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von Asmuth EGJ, Putter H, Mohseny AB, Schilham MW, Snowden JA, Saccardi R, Lankester AC. Automating outcome analysis after stem cell transplantation: The YORT tool. Bone Marrow Transplant 2023; 58:1017-1023. [PMID: 37280431 DOI: 10.1038/s41409-023-02009-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 06/08/2023]
Abstract
Hematopoietic stem cell transplantation is a high-risk procedure. Auditing and yearly outcome reviews help keep optimal quality of care and come with increased survival, but also has significant recurring costs. When data has been entered in a standardized registry, outcome analyses can be automated, which reduces work and increases standardization of performed analyses. To achieve this, we created the Yearly Outcome Review Tool (YORT), an offline, graphical tool that gets data from a single center EBMT registry export, allows the user to define filters and groups, and performs standardized analyses for overall survival, event-free survival, engraftment, relapse rate and non-relapse mortality, complications including acute and chronic Graft vs Host Disease (GvHD), and data completeness. YORT allows users to export data as analyzed to allow you to check data and perform manual analyses. We show the use of this tool on a two-year single-center pediatric cohort, demonstrating how the results for both overall and event-free survival and engraftment can be visualized. The current work demonstrates that using registry data, standardized tools can be made to analyze this data, which allows users to perform outcome reviews for local and accreditation purposes graphically with minimal effort, and help perform detailed standardized analyses. The tool is extensible to be able to accommodate future changes in outcome review and center-specific extensions.
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Affiliation(s)
- Erik G J von Asmuth
- Department of Pediatrics, Willem Alexander Children's Hospital, Leiden, The Netherlands.
| | - Hein Putter
- Department of Medical Statistics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Alexander B Mohseny
- Department of Pediatrics, Willem Alexander Children's Hospital, Leiden, The Netherlands
| | - Marco W Schilham
- Department of Pediatrics, Willem Alexander Children's Hospital, Leiden, The Netherlands
| | - John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Riccardo Saccardi
- Cellular Therapy and Transfusion Medicine, Careggi University Hospital, Firenze, Italy
| | - Arjan C Lankester
- Department of Pediatrics, Willem Alexander Children's Hospital, Leiden, The Netherlands
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WBMT Special Article on Key Elements in Quality and Accreditation in Hematopoietic Stem Cell Transplantation and Cellular Therapy. Transplant Cell Ther 2022; 28:455-462. [PMID: 35413459 DOI: 10.1016/j.jtct.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/23/2022] [Accepted: 04/04/2022] [Indexed: 11/23/2022]
Abstract
Hematopoietic stem cell transplantation (HSCT) represents an example of a highly complex and costly medical procedure with major applications in hematology and oncology. It is associated with life threatening complications and, consequently, increases demands on healthcare resources. While improving quality is an integral component of the healthcare strategic planning, drivers of quality may be variable and there is logical debate as to what drives quality in HSCT. Also, HSCT programs differ in their structures and availability of resources which drive the type of transplant and determine what is affordable and/or economically feasible. The complexity of HSCT procedure with involvement of different stakeholders necessitates not only regulatory frameworks but also robust quality systems to ensure consistent standards, demonstrate transparency for regulators, and define what quality means within the HSCT program. In an era of escalating healthcare complexity and heightened fiscal responsibility, transparency and accountability, accreditation contributes to ensuring that care meets the highest standards, and can serve as a risk mitigation strategy. Quality management has become an indispensable tool for the management of a complex medical intervention such as HSCT. It allows the transplant team to monitor its activities and identify areas for continuous improvement. The Worldwide Network for Blood and Marrow Transplantation (WBMT) had invited a group of international experts in HSCT and quality management to work on providing a summary document about the key elements in quality and accreditation in HSCT and highlight the foremost challenges of implementing them with special focus on low- and middle-income economies (LMIEs).
