![]() 19 Design and Methods Selection of the panel In the modified version of the method, a face-to-face meeting with presentation of the results precedes the second round of rating. 18 The Delphi consensus method is characterized by the fact that participants rate the statements individually and anonymously in at least two rounds of evaluation. ![]() Therefore, the European Group for Blood and Marrow Transplantation (EBMT) launched a project to define indications for HDT-ASCR and for allogeneic transplantation in patients with FL in the rituximab era in Europe following a RAND-modified Delphi consensus method.Ĭonsensus methods are well-defined processes used in the health field to obtain expert opinion when no evidence-based data are available by providing a systematic, transparent and explicit method to reach consensus. In the absence of randomized controlled trials (RCT) addressing these questions, systematic reviews inevitably fail to provide conclusions helpful for clinical decision making, 17 whereas traditional narrative reviews are prone to be biased by the individual view and expertise of the authors. Moreover, the advent of reduced intensity conditioning regimens (RIC) has considerably reduced the mortality associated with allogeneic transplantation, broadening the population of patients who are potentially candidates for such a procedure and raising the question as to whether its benefits can outweigh those of HDT-ASCR. ![]() The demonstration that maintenance rituximab at relapse prolongs progression-free survival (PFS) (and, in some studies, overall survival, OS) 4– 7 has been used as an argument against consolidation of second remission with HDT-ASCR. This task has become even more difficult in recent years, thanks to the significant improvement in the outcome of patients with FL. ![]() Thus, defining the role of hematopoietic stem cell transplant (HSCT) in the therapeutic algorithm of patients with FL is one of the major challenges in the management of this disease. Although allogeneic transplantation and high-dose therapy with autologous stem cell rescue (HDT-ASCR) are effective treatment options, the considerable morbidity and mortality associated with these therapeutic options has to be taken into account. 1– 3 However, in spite of this, FL remains an incurable disease using standard therapies. In recent years, the significant advances in the management of patients with follicular lymphoma (FL) have resulted in a substantial improvement in their outcome. In the absence of evidence-based data, the consensus method used was a valuable tool to define indications for hematopoietic stem cell transplant in follicular lymphoma. No consensus was reached on the role of high-dose therapy with autologous stem cell rescue in low-risk first relapse, or on when an allotransplant should be preferred over high-dose therapy with autologous stem cell rescue. Consensus was reached that: 1) high-dose therapy with autologous stem cell rescue is not an appropriate option to consolidate first remission in patients responding to immuno-chemotherapy outside clinical trials 2) in patients with first chemo-sensitive relapse, high-dose therapy with autologous stem cell rescue is an appropriate option to consolidate remission, especially in patients with a short response after immuno-chemotherapy or with high-risk FLIPI 3) high-dose therapy with autologous stem cell rescue is also appropriate in second/subsequent chemo-sensitive relapses 4) allotransplant (preferably a reduced intensity conditioning-allotransplant) should be considered at relapse after high-dose therapy with autologous stem cell rescue. After pre-defining statements, these were individually/anonymously scored by each participant using a 9-point scale. In the absence of evidence-based data, a RAND-modified Delphi procedure was used by an expert panel. The aim of this project was to define indications for hematopoietic stem cell transplantation in follicular lymphoma in Europe.
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