The BEST collaborative is a unique freestanding group of approximately 100 manufacturers, clinicians and scientists committed to improving transfusion practice through international studies. The group is organised in 4 work teams (Conventional Components, Cellular Therapies, Clinical Studies and Transfusion Safety), although members generally contribute across these groupings. Scientific membership is refreshed every 4 years, and the Associate Membership category provides an opportunity for young investigators to contribute. BEST members meet twice yearly to brainstorm new ideas for studies and to discuss work in progress. BEST is a highly productive group, with more than 50 publications in recent years. It provides a rare opportunity for transfusion practitioners to work with manufacturers on issues important to patient care.

For information about sponsoring BEST Collaborative, please contact The BEST Collaborative Chair, Lorna Williamson, MD.

The Conventional Components Team

The Conventional Components Team of BEST seeks to coordinate individual efforts and conduct collaborative international studies that address developmental and regulatory issues regarding the composition and validation of the conventional blood components: red cells, platelets and plasma. Our projects are based principally in the laboratories and blood centers of the BEST members. We perform pilot exploratory studies, interlaboratory comparisons, and small randomized trials. While principally focused on the methods and needs of advanced blood systems, we have also performed projects suited to countries with emerging economies or even to blood use in field and emergency situations.

Recent projects from the Conventional Components Team have included:

• The collaborative development of several new platelet storage solutions.
• Proposed standards for measurement of the in vivo recovery of platelets.
• An international comparison of methods for measuring red cell ATP, 2,3-DPG, and hemolysis.
• A major review of all Cr-51 radioactive red cell recovery studies in the past 15 years to understand the implications of new US FDA standards.

Current projects include:

• A comparison of single label and double label red cell survival measures.
• An evaluation of the metabolic effects of holding whole blood at room temperature for up to 26 hours before processing into components.
• Measures of the composition of plasma for transfusion processed and stored by a variety of methods and stored thawed for up to 10 days.

The Conventional Components Team is working improve the processing, quality, and utility of conventional blood components.

The team leaders for Conventional Components are John R. Hess, MD, MPH, FACP, FAAAS, Professor of Pathology and Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA and Pieter van der Meer, PhD, Senior Scientist, Sanquin Blood Bank North West, Amsterdam, the Netherlands.

The Transfusion Safety Team

The Transfusion Safety Team of BEST seeks to conduct collaborative international studies that address questions regarding the safe transfusion of blood and components. Our projects are based principally in hospitals related to BEST members. We perform pilot exploratory studies, definitive large-scale studies, randomized trials, surveys, laboratory-based investigation and qualitative research. While principally focused on advanced healthcare systems, we are also eager to consider projects suited to countries with emerging economies.

Recent projects from the Transfusion Safety team have included:

• A definitive study on the frequency of mis-labeled and mis-collected blood samples used for pre-transfusion testing.
• A randomized cluster-design study on the utility of a low-cost method to reduce the risk of mis-transfusion clerical errors at the bedside.
• A practical tool for use of statistical process control to monitor critical processes in the transfusion process.

Current projects include:

• A qualitative study using focus group feedback to explore weaknesses in the bedside clerical check prior to transfusion.
• An international survey of methods used to assess the appropriate use of blood components.
• A study to model the effect of changes in RBC storage on the inventory of blood available for patient use in hospitals.

The Transfusion Safety Team is excited about upcoming opportunities to improve the overall process of blood transfusion through the conduct of international cooperative studies.

The team leaders for Clinical Studies are Walter (Sunny) Dzik, MD, Co-Director Blood Transfusion Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA (USA) and Mike Murphy, MD, FRCP, FRCPath, Professor of Blood Transfusion Medicine, University of Oxford, and Consultant Haematologist, NHS Blood & Transplant and Oxford Radcliffe Hospitals, Oxford (UK).

The Clinical Studies Team

The Clinical Studies Team of BEST seeks to address clinically related topics in transfusion medicine through design and execution of clinically related laboratory studies, pilot clinical studies to generate supporting data larger randomized controlled trials, and guideline development. The study methodology used to address different research questions had included survey methodology, observational studies and randomized controlled trials.

Past projects have included:

• Design and implementation of a randomized controlled trial to evaluate the safety and efficacy of low dose prophylactic platelet transfusions compared to standard dose platelets currently used
• Consolidation of international platelet databases that allowed for comparisons between countries
• Evaluation of the variability in antibody titration methods results between laboratories in an international study

Current projects include:

• The relationship between hemoglobin content in a red cell concentrate and patient hemoglobin increment post transfusion.
• A comparison of the radiolabeled platelet recovery and survival in platelets prepared from whole blood with the buffy coat or platelet rich plasma method
• Platelet recovery and survival using phenotypic disparity as an alternative to radioisotopes
• Clinical practices in the use of ABO incompatible platelets using survey methods

The Clinical Studies Team is well positioned to identify and address clinical issues that vary between countries.

The team leaders for Clinical Studies are Larry Dumont, MBA, PhD, Assistant Professor of Pathology, Dartmouth Medical School, Lebanon, NH and Nancy Heddle MSc., FCSMLS(D), Associate Professor, Department of Medicine and Director of the McMaster Transfusion Research Program, McMaster University, Hamilton, ON.

Cellular Therapy Team

Members of this team work at leading institutions in North America, Europe and Asia. Key objectives of the team are to survey current practice in the preparation, assessment, storage and distribution of cellular therapy products and to perform detailed laboratory studies in selected areas of interest. Recent and current studies include:

• Interlaboratory proficiency testing of cord blood stem cell collections
• Intra and interlaboratory proficiency testing of dendritic cell products for immunotherapy protocols
• Assessment of stem cell storage and transportation aiming to define best practice
• Understanding the key release criteria for cellular therapy products
• Microbiological contamination of cellular therapy products
• Standardisation of colony forming units and other key parameters for the assessment of hemopoietic stem cells

The BEST cellular therapy team works closely with international organisations such as AABB, ISCT and EBMT in surveying current practice and its laboratory-based projects are conducted by expert scientists at leading institutions around the world. The results of all studies are published in leading scientific journals such as Transfusion and Cytotherapy. A list of recent publications is to be found on the website. We are keen to continue to forge new scientific links with researchers in other leading academic organisations and with key manufacturers of products used in the field of cellular therapy. We are committed to expanding our interests further into the fields of immunotherapy and regenerative medicine as these are developed for clinical study and subsequent routine application in specific patient groups. We hope that you share our belief that the horizons of cellular therapy are ever-expanding.

The team leaders for Cell Therapy are Ziggy Szczepiorkowski. MD, PhD, Dartmouth, US and Derwood Pamphilon MD, MRCPCH, FRCP, FRCPath. NHSBlood and Transplant, Bristol, UK.