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Snowden JA, McGrath E, Orchard K, Kröger N, Sureda A, Gratwohl A. Visions for a JACIE Quality Management System 4.0. Bone Marrow Transplant 2021; 56:2876-2881. [PMID: 34588628 PMCID: PMC8479268 DOI: 10.1038/s41409-021-01467-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 08/30/2021] [Accepted: 09/09/2021] [Indexed: 11/13/2022]
Abstract
Quality management has been part of hematopoietic stem cell transplantation (HSCT) from the very beginning. It evolved step-wise from open data exchange up to the introduction of the FACT/JACIE-based quality management system (QMS) 2 decades ago. This formal step has eased cooperation, and improved outcome for patients. Today’s expansion of cellular and targeted therapies and new drugs, and the regulatory requirements for advanced therapeutic medicinal products have touched the limits of the current system. Based on the Medicine 4.0 concept, the next step should integrate novel views of QMS. The old definition “Best Quality Transplant” will be replaced by “Optimal Treatment,” and encompass the entire health care journey. “Best outcome” will refer to overall survival, quality of life and costs, with or without HSCT, and will be compatible with all requirements by competent authorities. Decisions will be based on high-level evidence, supported by real-time digitized data collection, data analysis, incorporated into artificial-intelligence systems. To reach this goal, EBMT/JACIE will be challenged to start the process by further fostering harmonization within and between organizations at institutional, national, and European levels. Acceleration in information technology and modifications to working practices during the pandemic should facilitate this development to the next stage.
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Affiliation(s)
- John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Kim Orchard
- Department of Haematology, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Hospital Eppendorf, Hamburg, Germany
| | - Anna Sureda
- Catalan Institute of Oncology, Barcelona, Spain
| | - Alois Gratwohl
- Hematology, Medical Faculty, University of Basel, Basel, Switzerland.
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Fernandes RAML, de Oliveira Lima JT, da Silva BH, Sales MJT, de Orange FA. Development, implementation and evaluation of a management specialization course in oncology using blended learning. BMC MEDICAL EDUCATION 2020; 20:37. [PMID: 32028935 PMCID: PMC7006068 DOI: 10.1186/s12909-020-1957-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 01/30/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Identifying effective methods for safeguarding the efficient functioning of the healthcare system contributes significantly towards establishing a successful healthcare organization. Consequently, quality management programs are currently being implemented in healthcare as a vital strategy for patient care. Quality management encompasses protocols and guidelines in decision-making and in the evaluation of processes and treatment flowcharts, data analysis and health indicators, and addresses improvement in the interaction between different health professionals. Qualifying health professionals to perform quality management has represented a barrier to implementing a well-structured management system. Indeed, the pathway to qualifying health managers is often poorly outlined, with clear gaps in the definition of their competencies, training and career plans. Therefore, studies and education-related actions aimed at qualifying health professionals in management are vital if health services of excellence are to be established. The present study aimed to plan, develop, implement and evaluate a management specialization course in oncology using blended learning. METHODS Following approval by the institution's internal review board, the study was conducted at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP). The Analysis, Design, Development, Implementation and Evaluation (ADDIE) model was used to plan, develop, implement and evaluate the course. Data were collected as the course participants who had concluded all the modules evaluated the program. RESULTS A management course in oncology, consisting of ten sequential modules, was developed and implemented between March 2018 and February 2019. The course consisted of monthly face-to-face encounters, each with 12 h of activities, and distance education using a virtual learning environment. Each module was presented by a specialist on the subject in question. After the end-of-course conclusion work had already been handed in and evaluated by the tutors, the participants completed a form to assess the course using Kirkpatrick's training evaluation model. CONCLUSIONS A management course in oncology was developed using the ADDIE model. A high degree of satisfaction was found among the participants regarding improvements in their management skills and their professional behavior. The expectation is that this initiative will ultimately improve healthcare and reduce costs, as well as encourage further innovative educational actions for health professionals.
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Affiliation(s)
- Raphaella Amanda Maria Leite Fernandes
- Comprehensive Healthcare, Instituto de Medicina Integral Prof. Fernando Figueira, Setor de Pós-graduação Stricto Sensu, R. dos Coelhos 300, Boa Vista, Recife, Pernambuco, 50070-550, Brazil.
