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Stefanski HE, Kuxhausen M, Bo-Subait S, Kobusingye H, Mattila D, Schenfeld J, Sandschafer D, De Oliveira Brandao C, Burns LJ, Shaw BE, Pulsipher MA, Miller JP, Devine SM. Long-term outcomes of peripheral blood stem cell unrelated donors mobilized with filgrastim. Blood Adv 2024; 8:4196-4206. [PMID: 38687368 PMCID: PMC11372396 DOI: 10.1182/bloodadvances.2024012646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/05/2024] [Accepted: 04/17/2024] [Indexed: 05/02/2024] Open
Abstract
ABSTRACT Allogeneic hematopoietic cell transplantation is a life-saving procedure used to treat a variety of devastating diseases. It requires hematopoietic stem cells collected via filgrastim-mobilized peripheral blood stem cells (PBSCs) or bone marrow (BM) harvest from volunteer unrelated donors (URDs). There is a paucity of safety data regarding donors' long-term adverse events. This prospective, observational study combined PBSC donors enrolled in the NMDP Investigational New Drug trial and BM donors between 1 July 1999 and 30 September 2015. The primary objective was to describe the long-term incidence of myeloid malignancies. The secondary objectives included describing the long-term incidence of lymphoid malignancies, nonhematologic malignancies, autoimmune disorders, and thrombotic events. A total of 21 643 donors (14 530 PBSCs and 7123 BM) were included. The incidence rate of myeloid disorders per 100 000 person-years in donors of PBSCs was 2.53 (95% confidence interval [CI], 0.82-7.84) and in donors of BM, it was 4.13 (95% CI, 1.33-12.8). The incidence rate ratio of PBSCs/BM donors was 0.61 (95% CI, 0.12-3.03; P = .55). The incidence of other malignancies, autoimmunity, and thrombosis did not differ between the donor types. This comprehensive study of the long-term effects of filgrastim in URDs of PBSCs provides strong evidence that donors who receive filgrastim are not at an increased risk of these events compared with BM donors. It also provides reassurance to current donors undergoing stem cell mobilization as well as individuals considering joining stem cell registries, such as NMDP.
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Affiliation(s)
- Heather E Stefanski
- Center for International Blood and Marrow Transplant Research, NMDP, Minneapolis, MN
| | - Michelle Kuxhausen
- Center for International Blood and Marrow Transplant Research, NMDP, Minneapolis, MN
| | - Stephanie Bo-Subait
- Center for International Blood and Marrow Transplant Research, NMDP, Minneapolis, MN
| | - Hati Kobusingye
- Center for International Blood and Marrow Transplant Research, NMDP, Minneapolis, MN
| | - Deborah Mattila
- Center for International Blood and Marrow Transplant Research, NMDP, Minneapolis, MN
| | | | | | | | - Linda J Burns
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Michael A Pulsipher
- Huntsman Cancer Institute/Intermountain Primary Children's Hospital, Spencer Fox Eccles School of Medicine, The University of Utah, Salt Lake City, UT
| | - John P Miller
- Center for International Blood and Marrow Transplant Research, NMDP, Minneapolis, MN
| | - Steven M Devine
- Center for International Blood and Marrow Transplant Research, NMDP, Minneapolis, MN
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2
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Murakami MA, Connelly-Smith L, Spitzer T, Kassim AA, Penza SL, Al Malki MM, Mason J, Tourville C, Magliocco B, Barten J, Guidry-Groves H, Margolis J, Devine SM, Rennert WP, Stefanski HE. Bone Marrow Harvest: A White Paper of Best Practices by the NMDP Marrow Alliance. Transplant Cell Ther 2024; 30:663-680. [PMID: 38642840 DOI: 10.1016/j.jtct.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/12/2024] [Accepted: 04/14/2024] [Indexed: 04/22/2024]
Abstract
Data on recent bone marrow harvest (BMH) collections from the NMDP has shown that bone marrow (BM) quality has decreased based on total nucleated cell count in the product. To ensure that quality BM products are available to all recipients, the NMDP Marrow Alliance was formed in April 2021 to increase the capability of BM collection centers to safely deliver high-quality products consistently and to identify and disseminate guidelines for performing BMH. This white paper describes the best practices for BMH as defined by the NMDP Marrow Alliance.
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Affiliation(s)
| | - Laura Connelly-Smith
- Division of Hematology, Department of Medicine, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Thomas Spitzer
- Department of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Adetola A Kassim
- Department of Hematology and Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Sam L Penza
- Division of Hematology, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio
| | | | | | | | | | | | | | | | - Steven M Devine
- NMDP, Minneapolis, Minnesota; Center for International Blood and Marrow Transplant Research, National Marrow Donor Program, Minneapolis, Minnesota
| | - Wolfgang P Rennert
- Blood and Marrow Collection Program, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Heather E Stefanski
- NMDP, Minneapolis, Minnesota; Center for International Blood and Marrow Transplant Research, National Marrow Donor Program, Minneapolis, Minnesota.
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3
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Rennert WP, Smith M J, Cormier KA, Austin AE. Supportive Care of Hematopoietic Stem Cell Donors. Clin Hematol Int 2024; 6:43-50. [PMID: 38817695 PMCID: PMC11086998 DOI: 10.46989/001c.92460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/21/2023] [Indexed: 06/01/2024] Open
Abstract
Supportive care needs for hematopoietic stem cell recipients have been studied. Less is known about the care needs of stem cell donors. Care challenges arise at donor selection, preparation for the donation, the donation procedure and the immediate and long-term after-care. Care needs were analyzed for 1,831 consecutive bone marrow and peripheral stem cell donors at MedStar Georgetown University Hospital between January 2018 and August 2023 in support of a review of the current literature. During the selection, related donors may experience psychological pressures affecting their motivation, while donation centers may be willing to accept co-morbidities in these donors which might preclude donation in unrelated peers. For bone marrow donations, it is important to select donors not only according to optimal genetic matching criteria but also according to suitable donor/recipient weight ratios, to facilitate sufficient stem cell yields. During the donation preparation phase, side effects and complications related to stem cell stimulation must be anticipated and managed for peripheral cell donors, while the pros and cons of autologous blood donation should be evaluated carefully for bone marrow donors. The stem cell donation procedure itself carries potential side effects and complications as well. Peripheral cell donors may require a central line and may encounter hypocalcemia, thrombocytopenia, and anemia. Bone marrow donors face risks associated with anesthesia, blood loss and pain. Post-procedure care focusses on pain management, blood cell recovery and the psychological support necessary to regain a high quality-of-life existence. Hematopoietic stem donors are giving part of themselves to save another's life. They deserve comprehensive supportive care to accompany them throughout the donation process.
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Affiliation(s)
- Wolfgang P Rennert
- Blood and Marrow Collection ProgramMedStar Georgetown University Hospital
| | - Jenna Smith M
- Blood and Marrow Collection ProgramMedStar Georgetown University Hospital
| | - Katie A Cormier
- Blood and Marrow Collection ProgramMedStar Georgetown University Hospital
| | - Anne E Austin
- Stem Cell Transplant and Cellular TherapyVanderbilt University Medical Center
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4
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Chen L, Wen J, Xu X, Du J, Ruan Y, Feng X, Li J, He Y, Wu X. Safety and efficacy of peripheral blood stem cells collection in healthy children and pediatric patients with thalassemia major weighing 20 kg or less. J Clin Apher 2024; 39:e22102. [PMID: 38186371 DOI: 10.1002/jca.22102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/30/2023] [Accepted: 11/24/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Peripheral blood stem cell (PBSC) collection in children poses challenges due to their small size, low body weight (BW), and unique pediatric physiology, especially among children weighing 20 kg (kg) or less. METHODS PBSC collection data of both healthy children and patients with thalassemia major (TM) weighing 20 kg or less between January 2013 and December 2020 were reviewed. Moreover, PBSCs characteristics along with various aspects of efficiency and safety between healthy donors and patients with TM were compared. RESULTS A total of 262 PBSC procedures were performed on 255 children. Of these, 91 procedures were carried out on 85 allogeneic healthy donors, and 171 auto-backup collections were performed on 170 patients with TM to ensure PBSC availability and prevent transplantation failure. A minimum pre-apheresis hemoglobin (HGB) level of 60 g/L was discovered to be safe and feasible in patients with TM. The median CD34+ cell dose in the PBSC product during the initial apheresis procedure was higher in healthy donors compared to patients with TM (7.29 ± 5.28 × 106 cells/kg vs5.88 ± 4.23 × 106 cells/kg, P = .043). The total CD34+ cells/kg recipient weight exhibited a positive correlation with pre-apheresis monocyte counts, but a negative correlation with donor weight. Apheresis significantly reduced hematocrit and platelet counts in the allogeneic group compared to the autologous group. Patients with TM experienced a higher occurrence of bone pain related to granulocyte colony-stimulating factor treatment. Notably, no serious complications related to PBSCs mobilization, central venous catheter placement, or the apheresis procedure were observed in either group. CONCLUSIONS PBSCs collection was both safe and effective in healthy children and pediatric patients with TM weighing 20 kg or less.
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Affiliation(s)
- Libai Chen
- Department of Pediatrics, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Jianyun Wen
- Department of Pediatrics, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Xiaoxiao Xu
- Department of Pediatrics, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Jing Du
- Department of Pediatrics, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Yongsheng Ruan
- Department of Pediatrics, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Xiaoqin Feng
- Department of Pediatrics, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Juan Li
- Department of Pediatrics, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Yuelin He
- Department of Pediatrics, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Xuedong Wu
- Department of Pediatrics, Southern Medical University Nanfang Hospital, Guangzhou, China
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Itonaga H, Miyazaki Y, Aoki K, Shingai N, Ozawa Y, Fukuda T, Kataoka K, Kawakita T, Ueda Y, Ara T, Tanaka M, Katayama Y, Sawa M, Eto T, Kanda J, Atsuta Y, Ishiyama K. Allogeneic transplantation of bone marrow versus peripheral blood stem cells from HLA-identical relatives in patients with myelodysplastic syndromes and oligoblastic acute myeloid leukemia: a propensity score analysis of a nationwide database. Ann Hematol 2023; 102:1215-1227. [PMID: 36918415 DOI: 10.1007/s00277-023-05167-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 03/06/2023] [Indexed: 03/15/2023]
Abstract
Bone marrow (BM) and granulocyte colony-stimulating factor-mobilized peripheral blood stem cells (PBSC) are used as grafts from HLA-identical-related donors for adults with myelodysplastic syndrome (MDS). To assess the impact of graft sources on post-transplant outcomes in MDS patients, we conducted a retrospective analysis of a nationwide database. A total of 247 and 280 patients underwent transplantation with BM and PBSC, respectively. The inverse probability of treatment weighting (IPTW) methods revealed that overall survival (OS) was comparable between BM and PBSC (P = .129), but PBSC transplantation was associated with worse graft-versus-host disease (GVHD)-free/relapse-free survival (GRFS) (hazard rate [HR], 1.24; 95% confidence intervals [CIs], 1.00-1.53; P = 0.049) and chronic GVHD-free and relapse-free survival (CRFS) (HR, 1.29; 95% CIs, 1.13-1.73; P = 0.002) than BM transplantation. In the propensity score matched cohort (BM, n = 216; PBSC, n = 216), no significant differences were observed in OS and relapse; 3-year OS rates were 64.7% and 60.0% (P = 0.107), while 3-year relapse rates were 27.1% and 23.5% (P = 0.255) in BM and PBSC, respectively. Three-year GRFS rates (36.6% vs. 29.2%; P = 0.006), CRFS rate (37.7% vs. 32.5%; P = 0.003), and non-relapse mortality rates (13.9% vs. 21.1%; P = 0.020) were better in BM than in PBSC. The present study showed that BM transplantation provides a comparable survival benefit with PBSC transplantation and did not identify an enhanced graft-versus-MDS effect to reduce the incidence of relapse in PBSC transplantation.
