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Qi S, Zhang L, Chen Z, Wang Z, Ding L, Du Y, Xiong H. Clinical characteristics and outcomes of overt gastrointestinal bleeding in children undergoing haploidentical hematopoietic stem cell transplantation: a single-center retrospective analysis. BMC Pediatr 2024; 24:479. [PMID: 39068438 PMCID: PMC11282719 DOI: 10.1186/s12887-024-04950-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 07/15/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Overt gastrointestinal bleeding (GIB) is a potentially serious and life-threatening condition in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, relatively little information is available regarding overt GIB in children. OBJECTIVES To assess the prevalence, clinical patterns, and outcomes of overt GIB in children undergoing haploidentical hematopoietic stem cell transplantation (haplo-HSCT). METHODS A total of 123 consecutive patients with malignant or non-malignant blood disorders who received haplo-HSCT were reviewed in our hospital between October 2017 and October 2022. Overt GIB was determined as hematemesis, melena or hematochezia. Continuous variables were compared by Mann Whitney U test. Categorical parameters were compared by the χ2 test or Fisher's exact test. Kaplan-Meier curves and log-rank tests were used to assess overall survival (OS), non-relapse mortality (NRM) and relapse. Univariate and multivariate analyses were performed to identify potential risk factors of overt GIB development. RESULTS The median follow-up was 26.3 (range,1.7-74.8) months. Overt GIB occurred in 31 patients (25.2% incidence), with a median time elapsed after haplo-HSCT of 376 days (range, 58-1275 days). Compared with the non-GIB group, patients with overt GIB had reduced OS and increased NRM. In multivariate analysis, grade III-IV gut acute graft versus-host disease (aGvHD), thrombotic microangiopathy (TMA) and cytomegalovirus (CMV) viremia were significant risk factors for the occurrence of overt GIB after haplo-HSCT. CONCLUSIONS Overt GIB is a frequent complication after haplo-HSCT in pediatric patients, and associated with worse survival. Grade III-IV gut aGvHD, TMA and CMV viremia were associated with its development.
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Affiliation(s)
- Shanshan Qi
- Laboratory of Pediatric Hematology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, 100 Hong Kong Road, Wuhan, 430015, China
| | - Lannan Zhang
- Department of Hematology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, 100 Hong Kong Road, Wuhan, 430015, China
| | - Zhi Chen
- Department of Hematology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, 100 Hong Kong Road, Wuhan, 430015, China
| | - Zhuo Wang
- Department of Hematology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, 100 Hong Kong Road, Wuhan, 430015, China
| | - Lili Ding
- Department of Hematology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, 100 Hong Kong Road, Wuhan, 430015, China
| | - Yu Du
- Department of Hematology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, 100 Hong Kong Road, Wuhan, 430015, China
| | - Hao Xiong
- Laboratory of Pediatric Hematology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, 100 Hong Kong Road, Wuhan, 430015, China.
- Department of Hematology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, 100 Hong Kong Road, Wuhan, 430015, China.
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2
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Seftel MD, Pasic I, Parmar G, Bucher O, Allan DS, Bhella S, Hay KA, Ikuomola O, Musto G, Prica A, Richardson E, Truong TH, Paulson K. Hematopoietic Cell Transplantation Trends and Outcomes in Canada: A Registry-Based Cohort Study. Curr Oncol 2023; 30:9953-9967. [PMID: 37999143 PMCID: PMC10669983 DOI: 10.3390/curroncol30110723] [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: 10/24/2023] [Revised: 11/07/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023] Open
Abstract
Background: Hematopoietic cell transplantation (HCT) is an established therapy for hematologic malignancies and serious non-malignant blood disorders. Despite its curative potential, HCT is associated with substantial toxicity and health resource utilization. Effective delivery of HCT requires complex hospital-based care, which limits the number of HCT centres in Canada. In Canada, the quantity, indications, temporal trends, and outcomes of patients receiving HCT are not known. Methods: A retrospective cohort study of first transplants reported to the Cell Therapy Transplant Canada (CTTC) registry between 2000 and 2019. We determined overall survival (OS) and non-relapse mortality (NRM), categorizing the cohort into early (2000-2009) and later (2010-2019) eras to investigate temporal changes. Results: Of 18,046 transplants, 7571 were allogeneic and 10,475 were autologous. Comparing the two eras, allogeneic transplants increased in number by 22.3%, with greater use of matched unrelated donors in the later era. Autologous transplants increased by 10.9%. Temporal improvements in NRM were observed in children and adults. OS improved in pediatric patients and in adults receiving autologous HCT. In adults receiving allogeneic HCT, OS was stable despite the substantially older age of patients in the later era. Interpretation: HCT is an increasingly frequent procedure in Canada which has expanded to serve older adults. Noted improvements in NRM and OS reflect progress in patient and donor selection, preparation for transplant, and post-transplant supportive care. In allogeneic HCT, unrelated donors have become the most frequent donor source, highlighting the importance of the continued growth of volunteer donor registries. These results serve as a baseline measure for quality improvement and health services planning in Canada.
