Summary of feedback and performance of candidate GBIs
| Domains, subdomains and GBIs . | Feedback first round, (%/%) . | Performance first round, % (%/%) . | Feedback second round, (%/%) . | Performance second round, % (%/%) . | Final rating outcomes . |
|---|---|---|---|---|---|
| Total | 23: 14/9 (100/100) | 26: 16/10 (100/100) | |||
| Diagnosis, n = 23 | |||||
| 1.1 Basic diagnostic workup | |||||
| 1.1.1 WHO 2016 classification | 14/4 (100/44) | 83 (84/80) | 16/4 (100/40) | 94 (93/100) | Selected |
| 1.1.2 Peripheral blood count and smear | 14/4 (100/44) | 86 (86/85) | 16/4 (100/40) | 89 (89/85) | Selected |
| 1.1.3 Bone marrow cytology | 14/4 (100/44) | 84 (86/80) | 16/4 (100/40) | 95 (95/95) | Selected |
| 1.1.4 Iron staining | 14/4 (100/44) | 78 (76/85) | 16/4 (100/40) | 96 (96/95) | Selected |
| 1.1.5 Bone marrow histology including immunohistochemistry | 13/4 (93/44) | 79 (78/80) | 16/4 (100/40) | 85 (83/95) | Selected |
| 1.1.6 Cytogenetic analysis | 13/4 (93/44) | 88 (87/70) | 16/4 (100/40) | 95 (95/95) | Selected |
| 1.2 Supplementary diagnostic workup | |||||
| 1.2.1 Cytochemistry | 13/2 (93/22) | 44 (44/50) | — | — | Dropped after first round |
| 1.2.2 Immunophenotyping | 13/2 (93/22) | 52 (52/60) | — | — | Dropped after first round |
| 1.2.3 Fluorescence in situ hybridization | 13/2 (93/22) | 62 (65/40) | — | — | Dropped after first round |
| 1.2.4 Microarray comparative genomic hybridization | 13/1 (93/11) | 41 (39/80) | — | — | Dropped after first round |
| 1.2.5 Molecular diagnostics/NGS | 13/1 (93/11) | 76 (75/100) | 16/3 (100/30) | 85 (84/93) | Selected |
| 1.3 Diagnostic workup related to treatment | |||||
| 1.3.1 Serum erythropoietin in patients with symptomatic anemia | 13/3 (93/30) | 90 (88/100) | 16/4 (100/40) | 93 (92/95) | Selected |
| 1.3.2 Monitoring iron status | 13/3 (93/30) | 92 (91/100) | 16/4 (100/40) | 87 (85/95) | Selected |
| 1.3.3 TP53 mutation status in MDS del(5q) | 13/2 (93/22) | 85 (85/100) | 16/3 (100/30) | 86 (88/80) | Selected |
| 1.4 Risk stratification | |||||
| 1.4.1 Disease-based risk stratification | |||||
| 1.4.1.1 Disease-based risk stratification according to IPSS | 13/2 (93/22) | 79 (76/100) | — | — | Merged with 1.4.1.2 |
| 1.4.1.2 Disease-based risk stratification according to IPSS/IPSS-R | 13/2 (93/22) | 93 (92/100) | 16/3 (100/30) | 98 (100/87) | Selected |
| 1.4.1.3 Disease-based risk stratification according to WPSS | 13/2 (93/22) | 64 (59/100) | — | — | Dropped after first round |
| 1.4.2 Patient-based risk stratification | |||||
| 1.4.2.1 Patient-based risk stratification | 13/2 (93/22) | 74 (73/84) | 16/4 (100/40) | 72 (70/80) | Selected |
| 1.4.2.2 Assessment for germline predisposition for inherited hematological malignancy syndromes | 13/2 (93/22) | 56 (55/70) | — | — | Dropped after first round |
| 1.5 Follow-up/outcomes | |||||
