A survey of infectious disease clinical practices among paediatric blood and marrow transplant programmes in the United States

Chelsea Balian, Neena Kapoor, Ami Shah, Hisham Abdel-Azim, Kris Mahadeo*

Author address: 

Los Angeles, US


Objectives: In 2009, the American and European Societies of Blood and Marrow Transplantation in conjunction with several other key organizations, developed joint guidelines for the prevention of infectious complications among Blood and Marrow Transplant (BMT) recipients.1 It is unclear, the extent to which these guidelines have been implemented among Pediatric BMT (PBMT) centers. In addition, because BMT is a dynamic field, it is also unknown the extent to which clinical practice patterns have now changed with emerging literature. 
Methods: We conducted an online survey study (via anonymous email link) to assess common practices related to the care of the PBMT recipient among 64 clinical program directors (PD) of PBMT Centers in the United States, which are accredited by the Foundation for the Accreditation of Cellular Therapy (FACT). 
Results: The overall response rate was 56% (complete responses, n=24; partial responses {>50% <100%, questions answered}, n=12). Tables I and II summarize the response data. A comparison of reported practices with the expert recommendations is provided in both tables. Similar clinical practice patterns are reported among the majority of PBMT centers with regard to (1) the use of intravenous immune globulin (2) indications to initiate therapy for cytomegalovirus (CMV), adenovirus and BK virus; (3) criteria used to test for/ change therapy when CMV resistance is suspected; (4) use of inhaled ribavarin for respiratory syncitial virus (RSV); (5) prophylactic antibiotic coverage; (6) use of voriconazole in the setting of aspergillosis; (7) hospital visitation and home environment precautions. Clinical practice patterns regarding surveillance for late onset CMV was the least consistent and varied from the recommendations of the joint guidelines. 57% of PBMT centers do not monitor voriconazole levels (the lack of recommendation in the joint guidelines and associated clinical practice is incongruent with emerging data). 
Conclusion: Similar clinical practice patterns regarding infectious diseases, are reported among the majority of PBMT centers which are accredited by FACT in the United States. However, there is reported variation among PBMT centers regarding surveillance for late onset CMV. There also appears to be an evidence-gap regarding the need for monitoring of voriconazole levels among PBMT patients. 
1. Tomblyn M, et al. Guidelines for Preventing Infectious Complications among HSCT Recipients: A Global Perspective. BBMT. 15: 1143-1238. 2009. 



Full conference title: 

Annual Meeting of European Society for Blood and Marrow Transplantation
    • EBMT 39th (2013)