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Affiliation(s)
- Hidehiro Itonaga
- Department of Hematology, Nagasaki University Hospital, Nagasaki, Japan.
| | - Yasushi Miyazaki
- Department of Hematology, Nagasaki University Hospital, Nagasaki, Japan.,Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Kazunari Aoki
- Laboratory of Stem Cell Genetics, Institute for Life and Medical Sciences, Kyoto University, Kyoto, Japan
| | - Naoki Shingai
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Yukiyasu Ozawa
- Department of Hematology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Aichi, Japan
| | - Takahiro Fukuda
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Keisuke Kataoka
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.,Division of Molecular Oncology, National Cancer Center Research Institute, Tokyo, Japan
| | - Toshiro Kawakita
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Yasunori Ueda
- Department of Hematology/Oncology and Transfusion and Hemapheresis Center, Kurashiki Central Hospital, Okayama, Japan
| | - Takahide Ara
- Department of Hematology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Masatsugu Tanaka
- Department of Hematology, Kanagawa Cancer Center, Kanagawa, Japan
| | - Yuta Katayama
- Department of Hematology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Masashi Sawa
- Department of Hematology and Oncology, Anjo Kosei Hospital, Aichi, Japan
| | - Tetsuya Eto
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | - Junya Kanda
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Aichi, Japan.,Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Aichi, Japan
| | - Ken Ishiyama
- Department of Hematology, Kanazawa University Hospital, Kanazawa, Japan
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6
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Winterling J, Pahnke S, Lagnebjörk J, Hägglund H, Larfors G, Lenhoff S, Kisch AM. Worries and Psychological Well-Being in Potential Hematopoietic Stem Cell Donors Before Donation-A Swedish National Study. Transplant Proc 2023; 55:242-248. [PMID: 36528407 DOI: 10.1016/j.transproceed.2022.10.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/18/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The physical risks involved in donating hematopoietic stem cells have been thoroughly studied, but little is known about the psychological risks potential donors might face before donation. The aim of this study was to describe potential the pre-donation worries and psychological well-being of hematopoietic stem cell donors and investigate possible associations between donor characteristics and psychological well-being. METHODS In a cross-sectional, national cohort study, we describe pre-donation worries and psychological well-being and investigate possible associations between donor characteristics and psychological well-being. A questionnaire was sent to prospective adult hematopoietic stem cells donors. RESULTS The study included 210 participants, 47% of whom were related and 53% unrelated to the recipient. Of the participants, 39% reported great worry about the recipient and 12% great worry about themselves as potential donors. Symptoms of anxiety were expressed by 21%, whereas symptoms of depression were uncommon and perceived general mental health was slightly lower than in the Swedish population. Great worry about oneself, lower age, and female sex were related to increased anxiety and lower mental health. CONCLUSION This study highlighted that some potential donors report high levels of pre-donation worry and that greater worry about oneself, lower age, and female sex are associated with lower psychological well-being. Although further studies are needed to investigate this psychological risk over time, it is clear that some potential donors are particularly vulnerable.
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Affiliation(s)
- Jeanette Winterling
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Medical unit HHLH, Comprehensive Cancer Centre, Karolinska University Hospital, Stockholm, Sweden.
| | - Simon Pahnke
- Unit of Haematology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Johanna Lagnebjörk
- Unit of Haematology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Hans Hägglund
- Unit of Haematology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Gunnar Larfors
- Unit of Haematology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Stig Lenhoff
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Annika M Kisch
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden; Institute of Health Sciences, Lund University, Sweden
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Romon I, Castillo C, Cid J, Lozano M. Use of plerixafor to mobilize haematopoietic progenitor cells in healthy donors. Vox Sang 2021; 117:6-16. [PMID: 34159611 DOI: 10.1111/vox.13175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/09/2021] [Accepted: 04/29/2021] [Indexed: 11/29/2022]
Abstract
Increased transplant activity calls for improved stem cell collection, especially when peripheral blood is the preferred source of haematopoietic progenitor cells (HPCs). Plerixafor is a bicyclam molecule that mobilizes CD34+ cells by reversibly disrupting CXCR4-CXCL12-supported HPC retention. Plerixafor is given with granulocyte colony-stimulating factor (G-CSF) to help harvest autologous CD34+ cells for transplantation when mobilization with G-CSF fails. Mobilization protocols with the same doses of plerixafor and G-CSF have been used off-label in healthy allogeneic donors, with equal success and scarce side effects, both in adult and paediatric patients. Plerixafor has also been used as a sole mobilization agent. Plerixafor alone or coupled with G-CSF might lead to harvesting distinct cellular populations conferring improved engraftment properties and increased survival. Those characteristics might make plerixafor an especially attractive mobilization agent, particularly for non-related donations. However, available data are limited, and long-term follow-up is needed to clarify the best scenario for using plerixafor with or without G-CSF in healthy donors. In this review, we will summarize the evidence supporting this practice, highlighting the practical aspects and providing clues for an expanded use of plerixafor.
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Affiliation(s)
- Iñigo Romon
- Transfusion Service, Hematology and Hemotherapy Service, University Hospital Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Carlos Castillo
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICMHO, Hospital Clínic, IDIBAPS, UB, Barcelona, Spain
| | - Joan Cid
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICMHO, Hospital Clínic, IDIBAPS, UB, Barcelona, Spain
| | - Miquel Lozano
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICMHO, Hospital Clínic, IDIBAPS, UB, Barcelona, Spain
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8
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Should We Stop Collecting the Preoperative Autologous Blood before Bone Marrow Harvest? J Clin Med 2021; 10:jcm10102134. [PMID: 34069241 PMCID: PMC8156284 DOI: 10.3390/jcm10102134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/02/2021] [Accepted: 05/10/2021] [Indexed: 01/05/2023] Open
Abstract
Preoperative autologous blood donation (PAD) in bone marrow (BM) donors is performed to meet potential post-harvest transfusion needs and to avoid the risk of allogeneic transfusions. We reviewed retrospectively bone marrow harvests in 216 healthy donors during a ten-year period to determine the use of autologous blood. All donors except four had undergone PAD. The initial hemoglobin level of 153 g/L (male donors) and 135 g/L (female donors), respectively, decreased by about 8 g/L after preoperative blood donation and by 23 g/L after bone marrow harvest (medians). Autologous blood was administered to 70% of donors, 30% of the units remained unused. The evaluation of the risk of reaching transfusion threshold (<115 g/L males, <105 g/L females) revealed that donors with initial hemoglobin above 145 g/L and those weighing above 75 kg have minimal risk of requiring blood substitution (about 10%). A larger volume of bone marrow was obtained from male compared to female donors (1300 vs. 1100 mL) because of their higher body weight, which resulted in a higher number of procured nucleated cells (362 vs. 307 × 106/kg TNC, ns). The donor-recipient weight difference predicted the probability of sufficient collection. Only 1.5% of donors weighing ≥ 20 kg more than recipients failed to reach ≥3 × 108/kg TNC recipient. Our findings affirm previous data that PAD is unnecessary for healthy marrow donors and may be indicated individually after considering the pre-collection hemoglobin level, donor and recipient weight, and expected blood loss. Reasonable substitution cut-offs have to be set together with clinical symptom evaluation. The effective use of PAD also requires an adequate time interval between PAD and BM harvest.
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9
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Ong JQL, Lim LJH, Ho RCM, Ho CSH. Depression, anxiety, and associated psychological outcomes in living organ transplant donors: A systematic review. Gen Hosp Psychiatry 2021; 70:51-75. [PMID: 33721612 DOI: 10.1016/j.genhosppsych.2021.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 12/23/2022]
Abstract
With increasing demands for living organ donations, understanding the prevalence of depression and anxiety, which are the commonest psychiatric disorders in donors following organ transplantation, will serve to improve psychiatric care to safeguard donors' mental wellbeing. This descriptive systematic review examines all observational studies in English investigating prevalence of depression and anxiety in adult transplant donors using bibliographic databases. Sixty-two papers were included (kidney, n = 25; liver, n = 25; bone marrow, n = 7; uterus, n = 2; lung, n = 1; kidney and lung concurrently, n = 2). Post-transplantation depression and anxiety prevalence rates (Depression: 0-46.9%, Anxiety: 0-66.7%) did not differ significantly from pre-transplantation and were largely comparable to the general population. Other psychiatric disorders observed included bipolar disorder, conversion disorder, adjustment disorder and sleep disorder. Other psychological outcomes observed included lower quality of life, lower satisfaction of life and regret after donation. Pre-donation risk factors such as poor physical/psychological health status, and post-donation risk factors such as complicated post-surgical recovery and poor physical/psychological health in recipients were identified, predisposing donors to poor psychological outcomes. Individuals with risk factors should be monitored and provided with social support, psychoeducation, psychotherapy and long-term follow up. Future studies should adopt consistent methodological approaches to improve comparability between various studies. More research investigating poor psychological outcomes in other organ donors besides kidney and liver donors, donors who have past psychiatric history, unrelated and parent donors is warranted.