| 1.5.1 PROs* | 13/6 (93/67) | 62 (59/70) | 9/6 (56/60) | 73 (64/87) | Selected after reevaluation |
| 1.5.2 Response assessment | 13/5 (93/56) | 69 (65/76) | 16/3 (100/30) | 89 (93/73) | Selected |
| 1.5.3 Toxicity assessment | 13/7 (93/78) | 63 (64/57) | 16/8 (100/80) | 68 (60/85) | Dropped after second round |
| 1.5.4 Geriatric assessment* | 12/5 (86/56) | 51 (46/64) | 5/4 (31/40) | 62 (44/85) | Dropped after reevaluation |
| Therapy, n = 21 | |||||
| 2.1 Supportive care | |||||
| 2.1.1 Overtreatment of lower-risk MDS patients with asymptomatic cytopenia | 13/3 (93/30) | 63 (63/67) | 16/3 (100/30) | 64 (65/60) | Dropped after second round |
| 2.1.2 Transfusions | |||||
| 2.1.2.1 Transfusions of red blood cell concentrates | 13/3 (93/30) | 73 (79/47) | 16/4 (100/40) | 84 (86/75) | Selected |
| 2.1.2.2 Iron chelation | 13/3 (93/30) | 69 (63/100) | 16/3 (100/30) | 64 (61/80) | Dropped after second round |
| 2.1.2.3 Transfusions of platelet concentrates | 13/4 (93/44) | 78 (77/80) | 16/4 (100/50) | 84 (84/84) | Selected |
| 2.1.3 Antibacterial prophylaxis | 13/3 (93/30) | 60 (59/81) | — | — | Dropped after first round |
| 2.1.4 Granulocyte colony-stimulating factor for infections | 13/2 (93/22) | 54 (56/40) | — | — | Dropped after first round |
| 2.2 Lower-risk | |||||
| 2.2.1 Anemia | |||||
| 2.2.1.1 ESAs | 13/3 (93/30) | 89 (88/100) | 16/4 (100/40) | 91 (94/80) | Selected |
| 2.2.1.2 Granulocyte colony-stimulating factor for ESA refractoriness | 13/2 (93/22) | 62 (64/30) | — | — | Dropped after first round |
| 2.2.1.3 Overtreatment with growth factors | 13/3 (93/30) | 67 (67/67) | — | — | Dropped after first round |
| 2.2.1.4 LEN in MDS del(5q) | 13/2 (93/22) | 91 (90/100) | 16/4 (100/30) | 89 (91/80) | Selected |
| 2.2.1.5 LEN in non-del(5q) MDS | 13/2 (93/22) | 51 (49/70) | — | — | Dropped after first round |
| 2.2.1.6 Luspatercept in MDS with RS or mutated SF3B1 | 13/2 (93/11) | 40 (40/40) | — | — | Dropped after first round |
| 2.2.2 Other cytopenias | |||||
| 2.2.2.1 Immunosuppressive treatment* | 13/2 (93/22) | 63 (64/50) | 8/1 (50/10) | 62 (68/20) | Dropped after reevaluation |
| 2.2.2.2 Thrombopoietin-stimulating agents | 12/2 (86/22) | 60 (59/40) | — | — | Dropped after first round |
| 2.2.2.3 HMAs in lower-risk MDS | 13/2 (93/22) | 51 (46/73) | — | — | Dropped after first round |
| 2.3 Higher-risk | |||||
| 2.3.1 Unfit: Noneligible for (or declined) intensive treatment and/or allo-HSCT | |||||
| 2.3.1.1 HMAs in higher-risk MDS | 14/3 (100/30) | 92 (97/67) | 16/3 (100/30) | 83 (85/73) | Selected |
| 2.3.2 Fit: Eligible for intensive treatment and/or allo-HSCT | |||||
| 2.3.2.1 Induction with chemotherapy or HMA before allo-HSCT | 14/2 (100/22) | 66 (61/100) | 16/3 (100/30) | 77 (79/67) | Selected |
| 2.3.2.2 Postinduction chemotherapy for patients without a suitable donor | 13/2 (93/22) | 58 (54/80) | — | — | Dropped after first round |
