Allo-SCT). Fluconazole is used in all Auto-SCT and majority of Allo-SCT recipients; few centers used other agents (itraconazole, voriconazole, amphotericin B) in Allo-SCT. Prophylactic GCSF use varied among centers: Auto-SCT 77%, myeloablative Allo-SCT 33%, RIC Allo-SCT 27%. Use of ursodeoxycholic acid for venoocclusive disease (VOD) prophylaxis is variable: 60% (Allo-SCT) and 12% (Auto-SCT). Cyclosporine/methotrexate is the most commonly used GVHD prophylaxis in myeloablative Allo-SCT (93%); heterogeneity was seen in RIC SCT. Treatment of steroid refractory acute GVHD varied (ATG 53%, higher steroid dose 40%). CMV monitoring varied between antigenemia (53%) and PCR (40%) techniques. Pre-emptive anti CMV therapy is used in 86% of the centers, while 7% used routine CMV prophylaxis; 7% had no specific CMV management policy.
  
  
  CONCLUSIONS
  Consistency was observed in areas of pre-SCT work up, use of single rooms, HEPA filters and GVHD prophylaxis. Heterogeneity is observed in other practice aspects including other isolation measures, anti-microbial prophylaxis, VOD prophylaxis, growth factor use and treatment of steroid refractory GVHD. Further studies are needed to probe the impact of such practice variations on post-transplant outcome and to ascertain the best clinical practice approach.
authors.affiliation: King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. wrasheed@kfshrc.edu.sa
authors.forename: Walid
authors.initials: W
authors.lastname: Rasheed
authors.forename: Ardeshir
authors.initials: A
authors.lastname: Ghavamzadeh
authors.forename: Rosemarie
authors.initials: R
authors.lastname: Hamladji
authors.forename: Tarek
authors.initials: T
authors.lastname: Ben Othman
authors.forename: Amal
authors.initials: A
authors.lastname: Alseraihy
authors.forename: Fawzi
authors.initials: F
authors.lastname: Abdel-Rahman
authors.forename: Alaa
authors.initials: A
authors.lastname: Elhaddad
authors.forename: Abdulaziz
authors.initials: A
authors.lastname: Alabdulaaly
authors.forename: David
authors.initials: D
authors.lastname: Dennison
authors.forename: Ahmad
authors.initials: A
authors.lastname: Ibrahim
authors.forename: Ali
authors.initials: A
authors.lastname: Bazarbachi
authors.forename: Mohamed-Amine
authors.initials: MA
authors.lastname: Bekadja
authors.forename: Said Yousuf
authors.initials: SY
authors.lastname: Mohamed
authors.forename: Salman Naseem
authors.initials: SN
authors.lastname: Adil
authors.forename: Parvez
authors.initials: P
authors.lastname: Ahmed
authors.forename: Said
authors.initials: S
authors.lastname: Benchekroun
authors.forename: Mani
authors.initials: M
authors.lastname: Ramzi
authors.forename: Mohammad
authors.initials: M
authors.lastname: Jarrar
authors.forename: Kamran
authors.initials: K
authors.lastname: Alimoghaddam
authors.forename: Fazal
authors.initials: F
authors.lastname: Hussain
authors.forename: Amir
authors.initials: A
authors.lastname: Hamidieh
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Aljurf
mesh_terms: D000047:Academies and Institutes; D000890:Anti-Infective Agents / Q000627:therapeutic use; D016572:Cyclosporine / Q000627:therapeutic use; D003625:Data Collection; D006086:Graft vs Host Disease / Q000517:prevention & control; D013006:Growth Hormone / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation / Q000295:instrumentation / Q000379:methods; D006801:Humans; D019083:Mediterranean Region; D008727:Methotrexate / Q000627:therapeutic use; D011668:Pulmonary Veno-Occlusive Disease / Q000517:prevention & control; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
chemical_list: D000890:Anti-Infective Agents; D014580:Ursodeoxycholic Acid; D016572:Cyclosporine; D013006:Growth Hormone; D008727:Methotrexate