Suitability Criteria for Adult Related Donors: A Consensus Statement from the Worldwide Network for Blood and Marrow Transplantation Standing Committee on Donor Issues

Abstract

The number of allogeneic hematopoietic stem cell (HSC) transplants performed globally each year continues to increase. Advances in HLA typing, better supportive care, and administration of reduced-intensity conditioning regimens allow treatment of older patients with older sibling donors. Pretransplant donor assessment and testing are very important processes affecting the quality and safety of donation. For unrelated HSC donors detailed recommendations for health assessment have been published, allowing donation only if they are unrestrictedly healthy. Eligibility criteria for related donors are less strict and vary significantly between centers. In situations where a family donor does not meet the suitability criteria for unrelated donors, involved physicians often struggle with the decision whether the matched relative is suitable for donation or not. On behalf of the Worldwide Network for Blood and Marrow Transplantation Standing Committee on Donor Issues, we intended to develop a consensus document with recommendations for donor workup and final clearance of family donors who would not be able to serve as unrelated donors because of their age or pre-existing diseases. This article covers different topics intending to support decision-making, with the goal of minimizing medical risk to the donor and protection of the recipient from transmissible diseases.

Alloreactivity: the Janus-face of hematopoietic stem cell transplantation

“…They clarify the role of matching in times when HSCT should provide for each patient a better outcome regarding overall survival, quality of life and costs; 19 they add caution to current concepts to 'find a donor option for every patient. [12][13][14][15][16][17] They fit with recent studies that well-matched unrelated donor HSCT showed results similar to those with matched sibling donors. They suggest complete HLA-typing (12 out of 12 antigens) of unrelated donors 26,27 before decision-making.…”

“…Some early promising results have triggered a rapid expansion in the use of haploidentical donors; still, they await confirmation. [12][13][14][15][16] Recent results from a large EBMT study with high-risk AML patients indicate a similar outcome at 2 years after haploidentical as compared to 10/10 antigen matched unrelated donor transplants. Non-relapse mortality was reported to be higher, relapse incidence to be lower after haploidentical HSCT, 28 follow-up was short and risk profiles of the patients different.…”

“…The lack of a Human Leukocyte Antigen (HLA)-identical sibling donor for many patients has triggered the search for alternative donors, including mismatched family members or partially matched unrelated donors. [12][13][14][15] The degree of matching needed for an 'acceptable' unrelated donor is still not settled. Some approaches postulate' a donor option' for every patient.…”

Comparison of transplant outcomes from matched sibling bone marrow or peripheral blood stem cell and unrelated cord blood in patients 50 years or older

“…The upper age limit of MSD for BM and mobilized PBSC harvest is unclear [54]. In general, increasing recipient age is frequently accompanied by increased donor age in MSDs.…”

Effect of Aging and Predonation Comorbidities on the Related Peripheral Blood Stem Cell Donor Experience: Report from the Related Donor Safety Study

“…Inadequate data regarding RDs is concerning for a number of reasons. Although URD registries have specific guidelines regarding donor clearance [8], there are not generally accepted guidelines about when to reject a RD, although a publication from the Worldwide Network for Blood and Marrow Transplant advocates for transplant centers to adopt standards similar to URD registries [9]. In addition, RDs vary tremendously in age (from infants to individuals in their seventies) and are often willing to donate to family members in spite of significant comorbidities or potentially increased donor risk.…”