JACIE: from guidelines to clinical practice and continuous quality improvement, the Leon-Berard cancer center experience

JACIE, a European certification program for stem cell transplantation, has now been recognized by the French Health Authorities. It can be considered as an evaluation of professional practice, an activity that can be promoted by health centres. The present article has two aims: firstly, it describes the structure of the certification standard based on the relative structure of each of its components; secondly, it reports on the experience acquired by the Leon-Berard cancer centre (Lyon-France) during the certification of its own stem cell transplantation program. The JACIE manual written in English is divided into three parts corresponding to the three processes identified. Part B describes the clinical haematopoietic stem cell transplantation program. Part C is dedicated to the collection of haematopoietic stem cells from blood and marrow. Finally, part D applies to the cell therapy laboratory in charge of cell preservation and the preparation of grafts for re-infusion. After the application has been submitted to the JACIE board, a date is set for an inspection visit. The cell therapy laboratory at Leon-Berard cancer centre has already participated to a certified transplantation project of the Edouard-Herriot Hospital (Lyon public hospitals) [parts C and D of the certification]. The executive board proposed that the clinical haematology unit of the cancer centre also applied for JACIE certification. A multidisciplinary work group-combining document writing skills and a real capacity to convince and motivate clinical staff was formed. Secondly, a comprehensive collection of existing documents was issued and the clinical pathway of the patients was formalized so that no step of the graft process would be omitted. A physician from another hospital also tested the evaluation process with the organisation of a mock visit. He confirmed that everything was in good way and provided recommendations to improve the program. This huge preparation provided invaluable learning opportunities to the participants. After the final visit by JACIE inspectors, the cancer centre received four-year certification. The challenge is now to maintain this momentum for the next certifications and to better take into account the ethical and juridical constraints of haematopoietic stem cell transplantation.