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Affiliation(s)
- Jun Q L Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Roger C M Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore
| | - Cyrus S H Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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10
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Fujimoto A, Suzuki R, Orihara K, Iida M, Yamashita T, Nagafuji K, Kanamori H, Kodera Y, Miyamura K, Okamoto S, Hino M. Health-related quality of life in peripheral blood stem cell donors and bone marrow donors: a prospective study in Japan. Int J Hematol 2020; 111:840-850. [PMID: 32172446 DOI: 10.1007/s12185-020-02852-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 03/02/2020] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
Understanding of the impact of stem cell donation on donors' health-related quality of life (HRQOL) remains limited. A prospective observational study of eligible unrelated donors enrolled in the Japan Marrow Donor Program was conducted to compare HRQOL and adverse events (AEs) between peripheral blood stem cell (PBSC) and bone marrow (BM) donors. In total, 107 PBSC donors and 108 BM donors were enrolled. HRQOL scores for physical status were significantly lower in BM donors 1 week post-harvest (P < 0.001), but there were no significant differences between the two groups at baseline or 3 months post-harvest. PBSC donors were more likely to experience AEs before harvest (P < 0.001). However, at harvest, moderate-to-severe AEs were more common in BM donors (P = 0.001). After harvest, all grades of AEs were significantly higher in BM donors (P < 0.001). Among BM donors, a lower total physical score at baseline [odds ratio (OR) 1.21], female sex [OR 2.71], and young donors (OR 3.08) were risk factors for moderate-to-severe AEs at harvest, while among PBSC donors, only female sex (OR 4.86) was a risk factor. Our findings show better HRQOL during PBSC donation. These data help support decision-making by potential donors.
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Affiliation(s)
- Ayumi Fujimoto
- Department of Oncology and Hematology, Shimane University Hospital, Izumo, Japan
| | - Ritsuro Suzuki
- Department of Oncology and Hematology, Shimane University Hospital, Izumo, Japan
| | | | - Minako Iida
- Department of Promotion for Blood and Marrow Transplantation, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Takuya Yamashita
- Department of Hematology, St. Luke's International Hospital, Tokyo, Japan
| | - Koji Nagafuji
- Division of Hematology and Oncology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Heiwa Kanamori
- Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan
| | - Yoshihisa Kodera
- Department of Promotion for Blood and Marrow Transplantation, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Koichi Miyamura
- Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Shinichiro Okamoto
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Masayuki Hino
- Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
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11
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Zomerdijk N, Turner J, Hill GR, Gottlieb D. Adult related haematopoietic stem cell donor care: Views of Transplant Nurses. Eur J Oncol Nurs 2019; 41:56-63. [PMID: 31358258 DOI: 10.1016/j.ejon.2019.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 05/08/2019] [Accepted: 05/31/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE The objective of this mixed-methods study was to explore the experiences and perspectives of Transplant Nurses (TNs) in caring for related donors (RDs). METHOD In this mixed-methods study, both quantitative and qualitative data were collected from semi-structured interviews with seven TNs from two clinical hospitals. Closed and multiple-choice questions regarding the organisation of RD care were administered in addition to an in-depth exploration of TN experiences and perspectives of RD care. Interviews were audio-recorded, transcribed, and qualitative data was subjected to thematic analyses. RESULTS The analysis identified 5 themes relating to RD care: managing complex family dynamics and ambivalence; concerns about RD psychological adjustment; identifying and correcting RD misperceptions; limited guidelines and structured processes; limited training for the role and access to supervision. Five themes were identified describing the barriers to delivering RD care: RDs unwilling to express their concerns; language; time constraints; medical priority of clinicians; biomedical focus of TNs. All TNs agreed they would like additional training in the psychosocial management of RDs. TNs identified key areas for improvement, including psychosocial support and educational material. CONCLUSIONS Our results highlight the significant role of TNs in RD care, and underline issues specific to the current RD care environment. Lack of training for the role and limited guidelines addressing RD care management are key issues which may detrimentally affect RD care. The pivotal role of TNs must be acknowledged and supported by improving TN training and implementing clear guidelines for the management of RDs. The trial has been registered on the publicly accessible register: www.clinicaltrials.gov site with the identifier ACTRN12617000407392.
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Affiliation(s)
- Nienke Zomerdijk
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
| | - Jane Turner
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
| | - Geoffrey R Hill
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia; Fred Hutchinson Cancer Research Center, Sydney, NSW, Australia.
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12
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The case for plerixafor to replace filgrastim as the optimal agent to mobilize peripheral blood donors for allogeneic hematopoietic cell transplantation. Exp Hematol 2018; 70:1-9. [PMID: 30428338 DOI: 10.1016/j.exphem.2018.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/03/2018] [Accepted: 11/06/2018] [Indexed: 12/25/2022]
Abstract
Granulocyte colony-stimulating factor (G-CSF)-stimulated peripheral blood progenitor cells (G-PBs) from either a related or unrelated donor continue to be the preferred donor source for most allogeneic hematopoietic cell transplantation (HCT). Recently, the American Society for Blood and Marrow Transplantation has recommended marrow instead of G-PBs as an unrelated graft source due to its lower rate of chronic graft-versus-host disease (cGVHD). However, the use of marrow is limited by both clinical considerations (slower rate of engraftment and increased donor morbidity) and logistical considerations (use of operating room resources and increased physician utilization), so this recommendation has not been widely adopted. An optimal donor source would include the rapid engraftment characteristic and the low donor morbidity associated with G-PBs and a rate of cGVHD similar to or lower than that of marrow. Recent data suggest that plerixafor mobilized PBs (P-PBs) have the rapid engraftment characteristics of G-PBs in allogeneic HCT with less cGVHD. The biologic mechanism of the lower rate of cGVHD appears to be through mobilization of regulator natural killer cells and plasmacytoid dendritic cell precursors that are associated with lower acute and chronic GVHD compared with G-PBs and rapid engraftment characterized by rapid myeloid-repopulating capacity. We suggest that, based on the experience of the two Phase II clinical trials and the unique biology of plerixafor-mobilized donor product, it should be evaluated in Phase III trials as an approach to replacing G-CSF mobilization for allogeneic HCT.
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13
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Zomerdijk N, Turner JM, Hill GR. Adult-related haematopoietic stem cell donor experiences and the provision of information and psychosocial support: A systematic literature review. Eur J Cancer Care (Engl) 2018; 28:e12932. [PMID: 30277290 DOI: 10.1111/ecc.12932] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 08/26/2018] [Accepted: 08/31/2018] [Indexed: 01/12/2023]
Abstract
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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Affiliation(s)
- Nienke Zomerdijk
- Faculty of Medicine, Mental Health Centre, University of Queensland, Brisbane, Qld, Australia.,Royal Brisbane & Women's Hospital, Brisbane, Qld, Australia.,Bone Marrow Transplantation Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Qld, Australia
| | - Jane M Turner
- Faculty of Medicine, Mental Health Centre, University of Queensland, Brisbane, Qld, Australia.,Royal Brisbane & Women's Hospital, Brisbane, Qld, Australia
| | - Geoffrey R Hill
- Faculty of Medicine, Mental Health Centre, University of Queensland, Brisbane, Qld, Australia.,Royal Brisbane & Women's Hospital, Brisbane, Qld, Australia.,Bone Marrow Transplantation Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Qld, Australia
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14
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Billen A, Madrigal JA, Scior K, Shaw BE, Strydom A. Donation of peripheral blood stem cells to unrelated strangers: A thematic analysis. PLoS One 2017; 12:e0186438. [PMID: 29069088 PMCID: PMC5656410 DOI: 10.1371/journal.pone.0186438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 10/02/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Donation of haematopoietic stem cells, either through bone marrow (BM) or peripheral blood stem cell (PBSC) collection, is a generally safe procedure for healthy donors, although side effects are a known risk. Previous research, including our recent quantitative study, has shown that the psychosocial response to donating is usually a positive one and most donors would be willing to donate again in the future. This is often despite experiencing significant side effects during the donation process. Due to the relative recent introduction of PBSC, a comprehensive understanding of the range of physical and emotional issues donors may experience is lacking, as well as an understanding of specific donor characteristics Qualitative research can provide rich narrative data into these areas. This study was set up in order to identify specific donor characteristics and to further explore the relationship between pre-donation physical health and the donation experience, as previously identified in our quantitative study. METHODS It involved in-depth telephone interviews with 14 PBSC donors who participated in our original quantitative study. Thematic analysis was used to analyse the findings and the results provide a summary of participants' characteristics using themes and constituent codes. RESULTS We identified several donor characteristics, including strong intrinsic motivation, altruism, sense of duty, determination, low levels of ambivalence and the ability to develop a strong emotional relationship with an (unknown/anonymous) recipient whilst being able to manage strong feelings and emotions. CONCLUSIONS These personality traits may explain the resilience that has been observed previously in haematopoietic stem cells donors. Significant feelings of grief were reported after a recipient's death. Possibilities to alleviate these symptoms may include raising awareness of potential poor outcomes in the recipient and offering improved counselling services if the recipient dies. We acknowledge several limitations including the sampling frame.
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Affiliation(s)
- Annelies Billen
- Anthony Nolan, London, United Kingdom
- UCL Cancer Institute, London, United Kingdom
| | | | - Katrina Scior
- UCL Research Department of Clinical, Educational and Health Psychology, London, United Kingdom
| | - Bronwen E. Shaw
- Anthony Nolan, London, United Kingdom
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Andre Strydom
- UCL Mental Health Sciences Unit, London, United Kingdom
- * E-mail:
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15
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Stroncek DF, Shaw BE, Logan BR, Kiefer DM, Savani BN, Anderlini P, Bredeson CN, Hematti P, Ganguly S, Diaz MA, Abdel-Azim H, Ahmed I, Maharaj D, Seftel M, Beitinjaneh A, Seo S, Yared JA, Halter J, O'Donnell PV, Hale GA, DeFilipp Z, Lazarus H, Liesveld JL, Zhou Z, Munshi P, Olsson RF, Kasow KA, Szer J, Switzer GE, Chitphakdithai P, Shah N, Confer DL, Pulsipher MA. Donor Experiences of Second Marrow or Peripheral Blood Stem Cell Collection Mirror the First, but CD34 + Yields Are Less. Biol Blood Marrow Transplant 2017; 24:175-184. [PMID: 28958894 DOI: 10.1016/j.bbmt.2017.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 09/20/2017] [Indexed: 11/16/2022]
Abstract
Little is known about the experiences of individuals donating peripheral blood stem cells (PBSCs) or marrow for a second time. To study this, unrelated donors making a second donation through the National Marrow Donor Program between 2004 and 2013 were evaluated. Experiences of second-time donors giving marrow (n = 118: first donation was PBSC in 76 and marrow in 42) were compared with those making only 1 marrow donation (n = 5829). Experiences of second-time donors giving PBSCs (n = 602) (first donation was PBSCs in 362; marrow in 240) were compared to first-time PBSC donors (n = 16,095). For donors giving a second PBSC or marrow donation there were no significant differences in maximum skeletal pain, maximum symptoms measured by an established modified toxicity criteria, and recovery time compared with those who donated only once. Notably, the yield of marrow nucleated cells and PBSC CD34+ cells with second donations was less. As previously noted with single first-time donations, female (PBSCs and marrow) and obese donors (PBSCs) had higher skeletal pain and/or toxicity with a second donation. PBSC donors who experienced high levels of pain or toxicity with the first donation also experienced high levels of these symptoms with their second donation and slower recovery times. In conclusion, for most donors second donation experiences were similar to first donation experiences, but CD34+ yields were less. Knowledge of the donor's first experience and stem cell yields may help centers decide whether second donations are appropriate and institute measures to improve donor experiences.