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Affiliation(s)
- Matthew D. Seftel
- Canadian Blood Services, Vancouver, BC V6H 2N9, Canada; (G.P.); (D.S.A.)
- Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada;
| | - Ivan Pasic
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada; (I.P.); (S.B.); (A.P.)
- Faculty of Medicine, University of Toronto, Toronto, ON M5G 2M9, Canada
| | - Gaganvir Parmar
- Canadian Blood Services, Vancouver, BC V6H 2N9, Canada; (G.P.); (D.S.A.)
- Faculty of Medicine, University of Toronto, Toronto, ON M5G 2M9, Canada
| | - Oliver Bucher
- Department of Epidemiology, CancerCare Manitoba, Winnipeg, MB R3A 1M5, Canada; (O.B.); (O.I.); (G.M.); (E.R.)
| | - David S. Allan
- Canadian Blood Services, Vancouver, BC V6H 2N9, Canada; (G.P.); (D.S.A.)
- Department of Medicine and Biochemistry, Microbiology & Immunology, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Sita Bhella
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada; (I.P.); (S.B.); (A.P.)
- Faculty of Medicine, University of Toronto, Toronto, ON M5G 2M9, Canada
| | - Kevin Anthony Hay
- Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada;
- Division of Hematology, Department of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Terry Fox Laboratory, British Columbia Cancer Research Institute, Vancouver, BC V5Z 1L3, Canada
| | - Oluwaseun Ikuomola
- Department of Epidemiology, CancerCare Manitoba, Winnipeg, MB R3A 1M5, Canada; (O.B.); (O.I.); (G.M.); (E.R.)
| | - Grace Musto
- Department of Epidemiology, CancerCare Manitoba, Winnipeg, MB R3A 1M5, Canada; (O.B.); (O.I.); (G.M.); (E.R.)
| | - Anca Prica
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada; (I.P.); (S.B.); (A.P.)
- Faculty of Medicine, University of Toronto, Toronto, ON M5G 2M9, Canada
| | - Erin Richardson
- Department of Epidemiology, CancerCare Manitoba, Winnipeg, MB R3A 1M5, Canada; (O.B.); (O.I.); (G.M.); (E.R.)
| | - Tony H. Truong
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Calgary, Calgary, AB T3B 6A8, Canada;
| | - Kristjan Paulson
- Cell Therapy and Transplant Canada, Winnipeg, MB R3E 0V9, Canada;
- Department of Medical Oncology and Haematology, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada
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3
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Bailey AJM, Blake J, Ganz K, Seftel MD, Allan DS. HLA-haplotype redundancy and rareness in Canadian Blood Services' Stem Cell Registry and Cord Blood Bank: Novel metrics for optimizing utility. Transfusion 2023; 63:2114-2119. [PMID: 37750668 DOI: 10.1111/trf.17553] [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: 04/27/2023] [Revised: 07/20/2023] [Accepted: 07/22/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND The utility of unrelated donor registries that support allogeneic hematopoietic cell transplantation could be optimized through greater understanding of redundancy and rareness of HLA phenotypes. METHODS HLA phenotype rareness was determined using known HLA haplotype frequencies. Donor redundancy was determined through pairwise comparison of donor HLA profiles within an inventory. RESULTS Among 61,730 registrants in the Canadian Blood Services (CBS) Stem Cell Registry (SCR) with high resolution HLA typing at 5 loci, 6.6% of HLA phenotypes were redundant with variation across ethnic groups (8.3% of Caucasian phenotypes; 8% of Native American/First Nations, 4.4% of Asia-Pacific Islanders (API), 2.1% of Hispanic, 0.7% of African-American (AFA), and 4.5% of other ethnicities). A total of 18.5% of registrants had redundant HLA phenotypes with variation across ethnic groups. All 3716 cord blood units in the CBS's cord blood bank (CBB) had high resolution HLA typing at 5 loci and 202 units were redundant (5.4%) comprising 78 HLA phenotypes, with varying rareness. Repeated HLA phenotypes were from Caucasian donors (77%), multiple ethnicity (13%), API (9%), and AFA (1%). Registrants and CBUs with AFA ethnicity had the rarest phenotypes while Caucasian ethnicity was associated with the most common HLA phenotypes. CONCLUSIONS Redundancy was greater in the SCR compared to the CBB and was most common with CAU ethnicity. Recruiting non-Caucasian registrants and continued cord blood banking should reduce redundancy. A sub-inventory of redundant donors and cord blood units could support new uses for donor-supported cellular therapies that do not require HLA matching.
