Targeted Pathologic Evaluation of Bone Marrow Donors Identifies Previously Undiagnosed Marrow Abnormalities

Abstract

Potential bone marrow donors are screened to ensure the safety of both the donor and recipient. At our institution, potential donors with abnormal peripheral blood cell counts, a personal history of malignancy, or age >60 years are evaluated to ensure that they are viable candidates for donation. Evaluation of the marrow includes morphologic, flow cytometric and cytogenetic studies. 122 potential donors were screened between the years of 2001–2011, encompassing approximately 10% of all donors. The median age of the screened potential donors was 59 years, and included 59 men and 63 women. The donors were screened because of age >60 years old (33), anemia (22), cytopenias other than anemia (27), elevated peripheral blood counts without a concurrent cytopenia (20), elevated peripheral blood counts with a concurrent cytopenia (10), history of malignancy (4), abnormal peripheral blood differential (3), prior graft failure (1), history of treatment with chemotherapy (1), and body habitus (1). Marrow abnormalities were detected in 9% (11/122) of donors. These donors were screened because of anemia (5/22; 23%), age >60 years (2/33; 6%), history of malignancy (2/4; 50%), elevated peripheral blood counts (1/20; 5%), and body habitus (1/1; 100%). Abnormalities included plasma cell dyscrasia (3), abnormal marrow cellularity (3), clonal cytogenetic abnormalities (2), low-grade myelodysplastic syndrome (1), a mutated JAK2 V617F allele (1), and monoclonal B-cell lymphocytosis (1). Our experience indicates that extended screening of potential donors identifies a significant number of donors with previously undiagnosed marrow abnormalities.

Outcomes of Thalassemia Patients Undergoing Hematopoietic Stem Cell Transplantation by Using a Standard Myeloablative versus a Novel Reduced-Toxicity Conditioning Regimen According to a New Risk Stratification

“…We recently introduced this new comprehensive concept of pretransplantation pharmacological immunosuppression therapy followed by Flu and Bu as a composite conditioning platform forclass 3 HR thalassemia patients [14]. In the current investigation, we compared the outcomes of an expanded cohort of older (class 3 HR) patients undergoing HSCT with our novel approach (expanded from 13) with that of younger class 3 patients who received a standard MAC (BuCy4-based) regimen.…”

“…Sixty-five of these 98 patients received related and 33 patients received unrelated donor grafts. The data concerning some of these 98 patients were previously reported [14,16,17]. Patients and donors or their parents/caregivers signed informed consent before treatment.…”

“…Pretransplantation management was utilized for all patients who received the RTC regimen [14]. Before starting the immunosuppressive phase, all patients received hydroxyurea 20 mg/kg/day daily ≥ 3 months to decrease erythroid marrow expansion[14,15].…”

“…Before starting the immunosuppressive phase, all patients received hydroxyurea 20 mg/kg/day daily ≥ 3 months to decrease erythroid marrow expansion[14,15]. The RTC regimen consisted of 2 phases.…”

Inversion 3 Cytogenetic Abnormality in an Allogeneic Hematopoietic Cell Transplant Recipient Representative of a Donor-Derived Constitutional Abnormality

“…Disease transmission is a rare but well-documented complication of HCT with transmissible diseases, including infections, congenital disorders, autoimmune disorders, and hematologic and nonhematologic malignancies [10,11]. Case reports of transmission of donor malignancy in HCT recipients are extremely rare in the literature.…”