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Affiliation(s)
- David F Stroncek
- Department of Transfusion Medicine, Cell Processing Section, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Bronwen E Shaw
- Center for International Blood and Bone Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Brent R Logan
- Center for International Blood and Bone Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Deidre M Kiefer
- Center for International Blood and Bone Marrow Transplant Research, National Marrow Donor Program, Minneapolis, Minnesota
| | - Bipin N Savani
- Hematology & Stem Cell Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Paolo Anderlini
- Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Christopher N Bredeson
- The Ottawa Hospital Blood & Marrow Transplant Program, University of Ottawa, Ottawa, Ontario, Canada
| | - Peiman Hematti
- Department of Medicine, University of Wisconsin, Madison, Wisconsin
| | - Siddhartha Ganguly
- Hematologic Malignancies and Cellular Therapies, University of Kansas Medical Center, Westwood, Kansas
| | - Miguel Angel Diaz
- Unidad de Trasplante Hematopoyetico, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Hisham Abdel-Azim
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Ibrahim Ahmed
- Children's Mercy Hospital-UMKC, Kansas City, Missouri
| | - Dipnarine Maharaj
- South Florida Bone Marrow Transplant/Stem Cell Transplant Institute, Bethesda Health City, Boynton Beach, Florida
| | - Matthew Seftel
- Medical Oncology and Haematology, CancerCare Manitoba, Winnipeg, Ontario, Canada
| | - Amer Beitinjaneh
- Stem Cell Transplantation and Cell Therapy Program, Miller School of Medicine, University of Miami, Miami, Florida
| | - Sachiko Seo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Jean A Yared
- Department of Medicine, Greenbaum Cancer Center, University of Maryland, Baltimore, Maryland
| | - Joerg Halter
- Department of Haematology, University Hospital Basel, Basel, Switzerland
| | - Paul V O'Donnell
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gregory A Hale
- Cancer and Blood Disorders Institute, All Children's Hospital, St. Petersburg, Florida
| | - Zachariah DeFilipp
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hillard Lazarus
- Department of Medicine, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Jane L Liesveld
- Hematology-Oncology Unit, Department of Medicine, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
| | - Zheng Zhou
- University of Massachusetts, Marlboro, Massachusetts
| | - Pashna Munshi
- Georgetown University Hospital, Washington, District of Columbia
| | - Richard F Olsson
- Karolinska Institutet, Division of Therapeutic Immunology, Stockholm, Sweden
| | - Kimberly Anne Kasow
- Division of Hematology-Oncology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jeffrey Szer
- Department of Hematology and Bone Marrow Transplantation, Royal Melbourne Hospital City Campus, Victoria, Australia
| | - Galen E Switzer
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Pintip Chitphakdithai
- Center for International Blood and Bone Marrow Transplant Research, National Marrow Donor Program, Minneapolis, Minnesota
| | - Nirali Shah
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Dennis L Confer
- Center for International Blood and Bone Marrow Transplant Research, National Marrow Donor Program, Minneapolis, Minnesota
| | - Michael A Pulsipher
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
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16
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Pahnke S, Larfors G, Axdorph-Nygell U, Fischer-Nielsen A, Haastrup E, Heldal D, Itälä-Remes M, Johansson JE, Kauppila M, Lenhoff S, Ljungman P, Niittyvuopio R, Sandstedt A, Hägglund H. Short-term side effects and attitudes towards second donation: A comparison of related and unrelated haematopoietic stem cell donors. J Clin Apher 2017; 33:226-235. [PMID: 28833474 DOI: 10.1002/jca.21576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/02/2017] [Accepted: 08/01/2017] [Indexed: 11/11/2022]
Abstract
The Nordic Register of Haematopoietic Stem Cell Donors (NRHSD) has registered related and unrelated donors from 10 transplant centres in Sweden, Norway, Finland and Denmark since 1998. We present a prospective, observational study of 1,957 donors, focusing mainly on the differences between related and unrelated donors. Related donors are reported to have more comorbidities, but similar side effects compared with unrelated donors. Side effects after BM or PBSC donation are generally of short duration and in this study no deaths, myocardial infarctions, splenic ruptures, or thromboembolic events are reported. Interestingly, related donors express more hesitancy towards donating again when asked 1 month after donation.
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Affiliation(s)
- Simon Pahnke
- Department of Haematology, Uppsala University Hospital, Uppsala, Sweden.,Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Gunnar Larfors
- Department of Haematology, Uppsala University Hospital, Uppsala, Sweden
| | - Ulla Axdorph-Nygell
- Centre for Apheresis and Stem Cell Processing (CASH), Clinical Immunology/Transfusion Medicine, and Department of Haematology, Karolinska University Hospital, Stockholm, Sweden
| | - Anne Fischer-Nielsen
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Eva Haastrup
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Dag Heldal
- Department of Haematology, Oslo University Hospital, Oslo, Norway
| | - Maija Itälä-Remes
- Stem Cell Transplantation Unit, Turku University Hospital, Turku, Finland
| | - Jan-Erik Johansson
- Department of Haematology and Coagulation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marjut Kauppila
- Department of Haematology, Turku University Hospital, Turku, Finland
| | - Stig Lenhoff
- Department of Haematology, Skåne University Hospital, Lund, Sweden
| | - Per Ljungman
- Department of Haematology, Karolinska University Hospital, Division of Haematology, Karolinska Institutet, Stockholm, Sweden.,Department of Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Division of Haematology, Karolinska Institutet, Stockholm, Sweden.,Department of Medicine Huddinge, Karolinska University Hospital, Division of Haematology, Karolinska Institutet, Stockholm, Sweden
| | - Riita Niittyvuopio
- Stem Cell Transplantation Unit, Helsinki University Hospital, Helsinki, Finland
| | - Anna Sandstedt
- Department of Haematology, Linköping University Hospital, Linköping, Sweden
| | - Hans Hägglund
- Department of Haematology, Uppsala University Hospital, Uppsala, Sweden
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17
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Riezzo I, Pascale N, La Russa R, Liso A, Salerno M, Turillazzi E. Donor Selection for Allogenic Hemopoietic Stem Cell Transplantation: Clinical and Ethical Considerations. Stem Cells Int 2017; 2017:5250790. [PMID: 28680446 PMCID: PMC5478865 DOI: 10.1155/2017/5250790] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/03/2017] [Indexed: 11/18/2022] Open
Abstract
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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Affiliation(s)
- Irene Riezzo
- Institute of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Ospedale “Colonnello D'Avanzo”, Viale Degli Aviatori, 1, 71122 Foggia, Italy
| | - Natascha Pascale
- Institute of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Ospedale “Colonnello D'Avanzo”, Viale Degli Aviatori, 1, 71122 Foggia, Italy
| | - Raffaele La Russa
- Istituto Clinico-Scientifico Malzoni, 83100 Avellino, Italy
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00185 Rome, Italy
| | - Arcangelo Liso
- Institute of Hematology, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
| | - Monica Salerno
- Institute of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Ospedale “Colonnello D'Avanzo”, Viale Degli Aviatori, 1, 71122 Foggia, Italy
| | - Emanuela Turillazzi
- Institute of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Ospedale “Colonnello D'Avanzo”, Viale Degli Aviatori, 1, 71122 Foggia, Italy
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18
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Rubessa M, Polkoff K, Bionaz M, Monaco E, Milner DJ, Holllister SJ, Goldwasser MS, Wheeler MB. Use of Pig as a Model for Mesenchymal Stem Cell Therapies for Bone Regeneration. Anim Biotechnol 2017; 28:275-287. [PMID: 28267421 DOI: 10.1080/10495398.2017.1279169] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Bone is a plastic tissue with a large healing capability. However, extensive bone loss due to disease or trauma requires extreme therapy such as bone grafting or tissue-engineering applications. Presently, bone grafting is the gold standard for bone repair, but presents serious limitations including donor site morbidity, rejection, and limited tissue regeneration. The use of stem cells appears to be a means to overcome such limitations. Bone marrow mesenchymal stem cells (BMSC) have been the choice thus far for stem cell therapy for bone regeneration. However, adipose-derived stem cells (ASC) have similar immunophenotype, morphology, multilineage potential, and transcriptome compared to BMSC, and both types have demonstrated extensive osteogenic capacity both in vitro and in vivo in several species. The use of scaffolds in combination with stem cells and growth factors provides a valuable tool for guided bone regeneration, especially for complex anatomic defects. Before translation to human medicine, regenerative strategies must be developed in animal models to improve effectiveness and efficiency. The pig presents as a useful model due to similar macro- and microanatomy and favorable logistics of use. This review examines data that provides strong support for the clinical translation of the pig model for bone regeneration.
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Key Words
- ASC, adipose-derived stem cells
- BMP, bone morphogenetic protein
- BMSC, bone marrow mesenchymal stem cells
- Bone
- DEG, differentially expressed genes
- FDR, false-discovery rate
- HA, hydroxyapatite
- HA/TCP, hydroxyapatite/tricalcium phosphate
- MRI, magnetic resonance imaging
- MSC, mesenchymal stem cells
- ONFH, osteonecrosis of the femoral head
- PCL, Poly (ϵ-caprolactone)
- PEG, polyethylene glycol
- PLGA, polylactic-coglycolic acid
- TCP, beta tri-calcium phosphate
- USSC, unrestricted somatic stem cell
- scaffolds
- stem cells
- swine
- tissue engineering
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Affiliation(s)
- Marcello Rubessa
- a University of Illinois at Urbana-Champaign , Urbana , Illinois , USA
| | - Kathryn Polkoff
- a University of Illinois at Urbana-Champaign , Urbana , Illinois , USA
| | | | - Elisa Monaco
- b Oregon State University , Corvallis , Oregon , USA
| | - Derek J Milner
- a University of Illinois at Urbana-Champaign , Urbana , Illinois , USA
| | | | - Michael S Goldwasser
- a University of Illinois at Urbana-Champaign , Urbana , Illinois , USA.,d New Hanover Regional Medical Center , Wilmington , North Carolina , USA
| | - Matthew B Wheeler
- a University of Illinois at Urbana-Champaign , Urbana , Illinois , USA
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19
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Hequet O, Mialou V, Audat F, Wattel E, Chapel V, Revesz D, Jouet JP, Fisseaux B, Saoud M, Michallet M. Management of psychiatric complications in unrelated donor before unrelated peripheral hematopoietic stem cell collections. J Blood Med 2017; 8:1-4. [PMID: 28115876 PMCID: PMC5221806 DOI: 10.2147/jbm.s96465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Allogeneic hematopoietic stem cell transplantation can efficiently treat patients with severe hematological diseases. A human leukocyte antigen-compatible donor is required for performing transplantation. The occurrence of unexpected acute severe diseases in a donor can compromise the feasibility of allogeneic hematopoietic stem cell transplantation. However, when a severe health problem occurs in a donor while the recipient has already received a conditioning regimen, hematologists have to find the best solutions for the recipient, while the team in charge of the donor has to find the best medical solutions for the donor. We describe here the occurrence of psychiatric acute complications in an unrelated donor while the myeloablative conditioning regimen had already been given to the recipient. We report the successive decisions that were made in an emergency based upon the expertise of physicians specialized in hematology, apheresis, cell therapy, and psychiatry to preserve the donor's health and recipient's life.
