Related hematopoietic cell donor care: is there a role for unrelated donor registries?

Anthias, Chloe; Walraven, Suzanna M. van; Sørensen, B.; Faveri, Grazia Nicoloso de; Fechter, Mirjam; Cornish, Jacqueline; Bacigalupo, Andrea; Müller, Carlheinz; Boo, Michael; Shaw, Bronwen E.

doi:10.1038/bmt.2015.15

Cited by 17 publications

(7 citation statements)

References 22 publications

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“…The decline in BM as a cell source for adult‐related donor transplants is such that transplant physicians entering the field now are unlikely to gain sufficient exposure to become experts in BM harvesting outside the largest transplant centers. Solutions to this problem require consideration by the transplant community; for example, in the Netherlands this has been addressed by UD registry–affiliated collection centers performing BM harvests for both related and UDs …”

Section: Discussionmentioning

confidence: 99%

Harvests from bone marrow donors who weigh less than their recipients are associated with a significantly increased probability of a suboptimal harvest yield

et al. 2016

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BACKGROUND:Previous studies have demonstrated the importance of bone marrow (BM) harvest yield in determining transplant outcomes, but little is known regarding donor and procedure variables associated with achievement of an optimal yield. We hypothesized that donor demographics and variables relating to the procedure were likely to impact the yield (total nucleated cells [TNCs]/kg recipient weight) and quality (TNCs/mL) of the harvest. STUDY DESIGN AND METHODS:To test our hypothesis, BM harvests of 110 consecutive unrelated donors were evaluated. The relationship between donor or procedure characteristics and the BM harvest yield was examined. RESULTS:The relationship between donor and recipient weight significantly influenced the harvest yield; only 14% of BM harvests from donors who weighed less than their recipient achieved a TNC count of more than 4 3 10 8 /kg compared to 56% of harvests from donors heavier than their recipient (p 5 0.001). Higher-volume harvests were significantly less likely to achieve an optimal yield than lower-volume harvests (32% vs. 78%; p 5 0.007), and higher-volume harvests contained significantly fewer TNCs/mL, indicating peripheral blood contamination. BM harvest quality also varied significantly between collection centers adding to recent concerns regarding maintenance of BM harvest expertise within the transplant community. CONCLUSION:Since the relationship between donor and recipient weight has a critical influence yield, we recommend prioritizing this secondary donor characteristic when selecting from multiple well-matched donors. Given the declining number of requests for BM harvests, it is crucial that systems are developed to train operators and ensure expertise in this procedure is retained.T he past two decades have seen a reduction in the number of unrelated donor (UD) bone marrow (BM) harvests performed, as the proportion of transplants using peripheral blood stem cells (PBSCs) has increased. Although several studies have examined the clinical impact of BM composition on the outcome of hematopoietic stem cell transplantation, relatively few studies have concentrated on the donor or procedure characteristics that influence the yield from BM harvests. To achieve a concentrated high-quality harvest, minimization of peripheral blood contamination is essential. Several early studies demonstrated the benefit of small-volume aspirations (<5 mL) from multiple punctures sites as opposed to larger-volume aspirations.13-15 Stimulation of the BM by prior granulocyte-colony-stimulating factor administration can also improve the TNC yield per donor weight, 16 but this is not routine practice in UDs, where donor safety considerations are paramount. A study of 166 BM donors reported that both a higher donor body mass index (BMI) and donor weight were associated with an improved CD34 yield at BM harvest, while donor age, sex, and height had no impact on yield. 17Other studies have noted a correlation between high donor weight and increased quality (TNCs/mL) of BM harvested. 18,19 It is...

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Section: Discussionmentioning

confidence: 99%

Harvests from bone marrow donors who weigh less than their recipients are associated with a significantly increased probability of a suboptimal harvest yield

et al. 2016

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“…For example, studies reported that donors thought meeting with the transplant team prior to donation was helpful but failed to provide any further detail regarding the content and delivery mode of the information provided. The issue which remains is whether any parallels can be drawn between the management of related HSC donors as mentioned in the literature and current recommendations and guidelines for the care of related HSC donors (Anthias et al, ; Clare et al, ; O’Donnell et al, ; Van Walraven et al, ).…”

Section: Discussionmentioning

confidence: 99%

Adult‐related haematopoietic stem cell donor experiences and the provision of information and psychosocial support: A systematic literature review

2018

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For blood cancer patients, haematopoietic stem cells (HSC) donated by a relative can be lifesaving. However, related donors can face significant physical and psychosocial challenges. As the demand for adult‐related HSC donors is increasing, it is important to review our understanding of adult‐related HSC donors’ need for and availability of information and psychosocial support with a view to identifying gaps in the literature. A systematic review of relevant studies (2000–2017) was conducted using five databases with supplementary hand searching. Sixteen studies involving 1,024 related HSC donors met the following criteria: English or Dutch language, peer‐reviewed, sampled first‐time‐related HSC donors, ≥18 years, haematological malignancies, assessed psychosocial aspects, retrospective or prospective and with or without comparison group. Data were abstracted, and study quality was assessed using the PRISMA criteria. Studies contained limited information on the provision of information and psychosocial support. Most studies addressed pre‐donation information, and none reported providing information or support to donors post‐donation. Additionally, few studies formally assessed unmet needs. Recommendations include improved transparency of reporting for the availability, sources and timing of information and psychosocial support, and the identification of unmet needs to enable the development of educational and psychosocial interventions for this invaluable donor population.

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“…Situation of conflicts of interest (a member of the medical team engaged in both donation and transplantation), the lack of standardized clinical eligibility criteria and of centralization of adverse event, and donor follow-up reporting system are challenging points [56]. …”

Section: Donor Selectionmentioning

confidence: 99%

Donor Selection for Allogenic Hemopoietic Stem Cell Transplantation: Clinical and Ethical Considerations

Riezzo

Pascale

Russa

et al. 2017

Stem Cells International

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Allogenic hematopoietic progenitor cell transplantation (allo-HSCT) is an established treatment for many diseases. Stem cells may be obtained from different sources: mobilized peripheral blood stem cells, bone marrow, and umbilical cord blood. The progress in transplantation procedures, the establishment of experienced transplant centres, and the creation of unrelated adult donor registries and cord blood banks gave those without an human leucocyte antigen- (HLA-) identical sibling donor the opportunity to find a donor and cord blood units worldwide. HSCT imposes operative cautions so that the entire donation/transplantation procedure is safe for both donors and recipients; it carries with it significant clinical, moral, and ethical concerns, mostly when donors are minors. The following points have been stressed: the donation should be excluded when excessive risks for the donor are reasonable, donors must receive an accurate information regarding eventual adverse events and health burden for the donors themselves, a valid consent is required, and the recipient's risks must be outweighed by the expected benefits. The issue of conflict of interest, when the same physician has the responsibility for both donor selection and recipient care, is highlighted as well as the need of an adequate insurance protection for all the parties involved.

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Related hematopoietic cell donor care: is there a role for unrelated donor registries?

Cited by 17 publications

References 22 publications

Harvests from bone marrow donors who weigh less than their recipients are associated with a significantly increased probability of a suboptimal harvest yield

Harvests from bone marrow donors who weigh less than their recipients are associated with a significantly increased probability of a suboptimal harvest yield

Adult‐related haematopoietic stem cell donor experiences and the provision of information and psychosocial support: A systematic literature review

Donor Selection for Allogenic Hemopoietic Stem Cell Transplantation: Clinical and Ethical Considerations

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