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Coats T, Bean D, Basset A, Sirkis T, Brammeld J, Johnson S, Thomas I, Gilkes A, Raj K, Dennis M, Knapper S, Mehta P, Khwaja A, Hunter H, Tauro S, Bowen D, Jones G, Dobson R, Russell N, Dillon R. A novel algorithmic approach to generate consensus treatment guidelines in adult acute myeloid leukaemia. Br J Haematol 2022; 196:1337-1343. [PMID: 34957541 DOI: 10.1111/bjh.18013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/08/2021] [Indexed: 11/29/2022]
Abstract
Induction therapy for acute myeloid leukaemia (AML) has changed with the approval of a number of new agents. Clinical guidelines can struggle to keep pace with an evolving treatment and evidence landscape and therefore identifying the most appropriate front-line treatment is challenging for clinicians. Here, we combined drug eligibility criteria and genetic risk stratification into a digital format, allowing the full range of possible treatment eligibility scenarios to be defined. Using exemplar cases representing each of the 22 identified scenarios, we sought to generate consensus on treatment choice from a panel of nine aUK AML experts. We then analysed >2500 real-world cases using the same algorithm, confirming the existence of 21/22 of these scenarios and demonstrating that our novel approach could generate a consensus AML induction treatment in 98% of cases. Our approach, driven by the use of decision trees, is an efficient way to develop consensus guidance rapidly and could be applied to other disease areas. It has the potential to be updated frequently to capture changes in eligibility criteria, novel therapies and emerging trial data. An interactive digital version of the consensus guideline is available.
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Affiliation(s)
- Thomas Coats
- Haematology Department, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
- Biostatistics and Health Informatics, King's College London, UK
| | - Daniel Bean
- Biostatistics and Health Informatics, King's College London, UK
- Health Data Research UK London, University College London, UK
| | - Aymeric Basset
- Biostatistics and Health Informatics, King's College London, UK
| | | | | | - Sean Johnson
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Ian Thomas
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Amanda Gilkes
- Haematology, Cardiff University School of Medicine, Cardiff, UK
| | - Kavita Raj
- Guys' and St Thomas' NHS Foundation Trust, London, UK
| | - Mike Dennis
- Haematology, The Christie NHS Foundation Trust, Manchester, UK
| | - Steve Knapper
- Haematology, Cardiff University School of Medicine, Cardiff, UK
| | - Priyanka Mehta
- Haematology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Asim Khwaja
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Hannah Hunter
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Sudhir Tauro
- Haematology, Ninewells Hospital & School of Medicine, University of Dundee, Dundee, UK
| | - David Bowen
- Haematology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Gail Jones
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Richard Dobson
- Biostatistics and Health Informatics, King's College London, UK
- Health Data Research UK London, University College London, UK
| | - Nigel Russell
- Guys' and St Thomas' NHS Foundation Trust, London, UK
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