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Affiliation(s)
- Olivier Hequet
- Apheresis Unit; Cell Therapy Laboratory, Etablissement Français du Sang (EFS) Rhône Alpes, Centre Hospitalier Lyon Sud, Pierre Bénite
| | - Valerie Mialou
- Cell Therapy Laboratory, Etablissement Français du Sang (EFS) Rhône Alpes, Centre Hospitalier Lyon Sud, Pierre Bénite
| | | | - Eric Wattel
- Hematological Unit, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite
| | - Valerie Chapel
- Hematological Unit, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite
| | | | | | - Brigitte Fisseaux
- Psychiatric Unit, Hospices Civils de Lyon, Centre Hospitalier, Bourgoin Jallieu
| | - Mohamed Saoud
- Psychiatric Unit, Hospices Civils de Lyon, Centre Hospitalier P Wertheimer, Lyon, France
| | - Mauricette Michallet
- Hematological Unit, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite
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20
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Lee MH, Jang JH, Min HJ, Jang HI, Nah JH, Lyu CJ, Han KS, Won JH, Lee YH, Chong SY, Mun YC, Lee WS, Kim SJ, Kim I. Predictors of general discomfort, limitations in activities of daily living and intention of a second donation in unrelated hematopoietic stem cell donation. Bone Marrow Transplant 2016; 52:258-263. [PMID: 27819689 DOI: 10.1038/bmt.2016.260] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 08/22/2016] [Accepted: 08/24/2016] [Indexed: 11/09/2022]
Abstract
We performed a retrospective study of 1868 consecutive unrelated donors to predict the risk factors related to general discomfort, limitations in activities of daily living (ADLs) and intention of a second donation in hematopoietic stem cell (HSC) donation. General discomfort and limitations in ADLs were assessed by numerical measurement (scores of 0-10) and donor's intention of a second donation by yes or no reply. The post-donation questionnaires were completed within 48 h after HSC collection and at 1 week, 4 weeks, and 4 months thereafter. Predictors of general discomfort included female sex (P<0.0001), bone marrow (BM) collection (P<0.0001) or PBSC collection through a central line (CL; P=0.0349), 2-day collection (P=0.0150) and negative or undetermined intention of a second donation on day 1 (P<0.0001). Predictors of limitations in ADLs included age group of 30-39 years (P=0.0046), female sex (P<0.0001), BM collection (P<0.0001) or PBSC collection through a CL (P<0.0001) and negative or undetermined intention of a second donation on day 1 (P<0.0001). The only predictor of positive intention of a second donation was male sex (P=0.0007). Age, sex and collection method and period should be considered risk factors when unrelated HSC donation is performed.
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Affiliation(s)
- M H Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
| | - J H Jang
- Korea Marrow Donor Program, Seoul, South Korea
| | - H J Min
- Clinical Research Institute, Konkuk University Medical Center, Seoul, South Korea
| | - H I Jang
- Korea Marrow Donor Program, Seoul, South Korea
| | - J H Nah
- Korea Marrow Donor Program, Seoul, South Korea
| | - C J Lyu
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - K-S Han
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - J H Won
- Department of Hematology-Oncology, Soon Chun Hyang University Hospital, Seoul, South Korea
| | - Y-H Lee
- Department of Pediatrics, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, South Korea
| | - S Y Chong
- Department of Internal Medicine, Bundang Cha Hospital, Seongnam, South Korea
| | - Y C Mun
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, South Korea
| | - W S Lee
- Department of Hematology and Oncology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - S J Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - I Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
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21
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Burns LJ, Logan BR, Chitphakdithai P, Miller JP, Drexler R, Spellman S, Switzer GE, Wingard JR, Anasetti C, Confer DL. Recovery of Unrelated Donors of Peripheral Blood Stem Cells versus Recovery of Unrelated Donors of Bone Marrow: A Prespecified Analysis from the Phase III Blood and Marrow Transplant Clinical Trials Network Protocol 0201. Biol Blood Marrow Transplant 2016; 22:1108-1116. [PMID: 27013014 DOI: 10.1016/j.bbmt.2016.02.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 02/27/2016] [Indexed: 10/22/2022]
Abstract
We report a comparison of time to recovery, side effects, and change in blood counts from baseline to after donation from unrelated donors who participated in the Blood and Marrow Transplant Clinical Trials Network phase III randomized, multicenter trial (0201) in which donor-recipient pairs were randomized to either peripheral blood stem cell (PBSC) or bone marrow (BM) donation. Of the entire cohort, 262 donated PBSC and 264 donated BM; 372 (71%) donors were from domestic and 154 (29%) were from international centers (145 German and 9 Canadian). PBSC donors recovered in less time, with a median time to recovery of 1 week compared with 2.3 weeks for BM donors. The number of donors reporting full recovery was significantly greater for donors of PBSC than of BM at 1, 2, and 3 weeks and 3 months after donation. Multivariate analysis showed that PBSC donors were more likely to recover at any time after donation compared with BM donors (hazard ratio, 2.08; 95% confidence interval [CI], 1.73 to 2.50; P < .001). Other characteristics that significantly increased the likelihood of complete recovery were being an international donor and donation in more recent years. Donors of BM were more likely to report grades 2 to 4 skeletal pain, body symptoms, and fatigue at 1 week after donation. In logistic regression analysis of domestic donors only in which toxicities at peri-collection time points (day 5 filgrastim for PBSC donors and day 2 after collection of BM donors) could be analyzed, no variable was significantly associated with grades 2 to 4 skeletal pain, including product donated (BM versus PBSC; odds ratio, 1.13; 95% CI, .74 to 1.74; P = .556). Blood counts were affected by product donated, with greater mean change from baseline to after donation for white blood cells, neutrophils, mononuclear cells, and platelets in PBSC donors whereas BM donors experienced a greater mean change in hemoglobin. This analysis provided an enhanced understanding of donor events as product donated was independent of physician bias or donor preference.
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Affiliation(s)
- Linda J Burns
- National Marrow Donor Program/Be the Match, Minneapolis, Minnesota; Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota.
| | - Brent R Logan
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Pintip Chitphakdithai
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - John P Miller
- National Marrow Donor Program/Be the Match, Minneapolis, Minnesota; Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Rebecca Drexler
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Stephen Spellman
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | | | - John R Wingard
- University of Florida College of Medicine, Gainesville, Florida
| | | | - Dennis L Confer
- National Marrow Donor Program/Be the Match, Minneapolis, Minnesota; Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
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22
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Kuan JW, Su AT, Leong CF, Tharyan P. Pegylated granulocyte colony stimulating factor versus non-pegylated granulocyte colony stimulating factor for peripheral stem cell mobilization. Hippokratia 2016. [DOI: 10.1002/14651858.cd010103.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Jew-Win Kuan
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak; Department of Medicine; 94300 Kota Samarahan Sarawak Malaysia
| | - Anselm Ting Su
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak; Department of Community Medicine and Public Health; 94300 Kota Samarahan Sarawak Malaysia
| | - Chooi-Fun Leong
- University Kebangsaan Malaysia Medical Center; Department of Pathology; Jalan Yaakob Latif Kuala Lumpur Wilayah Persekutuan Malaysia 56000
| | - Prathap Tharyan
- Christian Medical College; Cochrane South Asia, Prof. BV Moses Center for Evidence-Informed Health Care and Health Policy; Carman Block II Floor CMC Campus, Bagayam Vellore Tamil Nadu India 632002
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23
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Bank I, Wiersum-Osselton JC, Van Walraven SM, Netelenbos T, Fechter M, Marijt-van der Kreek T, Bär BMAM, Van der Bom JG, Brand A. Donors' health state the year after peripheral haematopoietic progenitor cell collection: A prospective follow-up study in related and unrelated donors compared to first-time platelet donors. J Clin Apher 2016; 31:523-528. [PMID: 26812941 DOI: 10.1002/jca.21444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 12/09/2015] [Indexed: 11/10/2022]
Abstract
Granulocyte colony-stimulating factor (G-CSF) mobilized peripheral haematopoietic progenitor cells collected by apheresis (HPC-A) are the most common source used for allogeneic hematopoietic stem cell transplantation (HSCT). Retrospective short and long-term donor follow-up studies show very low risks of serious complications and do not report compelling evidence of increased cancer occurrence. Some studies reported a prolonged period of leucopenia without an obvious association with infectious complications. However, beyond the first few weeks after the procedure a relationship between events is elusive. We therefore evaluated medical service utilization by prospectively recruited HPC-A donors and first-time platelet apheresis donors for comparison for 1 year after donation. Data were prospectively collected using questionnaires and by medical record review. A total of 215 HPC-A donors (111 unrelated donors and 104 related donors) and 96 first-time platelet donors consented to participation in the study. Follow-up was available for 202 (96%): questionnaires were returned by 74% and records from nonstudy contacts were available for 94% of donors. During the 1-year follow-up, 94 of the donors who returned questionnaires sought medical attention for diagnostic evaluation and/or treatment: 41% of HPC-A donors and 40% of platelet donors. Medical service utilization the first year after HPC-A donation is similar to that after first-time platelet donation. The occurrence of serious medical conditions in both related and unrelated HPC-A donors underscores the importance of participation in long-term follow-up in large cohorts. The findings in this relatively small cohort contribute to evidence on the safety of G-CSF mobilization and HPC-A. J. Clin. Apheresis 31:523-528, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- I Bank
- Sanquin - LUMC Jon J. Van Rood Centre for Clinical Transfusion Research, Leiden, the Netherlands.,Center for Innovation in Medical Education, Leiden University Medical Center, Leiden, the Netherlands
| | - J C Wiersum-Osselton
- Donor Services Unit, Sanquin Blood Supply, Leiden, the Netherlands.,TRIP Hemovigilance and Biovigilance Office, Leiden, the Netherlands
| | - S M Van Walraven
- TRIP Hemovigilance and Biovigilance Office, Leiden, the Netherlands.,Europdonor Foundation, Leiden, the Netherlands
| | - T Netelenbos
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, the Netherlands
| | - M Fechter
- Europdonor Foundation, Leiden, the Netherlands
| | | | - B M A M Bär
- Stem Cell Donor Bank Europdonor Nijmegen, Nijmegen, the Netherlands
| | - J G Van der Bom
- Sanquin - LUMC Jon J. Van Rood Centre for Clinical Transfusion Research, Leiden, the Netherlands
| | - A Brand
- Sanquin - LUMC Jon J. Van Rood Centre for Clinical Transfusion Research, Leiden, the Netherlands.,Europdonor Foundation, Leiden, the Netherlands
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24
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Deotare U, Al-Dawsari G, Couban S, Lipton JH. G-CSF-primed bone marrow as a source of stem cells for allografting: revisiting the concept. Bone Marrow Transplant 2015; 50:1150-6. [PMID: 25915812 DOI: 10.1038/bmt.2015.80] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/10/2015] [Accepted: 03/12/2015] [Indexed: 12/23/2022]
Abstract
The source of hematopoietic stem cells (HSCs) for allogeneic transplantation has evolved over the last decades, from the sole use of unstimulated bone marrow (BM) to the use of G-CSF (filgrastim)-mobilized peripheral blood, G-CSF-primed BM (G-BM) and cord blood. G-CSF-mobilized PBSC has replaced BM as the most commonly used source of allogeneic stem cells. G-BM is a source of HSCs, with studies demonstrating the safety and feasibility of this strategy with the potential for reducing GvHD, while retaining the speed of engraftment. Although the G-BM had lost its use as the optimal source of stem cells, after the widespread use of haploidentical transplantation, their use has resurfaced in 2010. This source can still be used in today's world of transplantation in aplastic anemia and other benign diseases, as well as in children donors. This study intends to review the evidence for this approach and whether this approach still has merit in the ever-evolving field of allogenic HSC transplantation. The merit of G-BM is its ability to offer speed of engraftment with reduced GvHD.