| 2.3.2.3 Postinduction chemotherapy for patients with a complicated induction course | 13/2 (93/22) | 49 (44/80) | — | — | Dropped after first round |
| 2.3.2.4 Upfront allo-HSCT | 13/2 (93/22) | 68 (62/90) | 16/3 (100/30) | 79 (84/53) | Selected |
| 2.3.2.5 Allo-HSCT | 13/2 (93/22) | 79 (75/100) | 15/3 (94/30) | 89 (93/67) | Selected |
| Provider/infrastructural characteristics, n = 17 | |||||
| 3.1 Certification and accreditation | |||||
| 3.1.1 Institutions certified in hemato-oncology | 11/5 (79/56) | 64 (58/100) | — | — | Dropped after first round |
| 3.1.2 Access to a certified/accredited diagnostics laboratory | 13/6 (93/67) | 78 (76/83) | 15/6 (94/60) | 76 (69/93) | Dropped after second round |
| 3.2 Personnel | |||||
| 3.2.1 Board-certified and appropriately trained physicians | 13/3 (93/33) | 79 (80/80) | 15/5 (94/50) | 83 (84/80) | Dropped after second round |
| 3.2.2 Nursing expertise | 12/8 (86/89) | 73 (77/68) | 15/8 (94/80) | 78 (77/80) | Dropped after second round |
| 3.2.3 Multidisciplinary care team | 12/9 (86/100) | 70 (72/69) | 15/9 (94/90) | 89 (92/84) | Selected |
| 3.3 Organization | |||||
| 3.3.1 Safe handling of cytotoxic drugs | 12/7 (86/78) | 67 (68/66) | 15/7 (94/70) | 85 (79/97) | Selected |
| 3.3.2 Isolation ward | 13/8 (94/89) | 75 (70/85) | 15/7 (94/70) | 78 (75/86) | Dropped after second round |
| 3.3.3 Interdisciplinary diagnostic review | 13/6 (94/67) | 79 (86/63) | 15/7 (94/70) | 87 (84/94) | Selected |
| 3.3.4 Interdisciplinary treatment board | 12/5 (86/56) | 79 (75/88) | 15/7 (94/70) | 87 (85/91) | Selected |
| 3.3.5 Multidisciplinary care board | 10/8 (71/89) | 77 (85/80) | 15/7 (94/70) | 80 (72/97) | Dropped after second round |
| 3.3.6 Teaching and continuing education | 12/8 (86/89) | 68 (68/68) | 15/7 (94/70) | 85 (83/91) | Selected |
| 3.3.7 Emergency services for hemato-oncological diseases | 13/8 (93/89) | 86 (83/93) | 15/7 (94/70) | 88 (87/91) | Selected |
| 3.3.8 Standard operating procedures | 12/5 (86/56) | 75 (75/80) | 15/8 (94/80) | 79 (75/88) | Dropped after second round |
| 3.4 Cooperation | |||||
| 3.4.1 Multi-institutional care network | 11/7 (79/78) | 62 (60/63) | — | — | Dropped after first round |
| 3.4.2 Prospective clinical registries | 12/5 (84/56) | 66 (69/56) | 15/6 (94/60) | 84 (84/79) | Dropped after second round |
| 3.4.3 Biobanking | 13/4 (93/44) | 78 (71/80) | 15/5 (94/50) | 82 (81/84) | Dropped after second round |
| 3.4.4 Access to clinical trials | 12/7 (86/78) | 83 (83/80) | 15/8 (94/80) | 92 (95/88) | Selected |
| Domains, subdomains and GBIs . | Feedback first round, (%/%) . | Performance first round, % (%/%) . | Feedback second round, (%/%) . | Performance second round, % (%/%) . | Final rating outcomes . |
|---|---|---|---|---|---|
| Total | 23: 14/9 (100/100) | 26: 16/10 (100/100) | |||
