Maximizing optimal hematopoietic stem cell donor selection from registries of unrelated adult volunteers

Hurley, Carolyn Katovich; Viña, Marcelo Fernandez; Setterholm, Michelle

doi:10.1034/j.1399-0039.2003.00096.x

Cited by 45 publications

(31 citation statements)

References 62 publications

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“…[19][20][21] In contrast to the recruitment of Northwest European donors, the recruitment of new donors of non-Northwest European origin should be actively pursued, even though this has shown to be difficult. 7,10,22 Transplantation with cord blood units has shown to be successful for this group 23 as the matching criteria are less stringent. [24][25][26][27][28] Efforts to collect cord blood units from non-Northwest Europeans should be encouraged.…”

Section: Discussionmentioning

confidence: 99%

“…3 In spite of the increased donor pool, there is still a significant percentage of patients worldwide in need of a haematopoietic stem cell transplantation, who do not receive a graft. [4][5][6][7][8][9][10] The lack of acceptable donors always has been considered to be the primary cause of the failure to transplant. 11 However, it is possible that apart from an insufficient number of UDs there are other impediments in the donor search process.…”

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confidence: 99%

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How to improve the search for an unrelated haematopoietic stem cell donor. Faster is better than more!

Heemskerk

Walraven

Cornelissen

et al. 2005

Bone Marrow Transplant

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Summary:Many patients do not reach haematopoietic stem cell transplantation. Shortage of unrelated donors (UDs) is still seen as the main cause. However, with a worldwide UD pool containing more than 8 million donors, it is possible that other impediments are becoming more important. We analysed 549 UD searches for Dutch patients, performed between 1987 and 2000, in order to find the reasons for failure or success to reach transplantation. Between 1996 and 2000, 59% of the patients of Northwest European origin received a graft from an UD with a median time span of 4.4 months from the start of the search. In all, 11% of the patients lacked a compatible donor, while 30% became medically unfit for transplantation. This is in contrast to the patients of non-Northwest European origin for whom UD shortage is still the most important impediment; only 32% were transplanted while 50% lacked a compatible donor. We conclude that the shortage of donors is no longer the biggest constraint in unrelated stem cell transplantation for patients of Northwest European origin. It may be more effective to optimize the chance on transplantation by making the search process more efficient. Bone Marrow Transplantation (2005) 35, 645-652.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

How to improve the search for an unrelated haematopoietic stem cell donor. Faster is better than more!

Heemskerk

Walraven

Cornelissen

et al. 2005

Bone Marrow Transplant

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“…28 In clinical practice, the selection of an eligible allogeneic donor relies on optimal histocompatibility matching, with over 50% of patients receiving an MHC-matched (sibling or unrelated) donor transplant. 29 Here, we investigated the effect of CTLA-4 blockade without DLI on GVL effects and GVHD, in the context of MHC-matched, minor histocompatibility (miHC)-mismatched BMT. We show that CTLA-4 blockade can establish an antileukemic effect in the absence of GVH reactivity.…”

Section: Introductionmentioning

confidence: 99%

CTLA-4 blockade in murine bone marrow chimeras induces a host-derived antileukemic effect without graft-versus-host disease

et al. 2007

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We studied the effect of CTLA-4 blockade on graft-versusleukemia and graft-versus-host responses in a mouse model of minor histocompatibility-mismatched bone marrow transplantation. Early CTLA-4 blockade induced acute graft-versus-host disease. Delayed CTLA-4 blockade resulted in a lethal condition with lymphosplenomegaly, but with stable mixed T-cell chimerism, unchanged alloreactive T-cell frequencies and absent anti-host reactivity in vitro. In contrast, multiorgan lymphoproliferative disease with autoimmune hepatitis and circulating anti-DNA auto-antibodies were documented. Splenic lymphocytes exhibited ex vivo spontaneous proliferation and a marked proliferative response against host-type dendritic cells pulsed with syngeneic (host-type) tissue-peptides. Both phenomena were exclusively mediated by host and not donor T cells, supporting an autoimmune pathogenesis. Selectively hostderived T-cell immune reactivity was equally documented against leukemia-peptide-pulsed dendritic cells, and this was paralleled by a strong in vivo antileukemic effect in anti-CTLA-4-treated and subsequently leukemia-challenged chimeras. In conclusion, delayed CTLA-4 blockade induced a host-derived antileukemic effect, occurring in the context of an autoimmune syndrome and strictly separated from graft-versus-host disease. Both antileukemic and autoimmune responses depended on the allogeneic component, as neither effect was seen after syngeneic bone marrow transplantation. Our findings reveal the potential of using CTLA-4 blockade to establish antileukemic effects after allogeneic hematopoietic stem cell transplantation, provided autoimmunity can be controlled.

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“…does not have statistics on the success rates of mixed race patients." Several studies, [4], [14], [6], [32], [1], [12], have estimated matching probabilities for persons of single races. But as far as we know, there are no published estimates of matching probabilities for persons of mixed race.…”

Section: Introductionmentioning

confidence: 99%

Stem Cell Donor Matching for Patients of Mixed Race

Bergstrom¹,

Garratt²,

Sheehan‐Connor³

2012

The B.E. Journal of Economic Analysis &Amp; Policy

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The plight of mixed-race leukemia patients unable to find stem cell donors with matching immunity types has received much media attention. Because of small samples, direct estimation of the distribution of immunity types for persons of mixed race has not been possible. However, because the alleles that control immunity type are located close together on a single chromosome, it is possible to estimate the distribution of types for mixed races, by using existing estimates of haplotype distributions for single races. We provide such estimates and calculate probabilities that persons of specific mixed-race combinations can find a match in the existing registry of potential donors. We also estimate probabilities that adding mixed-race donors to the registry will result in a life-saving match for a patient in need of a transplant and we compare the benefits and costs of adding new registrants of specified race or mixed race to the registry.

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Maximizing optimal hematopoietic stem cell donor selection from registries of unrelated adult volunteers

Cited by 45 publications

References 62 publications

How to improve the search for an unrelated haematopoietic stem cell donor. Faster is better than more!

How to improve the search for an unrelated haematopoietic stem cell donor. Faster is better than more!

CTLA-4 blockade in murine bone marrow chimeras induces a host-derived antileukemic effect without graft-versus-host disease

Stem Cell Donor Matching for Patients of Mixed Race

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