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Affiliation(s)
- Adrian J M Bailey
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Canadian Blood Services, Stem Cells and Centre for Innovation, Ottawa, Canada
| | - John Blake
- Canadian Blood Services, Stem Cells and Centre for Innovation, Ottawa, Canada
- Department of Industrial Engineering, Dalhousie University, Halifax, Canada
| | - Kathy Ganz
- Canadian Blood Services, Stem Cells and Centre for Innovation, Ottawa, Canada
| | - Matthew D Seftel
- Canadian Blood Services, Stem Cells and Centre for Innovation, Ottawa, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - David S Allan
- Canadian Blood Services, Stem Cells and Centre for Innovation, Ottawa, Canada
- Clinical Epidemiology & Regenerative Medicine, Ottawa Hospital Research Institute, Ottawa, Canada
- Transplant and Cellular Therapy, Division of Hematology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Canada
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4
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Parmar G, Green M, Mostert K, Lawless T, Dibdin N, Weiss J, Ganz K, Petraszko T, Seftel MD, Allan DS. A Portrait of Cord Blood Units Distributed for Transplantation from Canadian Blood Services' Cord Blood Bank: First Analysis. Curr Oncol 2022; 29:9572-9581. [PMID: 36547166 PMCID: PMC9777040 DOI: 10.3390/curroncol29120752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/23/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The Canadian Blood Services Cord Blood Bank (CBS CBB) was created to improve access to stem cell products for transplantation for patients across ethnic groups. An analysis of distributed units is needed to assess the effectiveness of the bank to meet the needs of patients from different ethnic groups. METHODS A descriptive analysis was performed on all cord blood units distributed from the CBS' CBB as of 30 June 2022. RESULTS Distribution of the first 60 units based on CBS' CBB inventory has been linear over time. A similar proportion of cord blood unit (CBU) recipients were pediatric or adult. More than half of the cord blood units (56.7%) were distributed to recipients outside of Canada, and CBUs were used to treat a broad range of hematologic and immune disorders. 43.3% of distributed CBUs were of non-Caucasian ethnicity and 18% were from donors self-reporting as multi-ethnic. The mean total nucleated cell counts and total CD34+ cell counts were 1.9 ± 0.1 × 109 cells and 5.3 ± 0.5 × 106 CD34+ cells, respectively. CD34+ cells per kg (recipient weight) varied significantly between pediatric (age 0-4), adolescent (age 5-17) and adult recipients (age 18 and older) (3.1 ± 0.5, 1.4 ± 0.5 and 0.9 ± 0.07 × 105 CD34+ cells/kg, respectively). HLA matching was 6/6 (15%), 5/6 (47%) or 4/6 (38%). CONCLUSIONS The CBS' CBB has facilitated the utilization of banked units for patients across a broad range of ages, geographic distribution, ethnicity, and diseases. Distributed units were well matched for HLA alleles and contained robust cell counts, reflecting a high-quality inventory with significant utility.
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Affiliation(s)
- Gaganvir Parmar
- Stem Cells, Canadian Blood Services, Ottawa, ON K2E 8A6, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Meagan Green
- Stem Cells, Canadian Blood Services, Ottawa, ON K2E 8A6, Canada
| | - Karen Mostert
- Stem Cells, Canadian Blood Services, Ottawa, ON K2E 8A6, Canada
| | - Tiffany Lawless
- Stem Cells, Canadian Blood Services, Ottawa, ON K2E 8A6, Canada
| | - Nicholas Dibdin
- Stem Cells, Canadian Blood Services, Ottawa, ON K2E 8A6, Canada
| | - Jason Weiss
- Stem Cells, Canadian Blood Services, Ottawa, ON K2E 8A6, Canada
| | - Kathy Ganz
- Stem Cells, Canadian Blood Services, Ottawa, ON K2E 8A6, Canada
| | - Tanya Petraszko
- Stem Cells, Canadian Blood Services, Ottawa, ON K2E 8A6, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC V1Y 1T3, Canada
| | - Matthew D. Seftel
- Stem Cells, Canadian Blood Services, Ottawa, ON K2E 8A6, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC V1Y 1T3, Canada
| | - David S. Allan
- Stem Cells, Canadian Blood Services, Ottawa, ON K2E 8A6, Canada
- Department of Medicine and Biochemistry, Microbiology & Immunology, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
- Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada
- Correspondence: ; Tel.: +1-613-737-8899 (ext. 75055)
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5
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Outcome of Haploidentical Peripheral Blood Allografts Using Post-Transplantation Cyclophosphamide Compared to Matched Sibling and Unrelated Donor Bone Marrow Allografts in Pediatric Patients with Hematologic Malignancies: A Single-Center Analysis. Transplant Cell Ther 2021; 28:158.e1-158.e9. [PMID: 34838785 DOI: 10.1016/j.jtct.2021.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/27/2021] [Accepted: 11/17/2021] [Indexed: 12/31/2022]
Abstract
