Biology of Blood and Marrow Transplantation 7:306-307 (2001) 9 2001 American Society for Blood and Marrow Transplantation GUEST EDITORIAL Documenting the Case for Stem Cell Transplantation: The Role of Evidence-Based Reviews and Implications for Future Research Statement of the Steering Committee for Evidence-Based Reviews of the American Society for Blood and Marrow Transplantation (ASBMT) Steering Committee Members: Roy Jones,1 Chair; Mary Horowitz, 2 Donna PVall, 3John R. Wingard, 4 Steven V/olff ~ 1University of Colorado Health Sciences Center, Denver, Colorado; 2IBMTR/ABMTR, Medical College of Wisconsin; Milwaukee, Wisconsin; 3Cardinal Glennon Children's Hospital, St. Louis University, St. Louis, Missouri; 4University of Florida Health Sciences Center College of Medicine, Gainesville, Florida; S~anderbilt University, Nashville, Tennessee Correspondence: Roy Jones, MD, PhD, University of Colorado Health Science Center, 4200 E. 9th Ave., Box B-190, Denver, CO 80262 (e-mail: roy.jones@uchsc.edu). Evidence based medicine is the conscientious, explicit, and judidous use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research [1]. Evidence-based medicine is a style of practice and teaching which may also help plan future research [2]. There are few fields of medicine that have been subjected to as much scrutiny or have generated as much controversy as high-dose cytotoxic therapy with stem cell transplantation (SCT). Although transplantation has been widely accepted by the medical community, many ongoing clinical trials con- tinue to investigate accepted indications and others that are not firmly established. The American Society for Blood and Marrow Trans- plantation (ASBMT) initiated a project to conduct system- atic, evidence-based reviews of the scientific literature for the use of blood and marrow transplantation for specific dis- eases. These reviews will use evidence-based medicine (EBM) guidelines to define therapy as effective or ineffec- tive, indicate treatment that has been inadequately studied, and suggest areas requiring well-designed clinical trials. Problematic study design issues also will be identified in these reviews, and recommendations about the conduct of future trials will be made, In today's health care environment, EBM is sometimes viewed as synonymous with "cost cutting" medicine and may be used to refuse reimbursement for expensive tests and treatments, thus limiting the clinical freedom of physicians and other providers. Often, however, reimbursement deci- sions are made not on the basis of evidence, but on a lack of convincing evidence. Of course, many existing "standards of care" were originally established on the basis of anecdotal or other untested evidence. They are nonetheless difficult to replace with new options that have not met the rigorous standards of modern, evidence-based medicine. Unfortunately, patients continue to be denied SCT because of its relatively high cost even when it is widely accepted by clinicians as the most efficacious therapy. In some cases, blood and marrow transplantation continues to be viewed as investigational or experimental. Some managed care organizations are reluctant to reimburse medical proce- dures that they perceive to be novel, investigational, or more expensive than conventional therapies. These reviews will therefore also address the issue of inadequate reim- bursement for transplantation in cases where efficacy is widely recognized, and document its role in treating a vari- ety of diseases. SCT AS THERAPY FOR DIFFUSE LARGE CELL B-CELL NON-HODGKIN'S LYMPHOMA The first in the series of reviews, published in this issue of the Journal, focuses on the use of high-dose cytotoxic therapy and SCT for the treatment of diffuse large cell B-cell 306