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From Data to Peer Reviewed
Publication
Behind the scenes tour Douglas Rizzo, MD MS
February 21, 2017
There are no conflicts of interest to disclose.
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Outline
• What does CIBMTR do with the data we
share? (eg “the data I worked so hard to
provide”)
• How does CIBMTR transform data into a
study?
• Why does CIBMTR ask me questions about
my center’s data?
– “Why is CIBMTR always looking for more data”
• What is CIBMTR doing to make it easier to
get data back? 2
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CIBMTR Number of Patients Registered, 1970-2016
Data are incomplete for 2016 3
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
22,000
24,000
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
200,000
220,000
240,000
19
70
19
72
19
74
19
76
19
78
19
80
19
82
19
84
19
86
19
88
19
90
19
92
19
94
19
96
19
98
20
00
20
02
20
04
20
06
20
08
20
10
20
12
20
14
20
16
Ne
w P
atie
nts
Pe
r Ye
ar
Cu
mu
lati
ve P
atie
nts
Re
gist
ere
d
Years
New Allogeneic Transplant Patients per Year
New Autologous Transplant Patients per Year
Cumulative Allogeneic Unrelated Donor Transplant Patients
Cumulative Allogeneic Related Donor Transplant Patients
Cumulative Autologous Transplant Patients
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Facilitating Data to Knowledge
Knowledge
Information
Data
• Experience
• Interpretations
• Patterns
• Calculations
• Relationships
• Standardization
• Observations
• Facts
Collecting
Organizing
Summarizing
Validating
Analyzing
Interpreting
Decision-making
4
FN / AGNIS™
DBtC™,
Reports &
Info Requests
Publications
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Cumulative Publications 1972-2016
0
200
400
600
800
1000
1200
1400
5
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89 CIBMTR Presentations in 2016
Conference Oral Poster Total
American Society of Hematology 21 7 28
BMT Tandem Meetings 14 6 20
European Society for BMT 3 5 8
European Immunogenetics and
Histocompatibility 3 0 3
American Society of Clinical Oncology 1 1 2
International Donor Registry Conference 0 2 2
Other Scientific Meetings 11 15 17
Total 53 36 89
6
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Outcomes Research (including Immunobiology
Research) is Core Activity of CIBMTR Accounting
for ~2/3 of our Publications
Observational Outcomes Research
64%
Health Services Research
4% Statistical
Methodology 6%
BMT CTN 9%
RCI BMT 1%
Bioinformatics 6%
Other 10%
7
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Who are we?
• The CIBMTR is a unique resource of data and statistical expertise to the scientific community for addressing important issues in HCT
• Network of >450 centers
• Clinical database with information for >450,000 HCT recipients
• Leading to: successful completion of hundreds of studies that have had an important impact on clinical practice!
DM108_2.ppt
Slide 8
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Why so essential?
• These data are the core of our resource
• This is what US Gov pays us to do
• This is what centers, physician scientists,
public hold us accountable for
• This is what we love to do – our mission, our
passion
• This is the value proposition of the CIBMTR
9
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Credits
• Kavita Bhavsar
• Waleska Perez
• Andrea Benoit
• Sue Logan
• Sharon Meiers
10
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How does data become transformed
into a published study?
• Who can/does propose studies that use data
from CIBMTR?
• Who decides what studies are worth doing?
• What is the process of completing a study?
• How do we decide when to ask centers for
data clarification?
– And how much data
• What is the benefit?
11
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Stages of a CIBMTR Research Study 1) Proposal
2) Protocol
3) Data File Preparation
4) Analysis
5) Manuscript Preparation
6) Submission
Slide 12
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• Overview of the desired project
– Should include study objective, endpoints, brief scientific justification, patient selection criteria and variables
– 1-2 pages – pre-specified format
• Process:
– Submit to CIBMTR (relevant Working Committee)
– WC leadership and statistician assess for feasibility, sufficient data, study overlap
– BMT Tandem Meeting
• PI / proposer presents study
• WC review scientific merit
• WC assigns a priority score
Proposal
Slide 13
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Who can propose a study?