- Olinda School of Medicine, Recife, Pernambuco, Brazil.
| | - Jurema Telles de Oliveira Lima
- Oncology Department, Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Pernambuco, Brazil
- Faculdade Pernambucana de Saúde, Recife, Pernambuco, Brazil
| | - Bruno Hipólito da Silva
- Distance Education Center, Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Pernambuco, Brazil
| | - Mozart Júlio Tabosa Sales
- Comprehensive Healthcare, Instituto de Medicina Integral Prof. Fernando Figueira, Setor de Pós-graduação Stricto Sensu, R. dos Coelhos 300, Boa Vista, Recife, Pernambuco, 50070-550, Brazil
| | - Flávia Augusta de Orange
- Faculdade Pernambucana de Saúde, Recife, Pernambuco, Brazil
- Teaching Hospital of the Federal University of Pernambuco, Recife, Pernambuco, Brazil
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Repaczki-Jones R, Hrnicek AK, Heissenbuttel A, Devine S, Fernandez H, Anasetti C. Defining Competency to Empower Blood and Marrow Transplant and Cellular Immunotherapy Quality Management Professionals in Healthcare. Biol Blood Marrow Transplant 2019; 25:179-182. [DOI: 10.1016/j.bbmt.2018.08.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 08/08/2018] [Indexed: 10/28/2022]
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JACIE accreditation for blood and marrow transplantation: past, present and future directions of an international model for healthcare quality improvement. Bone Marrow Transplant 2017; 52:1367-1371. [PMID: 28346416 PMCID: PMC5629362 DOI: 10.1038/bmt.2017.54] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 02/13/2017] [Indexed: 01/04/2023]
Abstract
Blood and marrow transplantation (BMT) is a complex and evolving medical speciality that makes substantial demands on healthcare resources. To meet a professional responsibility to both patients and public health services, the European Society for Blood and Marrow Transplantation (EBMT) initiated and developed the Joint Accreditation Committee of the International Society for Cellular Therapy and EBMT-better known by the acronym, JACIE. Since its inception, JACIE has performed over 530 voluntary accreditation inspections (62% first time; 38% reaccreditation) in 25 countries, representing 40% of transplant centres in Europe. As well as widespread professional acceptance, JACIE has become incorporated into the regulatory framework for delivery of BMT and other haematopoietic cellular therapies in several countries. In recent years, JACIE has been validated using the EBMT registry as an effective means of quality improvement with a substantial positive impact on survival outcomes. Future directions include development of Europe-wide risk-adjusted outcome benchmarking through the EBMT registry and further extension beyond Europe, including goals to faciliate access for BMT programmes in in low- and middle-income economies (LMIEs) via a 'first-step' process.
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The commitment and evaluation of the quality management plan by professionals from accredited stem cell transplant centers in Spain. Bone Marrow Transplant 2014; 49:990-2. [PMID: 24777187 DOI: 10.1038/bmt.2014.85] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Gratwohl A, Brand R, McGrath E, van Biezen A, Sureda A, Ljungman P, Baldomero H, Chabannon C, Apperley J. Use of the quality management system "JACIE" and outcome after hematopoietic stem cell transplantation. Haematologica 2014; 99:908-15. [PMID: 24488562 DOI: 10.3324/haematol.2013.096461] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Competent authorities, healthcare payers and hospitals devote increasing resources to quality management systems but scientific analyses searching for an impact of these systems on clinical outcome remain scarce. Earlier data indicated a stepwise improvement in outcome after allogeneic hematopoietic stem cell transplantation with each phase of the accreditation process for the quality management system "JACIE". We therefore tested the hypothesis that working towards and achieving "JACIE" accreditation would accelerate improvement in outcome over calendar time. Overall mortality of the entire cohort of 107,904 patients who had a transplant (41,623 allogeneic, 39%; 66,281 autologous, 61%) between 1999 and 2006 decreased over the 14-year observation period by a factor of 0.63 per 10 years (hazard ratio: 0.63; 0.58-0.69). Considering "JACIE"-accredited centers as those with programs having achieved accreditation by November 2012, at the latest, this improvement was significantly faster in "JACIE"-accredited centers than in non-accredited centers (approximately 5.3% per year for 49,459 patients versus approximately 3.5% per year for 58,445 patients, respectively; hazard ratio: 0.83; 0.71-0.97). As a result, relapse-free survival (hazard ratio 0.85; 0.75-0.95) and overall survival (hazard ratio 0.86; 0.76-0.98) were significantly higher at 72 months for those patients transplanted in the 162 "JACIE"-accredited centers. No significant effects were observed after autologous transplants (hazard ratio 1.06; 0.99-1.13). Hence, working towards implementation of a quality management system triggers a dynamic process associated with a steeper reduction in mortality over the years and a significantly improved survival after allogeneic stem cell transplantation. Our data support the use of a quality management system for complex medical procedures.
