Evidence- and opinion-based consensus from Delphi round 1 of the Asian aplastic anemia recommendation development

BACKGROUND: Implementing international guidelines for aplastic anemia (AA) in Asia remains challenging due to limited access to advanced diagnostic tools, restricted treatment options, and variation in healthcare policies. This highlights a need for region-specific guidance on the diagnosis and management of AA in Asia. METHODS: The Asian Aplastic Anemia Working Group consisted of 10 experts from across Asia (South Korea, Japan, China, Hong Kong, Malaysia, Taiwan, and Thailand) who met virtually twice and developed 16 thematic statements on the diagnosis and management of AA. Using an e-Delphi method, members voted asynchronously on these statements using a 5-point Likert scale. Consensus was predefined as "≥ 80% level of agreement among the Delphi participants." RESULTS: Sixteen thematic statements and 54 sub-statements were developed. The first three statements addressed AA definition, presentation, and causes; the next four focused on diagnosis and prognosis; and the remaining nine covered management, including clonal evolution, supportive care, and special populations. Fifteen statements reached consensus after the first voting round. However, one statement on the management of severe AA did not achieve consensus in the first round. CONCLUSION: This e-Delphi method has, for the first time, generated Asian, expert-derived, consensus recommendations for the diagnosis and management of AA.