The introduction of post-transplantation cyclophosphamide (PTCy) as graft-versus-host disease (GVHD) prophylaxis has made haploidentical (haplo) hematopoietic stem cell transplantation (HSCT) a common approach in adults, but pediatric experience is limited. Based on the encouraging adult data and with the aim of decreasing the risk of graft failure, our center is increasingly using peripheral blood stem cells (PBSCs) from haplo donors with PTCy. Here we compare outcomes of bone marrow (BM) transplantation with traditional donor choices, including matched sibling donors (MSDs) and 10/10 HLA matched unrelated donors (MUDs), with those of haplo PBSC grafts in pediatric patients with hematologic malignancies. In this retrospective single-center study, the primary endpoint was the comparison of GVHD-free relapse-free survival (GRFS; defined as absence of acute GVHD [aGVHD] grade III-IV, relapse, death, or chronic GVHD [cGVHD] requiring systemic therapy) for the 3 cohorts. Secondary endpoints included overall survival (OS), relapse-free survival (RFS), nonrelapse mortality (NRM), and incidence of aGVHD and cGVHD). A total of 104 consecutive patients underwent first allogeneic (allo)-HSCT for a hematologic malignancy or myelodysplastic syndrome between January 2014 and December 2020 using a haplo family donor (PBSCs; n = 26), an MSD (BM; n = 31), or an MUD (BM; n = 47). Patient demographic and transplantation characteristics were not significantly different across the cohorts, apart from remission status, with the haplo cohort having more patients in third or later complete remission before HSCT (P < .01). The median duration of follow-up for the entire cohort was 573 days. The cumulative incidence of aGVHD (grade II-IV or grade III-IV) was not significantly different among the cohorts; however, the cumulative incidence of cGVHD at 18 months was highest in the MUD cohort (31.7%, versus 10.0% in the MSD cohort and 9.2% in the haplo cohort; P = .02). There were no differences in the 18-month cumulative incidence of relapse or NRM. OS and RFS at 18 months were 80.7% (95% confidence interval [CI], 61.7% to 100%) and 73.8% (95% CI, 55.5% to 98.1%) for the haplo cohort, 83.4% (95% CI, 72.8% to 95.5%) and 70.3% (95% CI, 57.9% to 85.3%) for the MUD cohort, and 80.9% (95% CI, 66.9% to 97.7%) and 66.5% (95% CI, 50.5% to 87.5%) for the MSD cohort, with no statistically significant differences among the cohorts. GRFS at 18 months was 61% (95% CI, 43.3% to 85.9%) for the haplo cohort, 44.6% (95% CI, 31.8% to 62.5%) for the MUD cohort, and 62.1% (95% CI, 45.7% to 84.3%) for the MSD cohort (P = .26). Haploidentical PBSC HSCT with PTCy had comparable outcomes to MSD and MUD BM HSCT and less cGVHD compared with MUD BM HSCT in children. The logistical advantages and lower resource burden of haplo HSCT with PBSCs make it a feasible alternative to MUD HSCT in children with hematologic malignancies. Nonetheless, given that this is a retrospective comparison of transplantation platforms rather than donor types, further prospective studies are warranted. © 2021 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
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6
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Fingrut W, Messner HA, Allan D. Targeted recruitment of optimal donors for unrelated hematopoietic cell transplantation: The Stem Cell Club process. Hematol Oncol Stem Cell Ther 2020; 13:220-231. [DOI: 10.1016/j.hemonc.2020.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 10/30/2018] [Accepted: 04/05/2020] [Indexed: 01/05/2023] Open
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7
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Li EW, Lee A, Vaseghi-Shanjani M, Anagnostopoulos A, Jagelaviciute G, Kum E, Petraszko T, Elmoazzen H, Allan D, Fingrut W. Development and Evaluation of a Whiteboard Video Series to Support the Education and Recruitment of Committed Unrelated Donors for Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2020; 26:2155-2164. [DOI: 10.1016/j.bbmt.2020.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/21/2020] [Accepted: 07/07/2020] [Indexed: 01/06/2023]
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8
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Fingrut W, Cuperfain AB, Chan SWS, Ptak E, Kahlon M, Dhaliwal J, Naidu A, Wang YG, Baribeau O, Mahmoudi T, Lee A, Suppiah R, Luo OD, Green M, Weiss JT, Mercer D, Elmoazzen H, Petraszko T, Allan D. Development and evaluation of stem cell collection procedure diagrams to support the education and recruitment of committed stem cell donors. Vox Sang 2020; 116:239-248. [PMID: 32970876 DOI: 10.1111/vox.13010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Diagrams which allow potential unrelated stem cell donors to visualize the stem cell collection process were hypothesized to support the recruitment and education of committed stem cell donors. STUDY DESIGN AND METHODS A series of bone marrow and peripheral blood stem cell collection procedure diagrams were developed, featuring young adult male donors of varied ethnic backgrounds. Post-implementation, surveys were conducted to evaluate stakeholder perspective on the diagrams' utility. A quality improvement project was conducted at five stem cell drives from 2017 to 2018 at