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Affiliation(s)
- U Deotare
- Allogeneic Bone Marrow Transplant Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - G Al-Dawsari
- Allogeneic Bone Marrow Transplant Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - S Couban
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - J H Lipton
- Allogeneic Bone Marrow Transplant Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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25
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Billen A, Madrigal JA, Strydom A, Szydlo RM, Switzer GE, Shaw BE. Predonation health-related quality of life scores predict time to recovery in hematopoietic stem cell donors. Biol Blood Marrow Transplant 2014; 21:350-6. [PMID: 25452034 DOI: 10.1016/j.bbmt.2014.10.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 10/29/2014] [Indexed: 01/09/2023]
Abstract
The physical reactions to hematopoietic stem cell donation have been extensively studied, but less is known about factors that predict poorer donation experiences. The aim of this prospective study was to examine demographic and health-related quality of life (HRQOL) factors that might be associated with recovery and side effects. We also described the changes in HRQOL during the donation process. In total, 275 peripheral blood stem cell (PBSC) and 37 bone marrow (BM) consecutive donors completed the SF-36 questionnaire predonation and 4 weeks, and 3 months postdonation. Predonation HRQOL markers were the strongest predictors of time to recovery. Poorer predonation physical health was associated with longer recovery (P = .017) and certain side effects in PBSC donors. Poorer predonation mental health was associated with longer recovery in BM donors (P = .03) and pain after PBSC donation (P = .003). Physical HRQOL scores declined significantly from predonation to 4 weeks postdonation. This was shown both for PBSC and BM donors (P < .001 and P = .009, respectively), but the decline was much greater for BM donors. There was a return to predonation HRQOL values 3 months after donation in both groups with values well above the mean of the general population (P < .001).
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Affiliation(s)
- Annelies Billen
- UCL Cancer Institute and Anthony Nolan Research Institute, London, United Kingdom.
| | - J Alejandro Madrigal
- UCL Cancer Institute and Anthony Nolan Research Institute, London, United Kingdom
| | - Andre Strydom
- UCL Mental Health Sciences Unit, London, United Kingdom
| | - Richard M Szydlo
- Department of Medicine, Imperial College London, London, United Kingdom
| | - Galen E Switzer
- Department of General Internal Medicine, University of Pittsburgh and Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Bronwen E Shaw
- UCL Cancer Institute and Anthony Nolan Research Institute, London, United Kingdom; Department of Haematology, Royal Marsden Hospital, London, United Kingdom
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26
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Alwasaidi T, Bredeson C. Peripheral blood stem cells or bone marrow as the graft source for allogeneic hematopoietic cell transplantation? J Taibah Univ Med Sci 2014. [DOI: 10.1016/j.jtumed.2013.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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27
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A review of the haematopoietic stem cell donation experience: is there room for improvement? Bone Marrow Transplant 2014; 49:729-36. [DOI: 10.1038/bmt.2013.227] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 11/29/2013] [Accepted: 12/02/2013] [Indexed: 11/08/2022]
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28
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Switzer GE, Bruce JG, Harrington D, Haagenson M, Drexler R, Foley A, Confer D, Bishop M, Anderlini P, Rowley S, Leitman SF, Anasetti C, Wingard JR. Health-related quality of life of bone marrow versus peripheral blood stem cell donors: a prespecified subgroup analysis from a phase III RCT-BMTCTN protocol 0201. Biol Blood Marrow Transplant 2013; 20:118-27. [PMID: 24184336 DOI: 10.1016/j.bbmt.2013.10.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 10/26/2013] [Indexed: 10/26/2022]
Abstract
Hematopoietic stem cells can be procured from unrelated donors via either the bone marrow (BM) aspiration or peripheral blood stem cell (PBSC) collection methods. There is no evidence from prospective randomized trials in the unrelated donor setting about the relative health-related quality-of-life (HRQoL) benefits/costs to donors. The goals of this prospective longitudinal investigation were to describe and compare the donation-related HRQoL experiences of 332 BM and PBSC donors. Donors were interviewed before donation, 48 hours after donation, weekly until fully recovered, and at 6 and 12 months after donation. Before donation, BM donors had lower confusion, fewer concerns, and were more prepared for donation. Shortly after donation, BM donors reported more physical side effects. BM donors also reported more donation-related impact on their social activities. However, BM donors reported somewhat better psychological status and were more likely to indicate that the donation made their lives more meaningful. There were virtually no longer term differences in the experiences of the 2 donor groups, including no recovery time difference beginning 3 weeks after donation. Although BM donors may experience the process as more physically stressful and more psychologically beneficial in the short term, the longer term HRQoL consequences of BM and PBSC donors are similar.
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Affiliation(s)
- Galen E Switzer
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Clinical and Translational Science, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Jessica G Bruce
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Donna Harrington
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael Haagenson
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota; National Marrow Donor Program, Minneapolis, Minnesota
| | - Rebecca Drexler
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Amy Foley
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Dennis Confer
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Michelle Bishop
- University of Florida, College of Medicine, Gainesville, Florida
| | - Paolo Anderlini
- MD Anderson Cancer Center, University of Texas, Houston, Texas
| | - Scott Rowley
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey
| | - Susan F Leitman
- NIH Clinical Center, National Institutes of Health, Bethesda, Maryland
| | | | - John R Wingard
- University of Florida, College of Medicine, Gainesville, Florida
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29
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Semon JA, Zhang X, Pandey AC, Alandete SM, Maness C, Zhang S, Scruggs BA, Strong AL, Sharkey SA, Beuttler MM, Gimble JM, Bunnell BA. Administration of murine stromal vascular fraction ameliorates chronic experimental autoimmune encephalomyelitis. Stem Cells Transl Med 2013; 2:789-96. [PMID: 23981726 DOI: 10.5966/sctm.2013-0032] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Administration of adipose-derived stromal/stem cells (ASCs) represents a promising therapeutic approach for autoimmune diseases since they have been shown to have immunomodulatory properties. The uncultured, nonexpanded counterpart of ASCs, the stromal vascular fraction (SVF), is composed of a heterogeneous mixture of cells. Although administration of ex vivo culture-expanded ASCs has been used to study immunomodulatory mechanisms in multiple models of autoimmune diseases, less is known about SVF-based therapy. The ability of murine SVF cells to treat myelin oligodendrocyte glycoprotein35-55-induced experimental autoimmune encephalitis (EAE) was compared with that of culture-expanded ASCs in C57Bl/6J mice. A total of 1 × 10(6) SVF cells or ASCs were administered intraperitoneally concomitantly with the induction of disease. The data indicate that intraperitoneal administration of ASCs significantly ameliorated the severity of disease course. They also demonstrate, for the first time, that the SVF effectively inhibited disease severity and was statistically more effective than ASCs. Both cell therapies also demonstrated a reduction in tissue damage, a decrease in inflammatory infiltrates, and a reduction in sera levels of interferon-γ and interleukin-12. Based on these data, SVF cells effectively inhibited EAE disease progression more than culture-expanded ASCs.
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Affiliation(s)
- Julie A Semon
- Center for Stem Cell Research and Regenerative Medicine and
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30
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Garcia MC, Chapman JR, Shaw PJ, Gottlieb DJ, Ralph A, Craig JC, Tong A. Motivations, Experiences, and Perspectives of Bone Marrow and Peripheral Blood Stem Cell Donors: Thematic Synthesis of Qualitative Studies. Biol Blood Marrow Transplant 2013; 19:1046-58. [DOI: 10.1016/j.bbmt.2013.04.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 04/12/2013] [Indexed: 11/16/2022]
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31
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Funato M, Kaneko H, Sasai H, Kubota K, Ozeki M, Kanda K, Kato Z, Kondo N. Peripheral blood stem cell transplantation in a significant body weight difference between a smaller donor and a larger recipient: a case report. Transfus Apher Sci 2013; 49:504-6. [PMID: 23422651 DOI: 10.1016/j.transci.2013.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Revised: 09/27/2012] [Accepted: 01/10/2013] [Indexed: 11/24/2022]
Abstract
Allogeneic peripheral blood stem cell transplantation (PBSCT) is becoming a common transplantation procedure in children. However, few benefits have been reported, in particular in regard to the choice of small children as donors for larger recipients. We report a case of relapsed acute myeloid leukemia (body weight 52 kg and blood type O) who underwent allogeneic PBSCT from his smaller human leukocyte antigen-matched brother (body weight 29.9 kg and blood type A).
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Affiliation(s)
- Michinori Funato
- Department of Pediatrics, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan.
