Transmission of donor illness by stem cell transplantation: should screening be different in older donors?

Abstract

Summary:With increasing donor age, the potential of transmitting diseases from donor to recipient reaches new dimensions. Potentially transmittable diseases from donors include infections, congenital disorders, and acquired illnesses like autoimmune diseases or malignancies of hematological or nonhematological origin. While established nonmalignant or malignant diseases might be easy to discover, earlystage hematological diseases like CML, light-chain multiple myelomas, aleukemic leukemias, occult myelodysplastic syndromes and other malignant and nonmalignant diseases might not be detectable by routine screening but only by invasive, new and/or expensive diagnostic tests. In the following article, we propose recommendations for donor work-up, taking into consideration the age of the donors. In contrast to blood transfusions, stem cells from donors with abnormal findings might still be acceptable for HCT, when no other options are available and life expectancy is limited. This issue is discussed in detail in relation to the available donor and stem cell source. Finally, the recommendations presented here aim at harmonized worldwide work-up for donors to insure high standard quality.

Genetically identical twin transplantation for chronic lymphocytic leukemia

“…Transfer of leukemia by an allotransplant is reported in several leukemias including three cases of CLL. 27,28 Sala-Torra et al 28 suggested two mechanisms of donor-derived leukemia in the recipient. The first is the transfer of preleukemia cells from donor to recipient, most likely the scenario in our patient UPN 7.…”

“…The second is the development of leukemia in normal donor stem cells. These leukemia transfer cases at the time of transplant indicate the need for careful evaluation of donors prior to graft collection, 27,29 particularly if they are relatives, older, or have positive family history of CLL.…”

Uniform examination of stem cell donors

“…In this respect there is no agreement on donor counselling. Niederwieser suggests determining M-proteins in both donor and recipient, but does not advocate BM investigation unless there is a family history of malignancy [15], others advocate BM aspiration in all older related donors [16]. Considering the huge number of allogeneic HSCT performed the last decades, the reported number of donor derived haematological malignancies in recipients is low, although this may increase using more sensitive techniques to detect donor derived cells and with increase of aged donor ⁄ recipient pairs [17].…”

Allogeneic hematopoietic stem cell donation—standardized assessment of donor outcome data: A consensus statement from the Worldwide Network for Blood and Marrow Transplantation (WBMT)

“…Despite the fact, that related and unrelated donors might differ for many basic characteristics (Table 1), the quality of adverse reactions associated with stem cell donation is not expected to be different between related and unrelated donors forming the rationale for a uniform donor follow-up for all types of donors. Generally, donor eligibility criteria for related donors are less strict with only a few definite criteria 20 and may vary significantly between different centers. In contrast, eligibility criteria for unrelated donors are summarized by WMDA recommendations 21 resulting in somewhat more homogenous donor selection criteria.…”