which recruiters did or did not show the diagrams to potential donors. Following the drives, registrants were invited to complete a survey exploring their experience, knowledge and attitude towards donation. RESULTS The diagrams were implemented in Canada in 07/2016. Of 293 participating registrants (24·7% non-Caucasian males) recruited at five drives between 2017 and 2018, 76% (n = 197) were shown the diagrams. Participants who were shown the diagrams were significantly more likely to report that the recruiters appeared very knowledgeable (89% vs. 76%, P = 0·019) and to report improved self-reported knowledge of stem cell donation (P = 0·010) compared to participants not shown the diagram. Data are also shown demonstrating that stakeholders in donor recruitment used and valued the diagrams and that use of the diagrams was associated with improved donor recruitment outcomes in Canada. CONCLUSION This report is the first evaluation of stem cell collection diagrams in the literature. The diagrams are relevant to donor registries, recruitment organizations and transplant centres worldwide, and their use may support efforts to educate and recruit committed, ethnically diverse donors.
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Affiliation(s)
- Warren Fingrut
- Stem Cell Club, Toronto, ON, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Ari B Cuperfain
- Stem Cell Club, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sze Wah Samuel Chan
- Stem Cell Club, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Emilie Ptak
- Stem Cell Club, Toronto, ON, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Manjot Kahlon
- Stem Cell Club, Toronto, ON, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Justine Dhaliwal
- Stem Cell Club, Toronto, ON, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anish Naidu
- Stem Cell Club, Toronto, ON, Canada.,Faculty of Medicine, Western University, London, ON, Canada
| | - Yongjun George Wang
- Stem Cell Club, Toronto, ON, Canada.,Faculty of Medicine, Western University, London, ON, Canada
| | - Owen Baribeau
- Stem Cell Club, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tina Mahmoudi
- Stem Cell Club, Toronto, ON, Canada.,Faculty of Medicine, McMaster University, Hamilton, ON, Canada
| | - Anna Lee
- Stem Cell Club, Toronto, ON, Canada.,Faculty of Medicine, McMaster University, Hamilton, ON, Canada
| | - Roopa Suppiah
- Stem Cell Club, Toronto, ON, Canada.,Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Owen D Luo
- Stem Cell Club, Toronto, ON, Canada.,Faculty of Medicine, McGill University, Montreal, QC, Canada
| | | | | | | | | | - Tanya Petraszko
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Canadian Blood Services, Ottawa, ON, Canada
| | - David Allan
- Canadian Blood Services, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.,Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
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9
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Greco-Stewart V, Elmoazzen H, Morris G, Guo Y, Langdon C, Mercer D, Dibdin N, Allan DS. Improved access to better HLA-matched hematopoietic cells for allogeneic transplant: analysis of donors and cord blood units selected for Canadian patients in 2018. Transfusion 2020; 60:1508-1518. [PMID: 32319688 DOI: 10.1111/trf.15795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 02/10/2020] [Accepted: 02/12/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients undergoing hematopoietic cell transplantation (HCT) often require use of an unrelated donor or cord blood unit (CBU). An understanding of evolving practices in graft selection is needed for optimization of donor recruitment and cord blood collection. STUDY DESIGN AND METHODS Each donor workup (WU) requested in 2018 involving a Canadian (CDN) patient and unique donor product or CBU was reviewed (n = 598). Degree of HLA match; product origin (domestic or international [INT]); and non-HLA factors including donor age, sex, cytomegalovirus (CMV), and ABO compatibility were analyzed for WUs that proceeded to transplant (n = 414). We also analyzed changes compared to a similar analysis performed in 2013. RESULTS The majority of transplants used matched unrelated donors (MUDs; n = 323; 78%) and were most often young (≤35 years), male, INT donors (n = 136). The proportion of transplants involving MUDs, as opposed to mismatched unrelated donors or CBUs, increased by 12.4% compared with 2013. When young, male, CDN MUDs were identified in patient search reports but not selected, CMV mismatching and ABO incompatibility were most likely to have influenced the decision to use an INT MUD. Consistent with global trends, CBU transplants decreased compared to 2013; however, the degree of HLA matching improved significantly, and 27% of transplanted CBUs were procured from the Canadian Blood Services Cord Blood Bank. CONCLUSIONS Access to MUDs and better HLA-matched CBUs by CDN patients has increased since 2013. Ongoing recruitment of young registrants and cord blood donors with diverse HLA haplotypes will support selection of donors with optimal non-HLA characteristics.
