Success of an International Learning Health Care System in Hematopoietic Cell Transplantation: The American Society of Blood and Marrow Transplantation Clinical Case Forum

Abstract

The ASBMT Clinical Case Forum (CCF) was launched in 2014 as an online secure tool to enhance interaction and communication among hematopoietic cell transplantation (HCT) professionals worldwide through the discussion of challenging clinical care issues. After 14 months, we reviewed clinical and demographical data on cases posted in the CCF from 1/29/2014 to 3/18/2015. A total of 137 cases were posted during the study period. Ninety-two cases (67%) were allogeneic HCT, 29 (21%) autologous HCT and in 16 (12%) the type of transplant (auto vs. allo) was still under consideration. The diseases most frequently discussed included non-Hodgkin lymphoma (NHL; n = 30, 22%), acute myeloid leukemia (AML; n = 23, 17%) and multiple myeloma (MM; n = 20, 15%). When compared with the US transplant activity reported by the US Department of Health and Human Services, NHL and acute lymphoblastic leukemia cases were overrepresented in the CCF while myeloma was underrepresented (P < 0.001). A total of 259 topics were addressed in the CCF with a median of two topics/case (range 1-6). Particularly common topics included whether transplant was indicated (n = 57, 41%), conditioning regimen choice (n = 44, 32%), and post-HCT complications after day 100 (n = 43, 31%). The ASBMT CCF is a successful tool for collaborative discussion of complex cases in the HCT community worldwide and may allow identification of areas of controversy or unmet need from clinical, educational and research perspectives.

Practice Patterns and Preferences Among Hematopoietic Cell Transplantation Clinicians

“…Thus, there may be a role for electronic platforms that facilitate the spread of personal experience and published data throughout the transplantation community, such as the recently launched American Society for Blood and Marrow Transplantation Clinical Case Forum [13]. There may also be a role for entities such as the CIBMTR to develop point-of-care risk calculators that can guide clinical decision-making, similar to Adjuvant Online (https://adjuvantonline.com/), which is used for breast cancer [14,15]. These calculators could integrate known risk indices, such as the HCT-CI, and emerging risk factors as these are identified, so that clinician estimates of efficacy or toxicity would vary appropriately based on the literature, rather than converging around similar estimates for most scenarios as we observed in the vignettes.…”

The three numbers you need to know about healthcare: the 60-30-10 Challenge

“…How then, can we use this knowledge and evidence from other examples [35][36][37] to break the impasse to achieve better, more cost-effective, and safer care? The 60-30-10 Challenge is ample warning against trudging along the same well-worn tracks to disappointment.…”

Social Media and the Adolescent and Young Adult (AYA) Patient with Cancer

“…A recent example of such a forum is the American Society of Blood and Marrow Transplantation Clinical Case Forum, which serves as a professional discussion forum for experts in stem cell transplantation (22). In the first year since its launch in early 2014, 137 cases have been posted and discussed.…”