• Anyone from a participating CIBMTR center
• Anyone with a good idea, even if not from a
participating center
14
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Working Committee Structure • Acute Leukemia
• Autoimmune Diseases and
Cellular Therapies
• Chronic Leukemia
• Donor Health and Safety
• Graft Sources and
Manipulation
• Graft-vs-Host Disease
• Health Services and
International Studies
• Immunobiology
• Infection and Immune
Reconstitution
• Late Effects and Quality of
Life
• Lymphoma
• Non-Malignant Marrow
Disorders and Inborn Errors
of Metabolism
• Pediatric Cancer
• Plasma Cell Disorders and
Adult Solid Tumors
• Regimen-Related Toxicity
and Supportive Care
15
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Working Committee Organization
• Leadership
– 2-4 Chairs appointed by Advisory Committee
– MD CIBMTR Scientific Director
– PhD CIBMTR Statistical Director
– MS CIBMTR Statistician
• Membership
– Open to any investigator
– Total number of members: >2,600
16
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Working Committees
• Set priorities for observational outcomes
studies
• Evaluate study proposals to ensure relevance
and meaningful results
• Design and conduct relevant studies
• Assess and revise CIBMTR data collection
forms
• Plan and conduct workshops at CIBMTR
meetings
17
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It Takes a Village………..
CIBMTR PUBLICATIONS
by Federal U24 Grant Periods
1993-
1997
1998-
2002
2003-
2007
2008-
2012
2013-
2016*
Peer-reviewed
pubs 34 66 119 235 327
# Different
authors 177 295 357 775 1,403
# Different
institutions 98 158 211 339 542
~40% of studies led by junior investigators (paired with senior investigators)
* First 4 years of grant period 2013-2017
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Why so much work at the beginning?
• Stewardship of valuable resources
• Maximize the value of data, CIBMTR staff
and efforts to publish the most important,
impactful research that benefits patients,
researchers and the HCT community
• In other words – we take your work and
investment seriously
19
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Statistical Hours: MS Statistician Hours
20
• Average number of hours to complete a study:
310
– Protocol: 60
– Data File Preparation: 100
– Analysis: 80
– Manuscript Preparation/Journal Comments: 70
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Protocol Development • Clarifies the study objectives to Working
Committee participants
• Ensures that these objectives will be met by the analyses conducted at the Statistical Center
• Utilized by statisticians to prepare data-files for analyses
• Essential to a high quality research study
• Substantial scrutiny by all members of study team and the Statistical Center
DM108_8.ppt
Slide 21
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Protocol Outline • Objective: the purpose for which the data will be
analyzed
• Scientific Justification: summarize the rationale of the study
• Study Population: Selection criteria of the cases to be included in the analysis
• Outcomes
• Variables to be analyzed
• Study Design: specific statistical methodology
• Table describing the population
DM108_9.ppt
Slide 22
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Data File Preparation • Eligible subjects who are consecutively treated
at participating centers
• Requirements:
–Adequate follow-up
–Minimal missing data items
–Sufficient statistical power
–Series of steps to ensure data quality
• GOAL: Complete, consistent, high quality
research-ready data!
DM108_10.ppt
Slide 23
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Data File Preparation
- Process - • Selection criteria: restriction applied to the database.
Examples are:
– First auto or first twin HCT for MM
– Year or transplant: 1988-2003
– Available research information
– Exclude planned tandem transplants
• Creation of outcomes and variables to be analyzed: At this stage, the statistician checks the following:
– Adequate follow-up
– Missing values
– Data discrepancy/outliers
DM108_11.ppt
Slide 24
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Data File Preparation • Adequate follow-up: Request necessary
follow-up to centers
• Missing values:
– Not a key variable: Dropped if large percentage is missing
– Key variable: Center must be contacted
• Data discrepancy/outliers:
– Reviewed by Scientific Director and PI
– Contact centers for further details
DM108_12.ppt
Slide 25
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Data File Preparation
- Request -
Statistician
Study Coordinator
CRC
CIBMTR Centers
DM108_13.ppt
Slide 26
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Data File Preparation
- Request - STEP 1:
• Study protocol
• Study selection criteria
• Study file in Excel format with:
–CRC Code
–Patient identification (CCN, CRID, IUBMID, NMDP ID)
–Team Number
–Date of Birth
–Date of Transplant
–Type of request: data check, new data or form request
DM108_14.ppt
Slide 27
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Data File Preparation
- Request -
STEP 2:
• The study coordinator reviews the study request and updates statistician
DM108_29.ppt
Slide 28
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STEP 3:
– E-mail request
– Excel file
– Due date set up
– Supplemental forms
– Retired CIBMTR forms
Data File Preparation
- Request -
DM108_30.ppt
Due!