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Affiliation(s)
| | | | | | - Yiming Guo
- Stem Cells, Canadian Blood Services, Canada
| | | | | | | | - David S Allan
- Stem Cells, Canadian Blood Services, Canada.,Ottawa Hospital Research Institute, University of Ottawa, Canada.,Department of Medicine, University of Ottawa, Canada
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10
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Allan D, Kiernan J, Gragert L, Dibdin N, Bartlett D, Campbell T, Mostert K, Halpenny M, Ganz K, Maiers M, Petraszko T, Elmoazzen H. Reducing ethnic disparity in access to high-quality HLA-matched cord blood units for transplantation: analysis of the Canadian Blood Services' Cord Blood Bank inventory. Transfusion 2019; 59:2382-2388. [PMID: 31002398 DOI: 10.1111/trf.15313] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 02/27/2019] [Accepted: 03/06/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Launched in 2013, Canadian Blood Services' Cord Blood Bank (CBS' CBB) has built a high-quality, ethnically diverse cord blood repository that aims to reduce ethnic disparity in accessing suitable units for transplantation. METHODS AND RESULTS As of December 2016, 2000 units have been banked. The self-reported maternal ethnicity was 58% non-Caucasian. Overall, 26% of units were classified as multi-ethnicity with Caucasian (84%) most frequently observed in combination with Asian, First Nations (predominant indigenous peoples in Canada south of the Arctic Circle), or African ethnicity. Utilization scores that incorporate total nucleated and CD34+ cell counts in the CBS' CBB were associated with greater likelihood of utilization compared with the international inventory of units (p < 0.05). The distribution of utilization scores was similar for Caucasians compared with non-Caucasians (p < 0.05). Using HLA genotypes of cord blood units and their mothers, we determined probable ethnic assignments for each haplotype using HaploStats (National Marrow Donor Program). Significant increases in HLA-match likelihoods are predicted for all ethnicities as the inventory grows to its target of 10,000 units and the gap in HLA-match likelihoods for Caucasian and non-Caucasian patients progressively declines. CONCLUSIONS The CBS' CBB inventory is predicted to have high HLA-matching likelihoods across a broad spectrum of ethnic groups, improving access to high-quality stem cell products for all patients.
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Affiliation(s)
- David Allan
- Ottawa Hospital Research Institute and Department of Medicine, University of Ottawa, Ottawa, Ontario.,Canadian Blood Services' Cord Blood Bank, Ottawa, Ontario
| | - Jeffrey Kiernan
- Ottawa Hospital Research Institute and Department of Medicine, University of Ottawa, Ottawa, Ontario.,Canadian Blood Services' Cord Blood Bank, Ottawa, Ontario
| | | | | | | | - Todd Campbell
- Canadian Blood Services' Cord Blood Bank, Ottawa, Ontario
| | - Karen Mostert
- Canadian Blood Services' Cord Blood Bank, Ottawa, Ontario
| | | | - Kathy Ganz
- Canadian Blood Services' Cord Blood Bank, Ottawa, Ontario
| | - Martin Maiers
- National Marrow Donor Program, Minneapolis, Minnesota
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11
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Fan YH, Chen J, Wu DP. [The family and clinical analysis of matched parent-child in hematopoietic stem cell transplantation]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2018; 39:425-430. [PMID: 29779356 PMCID: PMC7342891 DOI: 10.3760/cma.j.issn.0253-2727.2018.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - D P Wu
- Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
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Fingrut W, Rikhraj K, Allan D. Targeted recruitment of male donors for allogeneic haematopoietic cell transplantation: A review of the evidence. Vox Sang 2018; 113:307-316. [DOI: 10.1111/vox.12632] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/13/2017] [Accepted: 12/19/2017] [Indexed: 12/13/2022]
Affiliation(s)
- W. Fingrut
- Faculty of Medicine; University of Toronto; Toronto ON Canada
| | - K. Rikhraj
- Faculty of Medicine; University of British Columbia; BC Canada
| | - D. Allan
- Ottawa Hospital Research Institute; University of Ottawa; Ottawa ON Canada
- Department of Medicine; University of Ottawa; Ottawa ON Canada