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Ferrà C, Jiménez-Lorenzo MJ, Feliu E, Ribera JM. [Analysis of the implementation of a Joint Accreditation Committee of the International Society for Cellular Therapy and European Group for Blood and Marrow Transplantation acreditation in a clinical program of hematopoietic progenitor cell transplantation]. Med Clin (Barc) 2011; 137:126-30. [PMID: 20303546 DOI: 10.1016/j.medcli.2010.01.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 01/21/2010] [Accepted: 01/26/2010] [Indexed: 11/28/2022]
Affiliation(s)
- Christelle Ferrà
- Servicio de Hematología Clínica, Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, España.
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Gratwohl A, Brand R, Niederwieser D, Baldomero H, Chabannon C, Cornelissen J, de Witte T, Ljungman P, McDonald F, McGrath E, Passweg J, Peters C, Rocha V, Slaper-Cortenbach I, Sureda A, Tichelli A, Apperley J. Introduction of a quality management system and outcome after hematopoietic stem-cell transplantation. J Clin Oncol 2011; 29:1980-6. [PMID: 21483006 DOI: 10.1200/jco.2010.30.4121] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE A comprehensive quality management system called JACIE (Joint Accreditation Committee International Society for Cellular Therapy and the European Group for Blood and Marrow Transplantation), was introduced to improve quality of care in hematopoietic stem-cell transplantation (HSCT). We therefore tested the hypothesis that the introduction of JACIE improved patient survival. PATIENTS AND METHODS Data on 41,623 allogeneic (39%) and 66,281 autologous (61%) HSCTs for an acquired hematologic disorder performed between 1999 and 2007 by 421 teams in Europe were used to assess the outcomes of patients who received a transplantation at baseline (> 3 years before application or no application), during preparation (3 years before application), during application (time from application to accreditation), and after JACIE accreditation. The analysis was clustered by team and stratified for year of HSCT, donor type, disease, conditioning, and gross national income per capita of the respective country. Patient's risks were adjusted for by their European Group for Blood and Marrow Transplantation score. RESULTS Patient outcome was systematically better when the transplantation center was at a more advanced phase of JACIE accreditation, independent of year of transplantation and other risk factors. Improvement was robust as quantified for relapse-free survival after allogeneic HSCT compared with baseline by a hazard ratio (HR) of 0.96 (95% CI, 0.90 to 1.03; P = .22) for preparation, 0.95 (95% CI, 0.88 to 1.03; P = .20) for application, and 0.86 (95% CI, 0.78 to 0.95; P = .01) for the accreditation (test for trend P = .01). Improvement from baseline was similar after autologous HSCT (HR for accreditation, 0.83; 95% CI, 0.74 to 0.93; P < .01). CONCLUSION Even with all the limitations of an observational study, these findings support the hypothesis that introduction of a comprehensive clinical quality management system is associated with improved outcome of patients after HSCT.
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Affiliation(s)
- Alois Gratwohl
- European Group for Blood and Marrow Transplantation Activity Survey Office, University Hospital, Basel, Switzerland.
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Iannalfi A, Bambi F, Tintori V, Lacitignola L, Bernini G, Mariani MP, Sanvito MC, Pagliai F, Brandigi F, Muscarella E, Tapinassi F, Faulkner L. Peripheral blood progenitor uncontrolled-rate freezing: a single pediatric center experience. Transfusion 2007; 47:2202-6. [PMID: 17714421 DOI: 10.1111/j.1537-2995.2007.01447.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Controlled-rate freezing (CRF) followed by storage in liquid nitrogen is employed by most centers as the standard procedure for peripheral blood progenitor cell (PBPC) cryopreservation. Uncontrolled-rate freezing (URF) at -80 degrees C is more simple, time-saving, less expensive, and, possibly, as effective as CRF. The aim of this retrospective analysis was to compare CRF and URF in childhood transplantation. STUDY DESIGN AND METHODS A total of 54 PBPC transplants performed in 39 children aged 3 to 16 years (median, 9.5 years) were analyzed: 23 transplants in 16 children with CRF versus 31 transplants performed in 23 children with -80 degrees C URF. All grafts contained at least 2 x 10(6) per kg unselected CD34+ cells, enumerated before freezing. Nucleated cells infused ranged from 1.32 x 10(8) to 4.3 x 10(8) per mL with a median of 3.1 x 10(8) per mL. Cryoprotectant solution consisted of a final dimethyl sulfoxide (DMSO) concentration of 10 percent DMSO with autologous plasma. RESULTS The two study groups did not differ in terms of timing of neutrophil and platelet recovery or transfusion requirements. Adverse events related to graft infusion, severe complications, and transplant-related mortality were not significantly different between CRF and URF groups. In both groups only mild adverse events were observed during graft administration. URF procedures, however, were simpler and less expensive. At a median follow-up of 72 months, no secondary myelodysplasia was observed in either group. CONCLUSION Our analysis suggests that URF is safe and effective in the pediatric population.
