ASH has long recognized the need for comprehensive guidelines and in the past three years has broken ground on developing and/or updating guidelines on several disease types, including venous thromboembolism (VTE), immune thrombocytopenia (ITP), acute myeloid leukemia (AML), and sickle cell disease (SCD). Additionally, an app for the guidelines has also been developed (see sidebar), and will update as new guidelines are published. Visit www.hematology.org/Guidelines for more information on all of the guidelines developed by ASH, including details on the state-of-the-art development methodology.
In November 2018, the Society published the first in a set of 10 guidelines on the treatment of VTE in the journal Blood Advances to help the medical community better manage this serious condition. In partnership with the McMaster University GRADE Centre, a world leader in guideline development, ASH convened 10 panels of more than 100 thrombosis experts to review evidence and formulate more than 200 recommendations on VTE, on specific issues including pregnancy, diagnosis, pediatrics, anticoagulation therapy, surgical prophylaxis, and more. Two new pocket guides for VTE are also available here at the annual meeting. To learn more, attend Monday’s Special Education Session on ASH Clinical Practice Guidelines on Venous Thromboembolism from 2:45 p.m. to 4:15 p.m. (Hall E1, Level 2 [Orange County Convention Center] – map it), chaired by Adam Cuker, MD, MS.
The 2019 ASH Clinical Practice Guidelines on ITP, also available in Blood Advances, were developed in partnership with the University of Oklahoma Health Sciences Center and synthesize all available evidence about existing treatments. The guidelines update an earlier set of recommendations published in 2011, and cover disease management in both children and adults, address appropriate corticosteroid use in adults, and tackle the complex decision-making surrounding second-line agents. Cindy Neunert, MD, is chair of the ASH ITP guideline panel and talked about the enormous potential for the updated guidelines. “Through these guidelines, ASH is helping to ensure that physicians and patients have access to all of the evidence available so they can evaluate various treatment options and make an informed decision, using the guideline recommendations as a foundation for care.” A new pocket guide for ITP is also available here at the annual meeting. Hear more from Dr. Neunert and other experts about some of these key recommendations during Sunday’s Special Education Session, from 4:30 p.m. to 6:00 p.m. (Tangerine 2 [WF2], Level 2 [Orange County Convention Center] – map it).
Evidence-based clinical practice guidelines on AML in older adults are currently in development and publication is forthcoming in 2020. Mikkael Sekeres, MD, MS, chairs the guideline panel on treatment of elderly patients with AML and explained that the group first addressed whether older adults should be treated at all, and, if so, the level of intensity, followed by developing recommendations for the types of regimens AML patients should receive and the role of post-remission therapy; they even provided guidance for transfusion support during palliative care and hospice. “We went through a rigorous, systematic process to develop these guidelines, to ensure the recommendations are of the highest quality, free from bias, and practical,” he said. “We’ve paid special attention to some of the hardest decisions doctors, and their patients, have to make in managing this very difficult cancer in this vulnerable population.” Dr. Sekeres will chair the Special Education Session on ASH Clinical Practice Guidelines on Acute Myeloid Leukemia in Older Adults, taking place Monday, December 9, from 7:00 a.m. to 8:30 a.m. (Tangerine 2 [WF2], Level 2 [Orange County Convention Center] – map it ).
The first in a series of clinical practice guidelines on SCD is also now available in Blood Advances. In 2016, ASH initiated the development of five SCD guidelines, addressing acute and chronic complications of the disease. This development, including systematic evidence review, as supported by the Mayo Evidence-Based Practice Center. Five guideline panels, which included more than 70 sickle cell disease experts and 10 patient representatives, reviewed evidence and formulated more than 50 recommendations. Hear from panel members as they highlight some of the most notable recommendations during the Special Education Session, Sunday from 12:00 p.m. to 1:30 p.m. (Tangerine 2 [WF2], Level 2 [Orange County Convention Center] – map it).
Did you know...
…that an app is available for the ASH Guidelines, available for iOS and Android devices, as well as for web browsers? The ASH Clinical Practice Guidelines App gives users an easy-access pathway to every recommendation from all available guidelines published by ASH. This includes the rationale for each recommendation, the benefits and harms associated with each recommended course of action, and more.
The app includes all published ASH guidelines presented in a multilayered, reader-friendly format. Users can choose to read the executive summary, in which all the recommendations from the selected guideline are presented in a short, easy-to-read article, or take a deep dive into each recommendation to explore the questions by clinical scenario, understand benefits and harms, and learn more about panel judgments and the certainty of the evidence. Highly motivated users can even access the summary of findings table showing the evidence supporting each recommendation.
The app also includes links other tools and resources designed to aid in clinical decision-making, including to the published guideline manuscripts, ASH’s Choosing Wisely–related content, and the ASH Pocket Guides app.