Slide 29
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Data File Preparation
- Request -
STEP 4:
• Timeline for study request
DM108_15.ppt
Slide 30
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Data File Preparation
- Request -
STEP 4:
• Why so much pressure on deadlines?
• CIBMTR has performance expectations for timely publications
– Expectations of funding partners
– Expectations of investigators
– Timeliness of the research question
DM108_15.ppt
Slide 31
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Advisory Committee Annual Metrics
Studies in Progress ≥3 years
0
20
40
60
80
100
2012 2013 2014 2015 2016
Num
ber
of s
tudi
es in
pro
gres
s ≥
3y
32
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Data File Preparation
- Request - STEP 5:
• CRCs send study request to centers
DM108_16.ppt
STEP 6:
CRCs collect responses from centers
STEP 7:
CRCs update study coordinator with responses
STEP 8:
Study Coordinators combine responses
STEP 9:
Study Coordinators update statistician and Database
Slide 33
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Data File Preparation
- Request - STEP 10:
• Statistician makes decision on subsequent requests
– cc: medical director on 2nd request
– phone call on 3rd
– a 4th request should not be necessary!
DM108_31.ppt
Slide 34
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Data File Preparation
- Common Data Checks -
• Acute GVHD onset >120 days
• Negative intervals
• GVHD prophylaxis=none
• Primary COD=primary disease and no evidence of disease post transplant
• Primary COD=missing
• New malignancy
DM108_21.ppt
Slide 35
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How are we trying to reduce our
requests to centers
• Improve clarity and structure of questions and
responses during forms revisions
• Increasing data quality/validation checks at
time of data entry in FN
– Sooner is better
• Streamline error correction process
– Electronic requests when feasible
– Electronic error corrections in FN for latest forms
• Data corrections for any given purpose
improve quality across all use cases 36
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Query Functionality: Overview
37
Form in CMP status has data quality issues
• CIBMTR staff will initiate queries on completed forms
Form will go to QRY Status
• The center will review each queried form and work to resolve
Form will go to PND status
• The resolution submitted by the center will be reviewed
Form will go back to CMP
status
• Once answers are approved, the form will go back to CMP status
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Reasons for Queries
38
• Each query will have a comment category put
on by CIBMTR staff
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Data File Preparation • Adequate follow-up: If adequate follow-up on
survivors was not obtained, all patients in the center are excluded from analysis
• Handling of potentially eligible patients excluded from the study file: Demographic characteristics must be compared between patients excluded and those included in the final study file
DM108_22.ppt
Slide 39
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Analyses • Description of the population
– Patient-, disease- and transplant characteristics
• Outcomes
– Univariate (probabilities)
– Multivariate (Relative Risk)
• Figures
• Review of final analyses by collective meeting of Statistical Center
DM108_23.ppt
Slide 40
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Manuscript/Submission • First draft manuscript
– Minimal data request
• Final draft manuscript
• Submit to a peer-reviewed journal
• Address journal comments
DM108_24.ppt
Slide 41
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What is the benefit?
• Peer reviewed publications with meaningful
impact on the field
– Benefit to participating centers
– Benefit to participating investigators
– Benefit to future patients
42
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Peer-Reviewed Publications 2004-2016
0
20
40
60
80
100
120
43
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A ‘super-massive’ black hole
NASA Spitzer project 44
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How can you get information back
from CIBMTR?