| Diagnosis, n = 23 | |||||
| 1.1 Basic diagnostic workup | |||||
| 1.1.1 WHO 2016 classification | 14/4 (100/44) | 83 (84/80) | 16/4 (100/40) | 94 (93/100) | Selected |
| 1.1.2 Peripheral blood count and smear | 14/4 (100/44) | 86 (86/85) | 16/4 (100/40) | 89 (89/85) | Selected |
| 1.1.3 Bone marrow cytology | 14/4 (100/44) | 84 (86/80) | 16/4 (100/40) | 95 (95/95) | Selected |
| 1.1.4 Iron staining | 14/4 (100/44) | 78 (76/85) | 16/4 (100/40) | 96 (96/95) | Selected |
| 1.1.5 Bone marrow histology including immunohistochemistry | 13/4 (93/44) | 79 (78/80) | 16/4 (100/40) | 85 (83/95) | Selected |
| 1.1.6 Cytogenetic analysis | 13/4 (93/44) | 88 (87/70) | 16/4 (100/40) | 95 (95/95) | Selected |
| 1.2 Supplementary diagnostic workup | |||||
| 1.2.1 Cytochemistry | 13/2 (93/22) | 44 (44/50) | — | — | Dropped after first round |
| 1.2.2 Immunophenotyping | 13/2 (93/22) | 52 (52/60) | — | — | Dropped after first round |
| 1.2.3 Fluorescence in situ hybridization | 13/2 (93/22) | 62 (65/40) | — | — | Dropped after first round |
| 1.2.4 Microarray comparative genomic hybridization | 13/1 (93/11) | 41 (39/80) | — | — | Dropped after first round |
| 1.2.5 Molecular diagnostics/NGS | 13/1 (93/11) | 76 (75/100) | 16/3 (100/30) | 85 (84/93) | Selected |
| 1.3 Diagnostic workup related to treatment | |||||
| 1.3.1 Serum erythropoietin in patients with symptomatic anemia | 13/3 (93/30) | 90 (88/100) | 16/4 (100/40) | 93 (92/95) | Selected |
| 1.3.2 Monitoring iron status | 13/3 (93/30) | 92 (91/100) | 16/4 (100/40) | 87 (85/95) | Selected |
| 1.3.3 TP53 mutation status in MDS del(5q) | 13/2 (93/22) | 85 (85/100) | 16/3 (100/30) | 86 (88/80) | Selected |
| 1.4 Risk stratification | |||||
| 1.4.1 Disease-based risk stratification | |||||
| 1.4.1.1 Disease-based risk stratification according to IPSS | 13/2 (93/22) | 79 (76/100) | — | — | Merged with 1.4.1.2 |
| 1.4.1.2 Disease-based risk stratification according to IPSS/IPSS-R | 13/2 (93/22) | 93 (92/100) | 16/3 (100/30) | 98 (100/87) | Selected |
| 1.4.1.3 Disease-based risk stratification according to WPSS | 13/2 (93/22) | 64 (59/100) | — | — | Dropped after first round |
| 1.4.2 Patient-based risk stratification | |||||
| 1.4.2.1 Patient-based risk stratification | 13/2 (93/22) | 74 (73/84) | 16/4 (100/40) | 72 (70/80) | Selected |
| 1.4.2.2 Assessment for germline predisposition for inherited hematological malignancy syndromes | 13/2 (93/22) | 56 (55/70) | — | — | Dropped after first round |
| 1.5 Follow-up/outcomes | |||||
| 1.5.1 PROs* | 13/6 (93/67) | 62 (59/70) | 9/6 (56/60) | 73 (64/87) | Selected after reevaluation |
| 1.5.2 Response assessment | 13/5 (93/56) | 69 (65/76) | 16/3 (100/30) | 89 (93/73) | Selected |
| 1.5.3 Toxicity assessment | 13/7 (93/78) | 63 (64/57) | 16/8 (100/80) | 68 (60/85) | Dropped after second round |
