This dearth of data underscores the importance placed on individualized patient care that involves shared decision making between the provider and the patient and family. These recommendations, however, are generally based on low certainty in the evidence. The importance of the patient’s and family’s preferences remained central to the discussion and associated recommendations. The recommendations for HSCT in patients with SCD are presented in terms of the primary SCD-related complications of concern, the age of the patient, and the type of transplantation under discussion. ![]() Interpretation of good practice statements An evaluation of the conditions and criteria (and the related judgments, research evidence, and additional considerations) that determined the conditional (rather than strong) recommendation will help identify research gaps. Performance measures about the suggested course of action should focus on whether an appropriate decision-making process is duly documented.įor researchers: This recommendation is likely to be strengthened (for future updates or adaptation) by additional research. Decision aids may be useful in helping individuals make decisions consistent with their individual risks, values, and preferences.įor policy makers: Policy making will require substantial debate and involvement of various stakeholders. Decision aids may be useful in helping patients to make decisions consistent with their individual risks, values, and preferences.įor clinicians: Different choices will be appropriate for individual patients, and clinicians must help each patient arrive at a management decision consistent with the patient’s values and preferences. Future research should include the development of a robust SCD registry to serve as a comparator for HSCT studies.įor patients: A majority of individuals in this situation would want the suggested course of action, but many would not. Key recommendations include considering HSCT for those with neurologic injury or recurrent acute chest syndrome at an early age and to improve nonmyeloablative regimens. Results: The panel agreed on 8 recommendations to help patients and providers assess how individuals with SCD should consider the timing and type of HSCT.Ĭonclusions: The evidence review yielded no randomized controlled clinical trials for HSCT in SCD therefore, all recommendations are based on very low certainty in the evidence. ![]() The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, including GRADE Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subject to public comment. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. ![]() The Mayo Evidence-Based Practice Research Program supported the guideline development process, including performing systematic evidence reviews (through 2019). Methods: The multidisciplinary guideline panel formed by ASH included 2 patient representatives and was balanced to minimize potential bias from conflicts of interest. Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and health professionals in their decisions about HSCT for SCD. Hematopoietic stem cell transplantation (HSCT) is currently the only curative intervention for SCD however, guidelines are needed to inform how to apply HSCT in clinical practice. Background: Sickle cell disease (SCD) is a life-limiting inherited hemoglobinopathy that results in significant complications and affects quality of life.
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