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32
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Potential adult sibling stem cell donors’ perceptions and opinions regarding an information and care model. Bone Marrow Transplant 2013; 48:1133-7. [DOI: 10.1038/bmt.2012.283] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 10/12/2012] [Accepted: 12/18/2012] [Indexed: 12/29/2022]
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33
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Acute toxicities of unrelated bone marrow versus peripheral blood stem cell donation: results of a prospective trial from the National Marrow Donor Program. Blood 2012; 121:197-206. [PMID: 23109243 DOI: 10.1182/blood-2012-03-417667] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Although peripheral blood stem cells (PBSCs) have replaced bone marrow (BM) as the most common unrelated donor progenitor cell product collected, a direct comparison of concurrent PBSC versus BM donation experiences has not been performed. We report a prospective study of 2726 BM and 6768 PBSC donors who underwent collection from 2004 to 2009. Pain and toxicities were assessed at baseline, during G-CSF administration, on the day of collection, within 48 hours of donation, and weekly until full recovery. Peak levels of pain and toxicities did not differ between the 2 donation processes for most donors. Among obese donors, PBSC donors were at increased risk of grade 2 to 4 pain as well as grade 2 to 4 toxicities during the pericollection period. In contrast, BM donors were more likely to experience grade 2 to 4 toxicities at 1 week and pain at 1 week and 1 month after the procedure. BM donors experienced slower recovery, with 3% still not fully recovered at 24 weeks, whereas 100% of PBSC donors had recovered. Other factors associated with toxicity included obesity, increasing age, and female sex. In summary, this study provides extensive detail regarding individualized risk patterns of PBSC versus BM donation toxicity, suggesting donor profiles that can be targeted with interventions to minimize toxicity.
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34
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Halter JP, van Walraven SM, Worel N, Bengtsson M, Hägglund H, Nicoloso de Faveri G, Shaw BE, Schmidt AH, Fechter M, Madrigal A, Szer J, Aljurf MD, Weisdorf D, Horowitz MM, Greinix H, Niederwieser D, Gratwohl A, Kodera Y, Confer D. Allogeneic hematopoietic stem cell donation-standardized assessment of donor outcome data: a consensus statement from the Worldwide Network for Blood and Marrow Transplantation (WBMT). Bone Marrow Transplant 2012; 48:220-5. [PMID: 22773129 DOI: 10.1038/bmt.2012.119] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The number of allogeneic hematopoietic SCTs performed globally each year continues to increase, paralleled by an increased demand for donors of therapeutic cells. Donor characteristics and collection procedures have undergone major changes during recent decades, and further changes are foreseen. Information on short- and long-term donor outcomes is of crucial importance to ensure maximal donor safety and availability. Current data, predominantly from unrelated donors, give reliable information on the frequent early events associated with donation-most of them of mild-to-moderate intensity. Information on the type and relative risk of serious adverse reactions is more limited. Moreover, only few data exist on long-term donor outcome. On the basis of this need, recommendations for a minimum data set for prospective donor follow-up were developed in a workshop with the participation of an international group of investigators actively involved in allogeneic stem cell donation under the auspices of and approved by the Worldwide Network for Blood and Marrow Transplantation. Establishment of a standardized global follow-up for both, related and unrelated, donors will enable monitoring of the short- and long-term safety profiles of hematopoietic cell donation and form a solid basis for future donor selection and counseling.
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Affiliation(s)
- J P Halter
- Department of Hematology, University Hospital Basel, Basel, Switzerland.
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35
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Wilson SM, Goldwasser MS, Clark SG, Monaco E, Bionaz M, Hurley WL, Rodriguez-Zas S, Feng L, Dymon Z, Wheeler MB. Adipose-derived mesenchymal stem cells enhance healing of mandibular defects in the ramus of swine. J Oral Maxillofac Surg 2012; 70:e193-203. [PMID: 22374062 DOI: 10.1016/j.joms.2011.10.029] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 10/24/2011] [Accepted: 10/25/2011] [Indexed: 12/21/2022]
Abstract
PURPOSE This study investigated the effect of adipose-derived mesenchymal stem cells (ASCs) injected locally or systemically on the bone regeneration of a 10-mm-diameter cylindrical noncritical-size defect in the ramus of the pig mandible. MATERIALS AND METHODS Fifteen Yorkshire pigs, weighing 60 to 80 kg, received bilateral 10-mm-diameter cylindrical surgical defects in each ramus of the mandible. Pigs received 1) a direct injection into the defect of 2.5 million carboxy-fluorescein diacetate succinimidyl ester-labeled ASCs from 1 of 2 pig donors (n = 6); 2) an ear vein injection of 5 million carboxy-fluorescein diacetate succinimidyl ester-labeled ASCs from 1 of 2 pig donors (n = 6); or 3) an ear vein injection of culture Dulbecco's Modified Eagle's Medium without stem cells (control; n = 3). Pigs from each treatment were sacrificed at 1 hour, 2 weeks, or 4 weeks after surgery. Healing of the defect was evaluated by dual-energy x-ray absorptiometry, micro-computed tomography, fluorescent microscopy, and histology. RESULTS Bone healing was accelerated in the ASC-injected treatment groups at 2 and 4 weeks after surgery compared with the control pigs. CONCLUSIONS Results from this animal model provide evidence that the injection of ASC locally into a bone defect or systemically can accelerate the healing of bone.
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Affiliation(s)
- Shanna M Wilson
- Department of Animal Sciences, University of Illinois, Urbana, IL 61801, USA
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36
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KISCH A, LENHOFF S, ZDRAVKOVIC S, BOLMSJÖ I. Factors associated with changes in quality of life in patients undergoing allogeneic haematopoietic stem cell transplantation. Eur J Cancer Care (Engl) 2012; 21:735-46. [DOI: 10.1111/j.1365-2354.2012.01354.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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37
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Risk of complications during hematopoietic stem cell collection in pediatric sibling donors: a prospective European Group for Blood and Marrow Transplantation Pediatric Diseases Working Party study. Blood 2012; 119:2935-42. [DOI: 10.1182/blood-2011-04-349688] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Abstract
We investigated prospectively factors influencing the safety of hematopoietic stem cell (HSC) collection in 453 pediatric donors. The children in the study donated either BM or peripheral blood stem cells (PBSCs) according to center policy. A large variability in approach to donor issues was observed between the participating centers. Significant differences were observed between BM and PBSC donors regarding pain, blood allotransfusion, duration of hospital stay, and iron supplementation; however, differences between the groups undergoing BM vs PBSC donation preclude direct risk comparisons between the 2 procedures. The most common adverse event was pain, reported mainly by older children after BM harvest, but also observed after central venous catheter (CVC) placement for PBSC collection. With regard to severe adverse events, one patient (0.7%) developed a pneumothorax with hydrothorax after CVC placement for PBSC collection. The risk of allotransfusion after BM harvest was associated with a donor age of < 4 years and a BM harvest volume of > 20 mL/kg. Children < 4 years were at higher risk than older children for allotransfusion after BM harvest and there was a higher risk of complications from CVC placement before apheresis. We conclude that PBSC and BM collection are safe procedures in children.
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Pillay B, Lee SJ, Katona L, De Bono S, Warren N, Fletcher J, Burney S. The psychosocial impact of haematopoietic SCT on sibling donors. Bone Marrow Transplant 2012; 47:1361-5. [DOI: 10.1038/bmt.2012.22] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Takita M, Tanaka Y, Kodama Y, Murashige N, Hatanaka N, Kishi Y, Matsumura T, Ohsawa Y, Kami M. Data mining of mental health issues of non-bone marrow donor siblings. J Clin Bioinforma 2011; 1:19. [PMID: 21884635 PMCID: PMC3164612 DOI: 10.1186/2043-9113-1-19] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Accepted: 07/20/2011] [Indexed: 01/25/2023] Open
Abstract
Background Allogenic hematopoietic stem cell transplantation is a curative treatment for patients with advanced hematologic malignancies. However, the long-term mental health issues of siblings who were not selected as donors (non-donor siblings, NDS) in the transplantation have not been well assessed. Data mining is useful in discovering new findings from a large, multidisciplinary data set and the Scenario Map analysis is a novel approach which allows extracting keywords linking different conditions/events from text data of interviews even when the keywords appeared infrequently. The aim of this study is to assess mental health issues on NDSs and to find helpful keywords for the clinical follow-up using a Scenario Map analysis. Findings A 47-year-old woman whose younger sister had undergone allogenic hematopoietic stem cell transplantation 20 years earlier was interviewed as a NDS. The text data from the interview transcriptions was analyzed using Scenario Mapping. Four clusters of words and six keywords were identified. Upon review of the word clusters and keywords, both the subject and researchers noticed that the subject has had mental health issues since the disease onset to date with being a NDS. The issues have been alleviated by her family. Conclusions This single subject study suggested the advantages of data mining in clinical follow-up for mental health issues of patients and/or their families.
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Affiliation(s)
- Morihito Takita
- Division of Social Communication System for Advanced Clinical Research, the Institute of Medical Science, the University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan.
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Strategies for regeneration of the bone using porcine adult adipose-derived mesenchymal stem cells. Theriogenology 2011; 75:1381-99. [DOI: 10.1016/j.theriogenology.2010.11.020] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 11/11/2010] [Accepted: 11/12/2010] [Indexed: 12/17/2022]
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Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) represents the first choice of treatment or an important therapeutic option for several diseases, but it is still marked by morbidity and mortality. In contrast, the donation of hematopoietic stem cells (HSCs) is considered to be a safe procedure. The invaluable ethical source of donation and its central role in transplantation implies that the greatest attention be due to the donor and to the donation process through a serious monitoring protocol for donor safety. Both the Joint Accreditation Committee and the European Committee pay particular attention to the notification of adverse events and adverse reactions. Bone marrow donation is a well established procedure, that has now been performed for >30 years. Although it does not require drug administration, there is hospital admission for 1-3 days with 7-10 days off work. The main risk is related to the anesthesia. Pain in the aspiration area, together with astenia are considered to be the most frequent side effects, as shown by the USA National Marrow Donor Program experience in 1,193 donations. In the European Group for Blood and Marrow Transplantation analysis performed between 1993 and 2005 on 27,770 first HSCTs from bone marrow, only 1 fatal event (pulmonary embolism) and 12 serious adverse events were observed. The most frequent adverse events were cardiac. The incidence of adverse events was significantly lower (P < .05) compared with peripheral blood HSC donors, which confirms the necessity of accurate attention to donor selection and evaluation in bone marrow donation.
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Affiliation(s)
- A Bosi
- Bone Marrow Transplantation Unit, Department of Hematology, University of Florence, Italy.
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Oliveira-Cardoso ÉAD, Santos MAD, Mastropietro AP, Voltarelli JC. Bone Marrow Donation from the Perspective of Sibling Donors. Rev Lat Am Enfermagem 2010; 18:911-8. [DOI: 10.1590/s0104-11692010000500011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 11/16/2009] [Indexed: 11/22/2022] Open
Abstract
This study aimed to characterize the sociodemographic profile of sibling bone marrow donors and to describe how they perceive the donation. This was a descriptive, exploratory and longitudinal study. Participants were 20 related bone marrow donors, between 18 and 42 years of age (mean=30.5 years, sd=7.47). Interviews were held before and immediately after the donation. Sociodemographic data were subject to descriptive statistical analysis and qualitative data to categorical content analysis. In the interviews held before the donation, stressor events were the sibling’s disease and treatment and the responsibility of being the donors. During the interviews after the donation, the following were mentioned: anxiety on the day before and on the day of the donation, pain the following day, and acknowledgement of the health team’s support as a facilitator of the donation process. In view of the findings, it is important for the team to outline intervention strategies to meet to the donors’ specific needs.