• Publications
• Website
• Summary slides
• Information requests
• Calculators
– Disease Risk Index, One year survival calculator
• CIBMTR Portal
– eDBTC – electronic Data Back to Centers
– Center performance analytics
45
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Summary Slides – HCT Trends and
Survival Data
• An annual report on data submitted to the
CIBMTR by centers worldwide
• Describes information related to practices
and general survival outcomes after
hematopoietic cell transplantation
• Current edition includes transplants
performed prior to 2015
46
https://www.cibmtr.org/ReferenceCenter/SlidesRepor
ts/SummarySlides/pages/index.aspx
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Disease Risk Index (DRI) Calculator
47
•The Disease Risk Index (DRI) is a validated tool to categorize groups of patients undergoing allogeneic stem cell transplantation (HCT) for hematologic malignancy by disease risk. It is intended for research purposes, to stratify patients in broad disease risk categories for retrospective or prospective studies. •The DRI considers only disease-related parameters (i.e., disease, stage and, for some diseases, cytogenetics) and was developed only for the primary outcome of overall survival after HCT. Publication Details
DRI Assignment Tool Disease*:
Disease Stage*:
DRI Group:
https://www.cibmtr.org/ReferenceCenter/Statistical/Tools/Pages/DRI.aspx
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CIBMTR Portal – Tools for Centers
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CIBMTR Portal
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eDBtC (enhanced DBtC) using Qlikview
• Dramatically improved user interface
• Self service and easy access
• Visualization of center analytics and descriptive statistics
– ~60 selectable data dimensions, TED and CRF variables
– ~30 predefined filters
• Logical organization of data in tabs
• Ad Hoc analysis – explore your data, including
outcomes
• Data will be refreshed monthly
• Export application source data will be retained on the
CIBMTR Portal Site
• Current DBtC data download capability retained 50
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eDBtC Patient Level Data
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Survival Calculator – 1 year
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• Calculates probability of
1 year survival after
allogeneic
transplantation for
individual patients
• Uses model developed
for annual center-
specific outcomes
analysis for US
transplant centers
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What can centers expect in Center
Performance Analytics (CPA)?
Selectable data dimensions include key variables for first allogeneic transplants facilitated in the U.S. in 2011, 2012 & 2013
Data is organized in category-specific tabs
Predefined filters enable limited comparative analysis based on center size, patient population (adult, pediatric, both), center performance, and region
Visualization of each center’s data relative to other centers in data set for selected dimensions
Analyze center's own one-year observed survival rate
Create center-specific query on data dimensions available in the data set
Export filtered data in Excel file format
Export the center's entire Center Specific data set
Data refreshed annually
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Patient
Age Group
Gender
HCT CI
History of Malignancy
KPS Category Score
KPS Score
Race
Recipient CMV Status
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Selectable Dimensions in CPA Disease Broad Disease
Disease stage
ALL Philadelphia chromosome
ALL T-cell lineage
CLL & other chronic Leukemia stage
NHL subtype
HL Chemo sensitivity
NHL Chemo Sensitivity
Interval Between DX & TX
Transplant Year of Transplant
Product Type
Donor Type/Graft Type/HLA
Product Type Details
BM or PBSC HLA Match
Single Cord Blood HLA Match
Conditioning Regimen Drugs
TBI
Prior Auto HCT
BM or PB donor Age at Transplant
BM or PB donor CMV status
BM or PB donor Race/ethnicity Match
BM or PB donor Parity
BM or PB donor Sex
BM or PB donor Sex Match
Outcomes
One year
Survival
Probability
Ad-hoc Query
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Accessing the new RFI tool
• Accessible through eDBtC from the Center
Dashboard or the Disease tabs (top right
corner “ASBMT RFI” button).
• Only available to active, U.S.-based centers.
• Application embedded into the Qlikview®
eDBtC application.
• Separate, independent filtering configuration
that allows users to switch between eDBtC
and the RFI module without having to clear or
reconfigure filter variables.
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Questions?