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Greco-Stewart V, Kiernan J, Killeen D, Haun S, Mercer D, Young K, Liwski RS, Allan DS. Unrelated donor choices for allogeneic hematopoietic cell transplantation in Canada: an evaluation of factors influencing donor selection. Transfusion 2017; 58:718-725. [DOI: 10.1111/trf.14458] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/20/2017] [Accepted: 10/24/2017] [Indexed: 12/12/2022]
Affiliation(s)
| | - Jeffrey Kiernan
- Centre for Transfusion Research
- University Health Network; Toronto Ontario Canada
| | - Donna Killeen
- OneMatch Stem Cell & Marrow Network; Canadian Blood Services
| | - Sherry Haun
- OneMatch Stem Cell & Marrow Network; Canadian Blood Services
| | - Dena Mercer
- OneMatch Stem Cell & Marrow Network; Canadian Blood Services
| | - Kimberly Young
- OneMatch Stem Cell & Marrow Network; Canadian Blood Services
| | - Robert S. Liwski
- OneMatch Stem Cell & Marrow Network; Canadian Blood Services
- Departments of Pathology and Microbiology & Immunology; Dalhousie University; Halifax Nova Scotia Canada
| | - David S. Allan
- OneMatch Stem Cell & Marrow Network; Canadian Blood Services
- Centre for Transfusion Research
- Ottawa Hospital Research Institute
- Department of Medicine; University of Ottawa; Ottawa Ontario Canada
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14
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Fingrut W, Parmar S, Cuperfain A, Rikhraj K, Charman E, Ptak E, Kahlon M, Graham A, Luong S, Wang YG, Yu J, Arora N, Suppiah R, Li EW, Lee A, Welsh C, Benzaquen M, Thatcher A, Baharmand I, Ladd A, Petraszko T, Allan D, Messner H. The Stem Cell Club: a model for unrelated stem cell donor recruitment. Transfusion 2017; 57:2928-2936. [DOI: 10.1111/trf.14327] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/28/2017] [Accepted: 08/03/2017] [Indexed: 11/26/2022]
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Armson BA, Allan DS, Casper RF. Sang de cordon ombilical : Counseling, prélèvement et mise en banque. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 38:S724-S739. [PMID: 28063576 DOI: 10.1016/j.jogc.2016.09.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Gaballa S, Ge I, El Fakih R, Brammer JE, Kongtim P, Tomuleasa C, Wang SA, Lee D, Petropoulos D, Cao K, Rondon G, Chen J, Hammerstrom A, Lombardi L, Alatrash G, Korbling M, Oran B, Kebriaei P, Ahmed S, Shah N, Rezvani K, Marin D, Bashir Q, Alousi A, Nieto Y, Qazilbash M, Hosing C, Popat U, Shpall EJ, Khouri I, Champlin RE, Ciurea SO. Results of a 2-arm, phase 2 clinical trial using post-transplantation cyclophosphamide for the prevention of graft-versus-host disease in haploidentical donor and mismatched unrelated donor hematopoietic stem cell transplantation. Cancer 2016; 122:3316-3326. [PMID: 27404668 DOI: 10.1002/cncr.30180] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 05/17/2016] [Accepted: 05/24/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND High-dose, post-transplantation cyclophosphamide (PTCy) to prevent graft-versus-host disease (GVHD) has improved outcomes in haploidentical (HAPLO) stem cell transplantation (SCT). However, it remains unclear whether this strategy is effective in SCT from 1-antigen human leukocyte antigen (HLA)-mismatched unrelated donors (9/10 MUD) and how the outcomes of these patients compare with those of haploidentical transplantation recipients. METHODS A parallel, 2-arm, nonrandomized phase 2 clinical trial was conducted of melphalan-based reduced-intensity conditioning with PTCy, tacrolimus, and mycophenolate mofetil to prevent GVHD in patients with high-risk hematologic malignancies who underwent HAPLO (n = 60) or 9/10 MUD (n = 46) SCT. RESULTS The 1-year overall and progression-free survival rates were 70% and 60%, respectively, in the HAPLO arm and 60% and 47%, respectively, in the 9/10 MUD arm. The day +100 cumulative incidence of grade II to IV acute GVHD and grade III to IV acute GVHD was 28% and 3%, respectively, in the HAPLO arm and 33% and 13%, respectively, in the 9/10 MUD arm. The 2-year cumulative incidence of chronic GVHD was 24% in the HAPLO arm and 19% in the 9/10 MUD arm. The 1-year cumulative incidence of nonrelapse mortality was 21% in the HAPLO arm and 31% in the 9/10 MUD arm, and the 1-year relapse rate was 19% in the HAPLO arm and 25% in the 9/10 MUD arm. CONCLUSIONS Although this was a nonrandomized study and could not serve as a direct comparison between the 2 groups, the authors conclude that PTCy-based GVHD prophylaxis is effective for both HAPLO and 9/10 MUD SCTs. Prospective randomized trials will be required to compare the efficacies of alternative donor options for patients lacking HLA-matched donors. Cancer 2016;122:3316-3326. © 2016 American Cancer Society.