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Impact of GvHD on quality of life in long-term survivors of haematopoietic transplantation. Bone Marrow Transplant 2010; 45:1534-9. [PMID: 20228854 DOI: 10.1038/bmt.2010.5] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Allogenic haematopoietic stem cell transplantation (HCT) has become an effective therapy in patients with various haematological malignancies. GvHD is known to be a major complication in this patient group and is assumed to have a major impact on patients' quality of life (QOL). Patients after BMT or transplantation of mobilized PBSCs were considered for enrolment in the study 6 months after transplantation. QOL and symptom burden were assessed using the EORTC QLQ-C30 and the QLQ-HDC29. Data from age- and sex-matched healthy controls were collected for comparison. In all, 100 patients (55.0% women; mean age 46.3 years) after allogeneic HCT were included in the study. In this patient group, we found a clinically relevant impact of GvHD on role functioning, global QOL, fatigue, dyspnoea, gastrointestinal side effects, worries/anxiety and skin problems. In comparison to healthy controls, various aspects of QOL were severely impaired. Our study revealed severe impairments of QOL in survivors of HCT, in particular in those suffering from GvHD. Taking into account, that the prevalence of GvHD might be higher in patients after PBSCT compared with patients after BMT, PBSCT is expected to lead to more severe impairments of QOL than BMT.
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Pamphilon D, Siddiq S, Brunskill S, Dorée C, Hyde C, Horowitz M, Stanworth S. Stem cell donation--what advice can be given to the donor? Br J Haematol 2009; 147:71-6. [PMID: 19681886 DOI: 10.1111/j.1365-2141.2009.07832.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Haematopoietic stem cell transplantation (HSCT) is widely used to treat patients with a range of haematological and non-haematological disorders. Both bone marrow and peripheral blood stem cell collection are associated with morbidity and, very rarely, mortality. We investigated the information that exists to adequately inform donors about the relative merits of each procedure. We carried out a systematic review analysing data from six prospective randomised controlled trials of related donors and discuss here the merits and drawbacks of this approach. Registry data mostly describes patient outcome but stem cell donor registries collect and report information on unrelated donors which could easily be extended to related donors. Further well-designed, randomised studies are required.
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Siddiq S, Pamphilon D, Brunskill S, Doree C, Hyde C, Stanworth S. Bone marrow harvest versus peripheral stem cell collection for haemopoietic stem cell donation in healthy donors. Cochrane Database Syst Rev 2009:CD006406. [PMID: 19160282 DOI: 10.1002/14651858.cd006406.pub2] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Haemopoietic stem cells can be collected from a donor either as a bone marrow harvest or by peripheral blood collection. Both techniques have risks for the donor. OBJECTIVES The aim of this review was to identify the adverse effects of haemopoietic stem cell donation and to compare the tolerability and safety of the two methods. SEARCH STRATEGY We searched bibliographic databases including the Cochrane Central Register of Controlled trials (CENTRAL) (The Cochrane Library 2008, issue 2), MEDLINE and EMBASE up to May 2008. We also searched reference lists of articles and contacted experts in the field. SELECTION CRITERIA Randomised controlled trials enrolling haemopoietic stem cell donors and evaluating the different methods of donating haemopoietic stem cells were eligible. DATA COLLECTION AND ANALYSIS Two authors independently screened studies for inclusion. We extracted data and evaluated methodological quality. Quantitative analysis was not possible for most outcomes, but where used we preferred random-effects models due to the variability between the included studies. MAIN RESULTS Six trials (807 donors) were eligible: all were substudies, or constituent parts of, larger randomised controlled trials of bone marrow and peripheral blood stem cell allogeneic transplantation. No included trial was designed solely to measure and assess the experience of stem cell donors. The donors in all studies were related to the stem cell recipient. Overall, both types of donors experienced pain subsequent to donation, and psychological morbidity. The trend was for bone marrow donors to experience more pain at the donation site, more overall adverse events, and more days of restricted activity. They were also more likely to require hospitalisation than peripheral blood stem cell donors. In contrast, peripheral blood stem cell donors experienced more pain prior to donation, which may be related to the pre-donation administration of granulocyte colony stimulating factor (G-CSF). The methodological quality of the studies was poor and indicated limitations due to the risk of selection and attrition bias. The proportion of donors from the parent trial not included in the donor substudies was also inadequately explained. AUTHORS' CONCLUSIONS The different short-term morbidities associated with each type of haemopoietic stem cell donation were clear, with bone marrow donors experiencing more pain and more restriction post-donation than peripheral blood donors. However, the studies were limited by their methodological quality, failure to provide long-term follow up (for which larger numbers of donors would be required) and a failure to apply consistent measures of quality of life in a way which allows more meaningful evaluation across studies.
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Affiliation(s)
- Samreen Siddiq
- Bristol Haematology Oncology Centre , United Bristol Healthcare Trust, Horfield Road , Bristol, UK, BS2 8ED
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Oliveirao ÉAD, Santoso MAD, Mastropietro AP, Voltarelli JC. Repercussões psicológicas do transplante de medula óssea no doador relacionado. PSICOLOGIA: CIÊNCIA E PROFISSÃO 2007. [DOI: 10.1590/s1414-98932007000300006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O desenvolvimento do transplante de medula óssea (TMO), nas últimas décadas, permitiu o tratamento de doenças que antes eram invariavelmente fatais. Dentre os tipos de transplante realizados, o alogênico exige a participação ativa de um membro familiar, em geral, o irmão, que arca com o encargo da doação. O objetivo do presente estudo é analisar as repercussões psicológicas dessa doação nos doadores relacionados. A amostra foi composta por dez doadores, vinculados à Unidade de TMO do HCFMRP-USP, avaliados antes e após a doação. Os instrumentos utilizados foram: roteiro de entrevista, escalas e técnicas projetivas. Os resultados demonstraram que o nível de ansiedade dos sujeitos se encontrava dentro do esperado, porém foram constatados sintomas de estresse. Afirmaram terem ficado ansiosos e relataram dor no momento pós-doação, mas acreditam que esta foi mais fácil do que imaginaram. Finalmente, em relação aos dados das técnicas projetivas, constatou-se uma alta suscetibilidade emocional, indícios de sugestionabilidade e dependência.
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Wiener LS, Steffen-Smith E, Fry T, Wayne A. Hematopoietic stem cell donation in children: a review of the sibling donor experience. J Psychosoc Oncol 2007; 25:45-66. [PMID: 17360315 PMCID: PMC2367259 DOI: 10.1300/j077v25n01_03] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Hematopoietic Stem Cell Transplant (HSCT) represents the second most frequent major organ transplant in the United States. Compared with other family members, siblings are more likely to be immunologically matched with the recipient and therefore are often the most suitable donors. Due to a dearth of information on the positive and adverse effects of HSCT on pediatric sibling donors, we sought to examine available data. Eight published reports assessing the pediatric sibling donor experience were identified in the literature. Studies were predominately small (n < 44) and cross-sectional. Results suggest a range of psychological distress responses with higher distress in pediatric donor than non-donor siblings. Recommendations include future longitudinal research on sibling donor psychosocial adjustment, identification of sibling donors at high risk for maladaptive responses, and development of educational and psychosocial interventions for this overlooked pediatric population.
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Affiliation(s)
- Lori S. Wiener
- Lori Wiener, Ph.D., ACSW, is Coordinator Pediatric Psychosocial Support & Research Program Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute. . Emilie Steffen-Smith, B.A., is a clinical research fellow, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, e-mail: . Terry Fry, M.D., is a staff clinician, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, e-mail: . Alan S. Wayne, M.D., is Clinical Director and Head, Hematologic Diseases Section, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, e-mail:
| | - Emilie Steffen-Smith
- Lori Wiener, Ph.D., ACSW, is Coordinator Pediatric Psychosocial Support & Research Program Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute. . Emilie Steffen-Smith, B.A., is a clinical research fellow, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, e-mail: . Terry Fry, M.D., is a staff clinician, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, e-mail: . Alan S. Wayne, M.D., is Clinical Director and Head, Hematologic Diseases Section, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, e-mail:
| | - Terry Fry
- Lori Wiener, Ph.D., ACSW, is Coordinator Pediatric Psychosocial Support & Research Program Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute. . Emilie Steffen-Smith, B.A., is a clinical research fellow, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, e-mail: . Terry Fry, M.D., is a staff clinician, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, e-mail: . Alan S. Wayne, M.D., is Clinical Director and Head, Hematologic Diseases Section, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, e-mail:
| | - Alan Wayne
- Lori Wiener, Ph.D., ACSW, is Coordinator Pediatric Psychosocial Support & Research Program Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute. . Emilie Steffen-Smith, B.A., is a clinical research fellow, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, e-mail: . Terry Fry, M.D., is a staff clinician, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, e-mail: . Alan S. Wayne, M.D., is Clinical Director and Head, Hematologic Diseases Section, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, e-mail:
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Pulsipher MA, Nagler A, Iannone R, Nelson RM. Weighing the risks of G-CSF administration, leukopheresis, and standard marrow harvest: ethical and safety considerations for normal pediatric hematopoietic cell donors. Pediatr Blood Cancer 2006; 46:422-33. [PMID: 16411207 DOI: 10.1002/pbc.20708] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Granulocyte colony stimulating factor (G-CSF) is used for collection of hematopoietic cells in most adult and a smaller but significant percentage of pediatric normal donor harvests. Short and long-term risks of G-CSF administration and leukopheresis are not well understood in the pediatric population. PROCEDURE Literature review including observations from the IBMTR, NMDP, EBMT, German Donor Registry, and the authors' work. RESULTS G-CSF causes temporary discomfort in a minority of younger donors. Rare serious side effects of G-CSF have yet to be reported in children. To date, an increase in hematological malignancies after short-term G-CSF use has not been detected in adult donors and no cases have been reported in children. Reported complications of leukopheresis in children are rare and minor, but donors <20 kg may be exposed to allogeneic blood products. Pediatric aged donors vary widely in their ability to assent or consent to the risks of a donation procedure. There are key regulations and ethical imperitives, which must be addressed in deciding which donation procedures are appropriate for minors. CONCLUSIONS While short term administration of G-CSF and leukopheresis appear to be safe and effective procedures when used to assist in collection of a hematopoietic cell graft from a normal pediatric donor, institutions adding or substituting one or both of these procedures for standard marrow donation must decide whether the donor should be considered a research subject, and if so, whether the new procedures are a minor increase over minimal risk. Because these procedures are being performed on and off study at many pediatric centers, a comprehensive study addressing donor safety could help clarify risks of rare adverse events.
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