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Affiliation(s)
- Alberto Iannalfi
- Stem Cell Transplantation Unit, Department of Hematology-Oncology, A. Meyer Pediatric Hospital, University of Florence, Florence, Italy.
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Samson D, Slaper-Cortenbach I, Pamphilon D, McGrath E, McDonald F, Urbano Ispizua A. Current status of JACIE accreditation in Europe: a special report from the Joint Accreditation Committee of the ISCT and the EBMT (JACIE). Bone Marrow Transplant 2007; 39:133-41. [PMID: 17245423 DOI: 10.1038/sj.bmt.1705564] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
JACIE (Joint Accreditation Committee of the ISCT and the EBMT) launched its first official inspection programme in January 2004. Since then, 35 centres in Europe have been inspected. Almost all were found to be functioning at a high level of excellence, with the majority having only minor deficiencies in compliance with the standards. In one-third of centres there were more significant deficiencies. The most common deficiencies were in quality management, and a survey of the applicant centres confirmed this was the area where centres experienced most difficulty in preparation for accreditation. Following correction of deficiencies, 28 centres have at the time of writing achieved full accreditation. Implementation of JACIE required a significant investment of time and resources by applicant centres. The majority required at least 18 months to prepare for accreditation and 85% needed to employ a quality manager and/or data manager on an ongoing basis. However, all centres felt their programme had benefited from the implementation of JACIE. In addition to the inspection and accreditation of individual centres, JACIE maintains an educational programme including training courses for inspectors and for centre preparation. JACIE is also working closely with other international organisations working in cellular therapy to develop international standards for all aspects of stem cell transplant. The recent implementation of Directive 2004/23/EC has provided an impetus for the implementation of JACIE in EU member states and in particular the requirements for safety of imported tissues and cells have emphasised the need for global harmonisation.
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Affiliation(s)
- D Samson
- JACIE Accreditation Office, EBMT Secretariat, Hospital Clínic de Barcelona, Barcelona, Spain
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Arpagaus M, Leibundgut EO, Zbären K, Brunold C, Ischi E, Tobler A, Zwicky C. Real-time process/quality control for HPC processing. Cytotherapy 2004; 6:505-13. [PMID: 15512917 DOI: 10.1080/14653240410005032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND JACIE Standards (FACT Standards in the USA) have been implemented in Europe since 1999. An on-site accreditation inspection took place at our center in January 2004. The purpose of this work was to develop a real-time process/quality control system meeting the JACIE Standards for HPC release. METHODS Data from 194 HPC processing procedures for autologous transplantation performed over a 5-year period were analyzed. The results of different processing methods applied at our facility were compared: (1) cryopreservation without washing cells (n=50), (2) washing cells (n=87), (3) cell-density separation (n=12) and (4) positive CD34 selection (n=45). RESULTS Four critical control points were set for the validation of HPC processing: (a) number of lost CD34(+) cells during processing, (b) contamination, (c) viability of the cells after thawing and (d) ability to reconstitute hematopoiesis after transplantation. On the basis of statistical analysis, ranges of acceptable values were defined for each critical control point and for each processing method. Those acceptable values were used for cell release and real-time quality control. DISCUSSION This study describes a model for the validation of HPC processing and for a real-time process/quality control system for HPC release. Optimization of processing techniques, standardization of methods and comparison between facilities will open the way towards external quality controls and quality improvement.
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Affiliation(s)
- M Arpagaus
- Hematology Department, University Hospital Inselspital, Berne, Switzerland
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