| 1.5.4 Geriatric assessment* | 12/5 (86/56) | 51 (46/64) | 5/4 (31/40) | 62 (44/85) | Dropped after reevaluation |
| Therapy, n = 21 | |||||
| 2.1 Supportive care | |||||
| 2.1.1 Overtreatment of lower-risk MDS patients with asymptomatic cytopenia | 13/3 (93/30) | 63 (63/67) | 16/3 (100/30) | 64 (65/60) | Dropped after second round |
| 2.1.2 Transfusions | |||||
| 2.1.2.1 Transfusions of red blood cell concentrates | 13/3 (93/30) | 73 (79/47) | 16/4 (100/40) | 84 (86/75) | Selected |
| 2.1.2.2 Iron chelation | 13/3 (93/30) | 69 (63/100) | 16/3 (100/30) | 64 (61/80) | Dropped after second round |
| 2.1.2.3 Transfusions of platelet concentrates | 13/4 (93/44) | 78 (77/80) | 16/4 (100/50) | 84 (84/84) | Selected |
| 2.1.3 Antibacterial prophylaxis | 13/3 (93/30) | 60 (59/81) | — | — | Dropped after first round |
| 2.1.4 Granulocyte colony-stimulating factor for infections | 13/2 (93/22) | 54 (56/40) | — | — | Dropped after first round |
| 2.2 Lower-risk | |||||
| 2.2.1 Anemia | |||||
| 2.2.1.1 ESAs | 13/3 (93/30) | 89 (88/100) | 16/4 (100/40) | 91 (94/80) | Selected |
| 2.2.1.2 Granulocyte colony-stimulating factor for ESA refractoriness | 13/2 (93/22) | 62 (64/30) | — | — | Dropped after first round |
| 2.2.1.3 Overtreatment with growth factors | 13/3 (93/30) | 67 (67/67) | — | — | Dropped after first round |
| 2.2.1.4 LEN in MDS del(5q) | 13/2 (93/22) | 91 (90/100) | 16/4 (100/30) | 89 (91/80) | Selected |
| 2.2.1.5 LEN in non-del(5q) MDS | 13/2 (93/22) | 51 (49/70) | — | — | Dropped after first round |
| 2.2.1.6 Luspatercept in MDS with RS or mutated SF3B1 | 13/2 (93/11) | 40 (40/40) | — | — | Dropped after first round |
| 2.2.2 Other cytopenias | |||||
| 2.2.2.1 Immunosuppressive treatment* | 13/2 (93/22) | 63 (64/50) | 8/1 (50/10) | 62 (68/20) | Dropped after reevaluation |
| 2.2.2.2 Thrombopoietin-stimulating agents | 12/2 (86/22) | 60 (59/40) | — | — | Dropped after first round |
| 2.2.2.3 HMAs in lower-risk MDS | 13/2 (93/22) | 51 (46/73) | — | — | Dropped after first round |
| 2.3 Higher-risk | |||||
| 2.3.1 Unfit: Noneligible for (or declined) intensive treatment and/or allo-HSCT | |||||
| 2.3.1.1 HMAs in higher-risk MDS | 14/3 (100/30) | 92 (97/67) | 16/3 (100/30) | 83 (85/73) | Selected |
| 2.3.2 Fit: Eligible for intensive treatment and/or allo-HSCT | |||||
| 2.3.2.1 Induction with chemotherapy or HMA before allo-HSCT | 14/2 (100/22) | 66 (61/100) | 16/3 (100/30) | 77 (79/67) | Selected |
| 2.3.2.2 Postinduction chemotherapy for patients without a suitable donor | 13/2 (93/22) | 58 (54/80) | — | — | Dropped after first round |
| 2.3.2.3 Postinduction chemotherapy for patients with a complicated induction course | 13/2 (93/22) | 49 (44/80) | — | — | Dropped after first round |
| 2.3.2.4 Upfront allo-HSCT | 13/2 (93/22) | 68 (62/90) | 16/3 (100/30) | 79 (84/53) | Selected |
| 2.3.2.5 Allo-HSCT | 13/2 (93/22) | 79 (75/100) | 15/3 (94/30) | 89 (93/67) | Selected |
| Provider/infrastructural characteristics, n = 17 | |||||
| 3.1 Certification and accreditation | |||||
| 3.1.1 Institutions certified in hemato-oncology | 11/5 (79/56) | 64 (58/100) | — | — | Dropped after first round |
| 3.1.2 Access to a certified/accredited diagnostics laboratory | 13/6 (93/67) | 78 (76/83) | 15/6 (94/60) | 76 (69/93) | Dropped after second round |
| 3.2 Personnel | |||||
| 3.2.1 Board-certified and appropriately trained physicians | 13/3 (93/33) | 79 (80/80) | 15/5 (94/50) | 83 (84/80) | Dropped after second round |
| 3.2.2 Nursing expertise | 12/8 (86/89) | 73 (77/68) | 15/8 (94/80) | 78 (77/80) | Dropped after second round |
| 3.2.3 Multidisciplinary care team | 12/9 (86/100) | 70 (72/69) | 15/9 (94/90) | 89 (92/84) | Selected |
| 3.3 Organization | |||||
| 3.3.1 Safe handling of cytotoxic drugs | 12/7 (86/78) | 67 (68/66) | 15/7 (94/70) | 85 (79/97) | Selected |
| 3.3.2 Isolation ward | 13/8 (94/89) | 75 (70/85) | 15/7 (94/70) | 78 (75/86) | Dropped after second round |
| 3.3.3 Interdisciplinary diagnostic review | 13/6 (94/67) | 79 (86/63) | 15/7 (94/70) | 87 (84/94) | Selected |
| 3.3.4 Interdisciplinary treatment board | 12/5 (86/56) | 79 (75/88) | 15/7 (94/70) | 87 (85/91) | Selected |
| 3.3.5 Multidisciplinary care board | 10/8 (71/89) | 77 (85/80) | 15/7 (94/70) | 80 (72/97) | Dropped after second round |
| 3.3.6 Teaching and continuing education | 12/8 (86/89) | 68 (68/68) | 15/7 (94/70) | 85 (83/91) | Selected |
| 3.3.7 Emergency services for hemato-oncological diseases | 13/8 (93/89) | 86 (83/93) | 15/7 (94/70) | 88 (87/91) | Selected |
| 3.3.8 Standard operating procedures | 12/5 (86/56) | 75 (75/80) | 15/8 (94/80) | 79 (75/88) | Dropped after second round |
| 3.4 Cooperation | |||||
| 3.4.1 Multi-institutional care network | 11/7 (79/78) | 62 (60/63) | — | — | Dropped after first round |
| 3.4.2 Prospective clinical registries | 12/5 (84/56) | 66 (69/56) | 15/6 (94/60) | 84 (84/79) | Dropped after second round |
| 3.4.3 Biobanking | 13/4 (93/44) | 78 (71/80) | 15/5 (94/50) | 82 (81/84) | Dropped after second round |
| 3.4.4 Access to clinical trials | 12/7 (86/78) | 83 (83/80) | 15/8 (94/80) | 92 (95/88) | Selected |
GBIs in italics were dropped during the first or second rating rounds. Rating feedback are shown with absolute numbers and fractions for MDS and non-MDS experts separately, where 100% corresponds to the total number of participants within each category. Performance is shown as agreement scores for overall, as well as MDS and non-MDS experts separately.
—, not applicable (as no second rating was performed); RS, ringed sideroblasts; WHO, World Health Organization; WPSS, WHO Classification-based Prognostic Scoring System.
GBIs that were rechallenged in the second round.