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Affiliation(s)
- Sameh Gaballa
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Isabell Ge
- University Medical Center Freiburg, Freiburg, Germany
| | - Riad El Fakih
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jonathan E Brammer
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Piyanuch Kongtim
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ciprian Tomuleasa
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sa A Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dean Lee
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Demetrios Petropoulos
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kai Cao
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gabriela Rondon
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Julianne Chen
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Aimee Hammerstrom
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lindsey Lombardi
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gheath Alatrash
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Martin Korbling
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Betul Oran
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Partow Kebriaei
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sairah Ahmed
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nina Shah
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Katayoun Rezvani
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David Marin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Qaiser Bashir
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amin Alousi
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yago Nieto
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Muzaffar Qazilbash
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Chitra Hosing
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Uday Popat
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elizabeth J Shpall
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Issa Khouri
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Richard E Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stefan O Ciurea
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Armson BA, Allan DS, Casper RF. Umbilical Cord Blood: Counselling, Collection, and Banking. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 37:832-844. [PMID: 26605456 DOI: 10.1016/s1701-2163(15)30157-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To review current evidence regarding umbilical cord blood counselling, collection, and banking and to provide guidelines for Canadian health care professionals regarding patient education, informed consent, procedural aspects, and options for cord blood banking in Canada. OPTIONS Selective or routine collection and banking of umbilical cord blood for future stem cell transplantation for autologous (self) or allogeneic (related or unrelated) treatment of malignant and non-malignant disorders in children and adults. Cord blood can be collected using in utero or ex utero techniques. OUTCOMES Umbilical cord blood counselling, collection, and banking, education of health care professionals, indications for cord blood collection, short- and long-term risk and benefits, maternal and perinatal morbidity, parental satisfaction, and health care costs. EVIDENCE Published literature was retrieved through searches of Medline and PubMed beginning in September 2013 using appropriate controlled MeSH vocabulary (fetal blood, pregnancy, transplantation, ethics) and key words (umbilical cord blood, banking, collection, pregnancy, transplantation, ethics, public, private). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date limits, but results were limited to English or French language materials. Searches were updated on a regular basis and incorporated in the guideline to September 2014. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, and national and international medical specialty societies. VALUES The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). BENEFITS, HARMS, AND COSTS Umbilical cord blood is a readily available source of hematopoetic stem cells used with increasing frequency as an alternative to bone marrow or peripheral stem cell transplantation to treat malignant and non-malignant conditions in children and adults. There is minimal harm to the mother or newborn provided that priority is given to maternal/newborn safety during childbirth management. Recipients of umbilical cord stem cells may experience graft-versus-host disease, transfer of infection or genetic abnormalities, or therapeutic failure. The financial burden on the health system for public cord blood banking and on families for private cord blood banking is considerable. Recommendations 1. Health care professionals should be well-informed about cord blood collection and storage and about factors that influence the volume, quality, and ability to collect a cord blood unit. (III-A) 2. Health care professionals caring for women and families who choose private umbilical cord blood banking must disclose any financial interests or potential conflicts of interest. (III-A) 3. Pregnant women should be provided with unbiased information about umbilical cord blood banking options, including the benefits and limitations of public and private banks. (III-A) 4. Health care professionals should obtain consent from mothers for the collection of umbilical cord blood prior to the onset of active labour, ideally during the third trimester, with ample time to address any questions. (III-A) 5. Health care professionals must be trained in standardized procedures (ex utero and in utero techniques) for cord blood collection to ensure the sterility and quality of the collected unit. (II-2A) 6. Umbilical cord blood should be collected with the goal of maximizing the content of hematopoietic progenitors through the volume collected. The decision to bank the unit will depend upon specific measures of graft potency. (II-2A) 7. Umbilical cord blood collection must not adversely affect the health of the mother or newborn. Cord blood collection should not interfere with delayed cord clamping. (III-E) 8. Health care professionals should inform pregnant women and their partners of the benefits of delayed cord clamping and of its impact on cord blood collection and banking. (II-2A) 9. Cord blood units collected for public or private banking can be used for biomedical research, provided consent is obtained, when units cannot be banked or when consent for banking is withdrawn. (II-3B) 10. Mothers may be approached to donate cells for biomedical research. Informed consent for research using cord blood should ideally be obtained prior to the onset of active labour or elective Caesarean section following established research ethics guidelines. (II-2A).
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Grosso D, Gaballa S, Alpdogan O, Carabasi M, Filicko-O’Hara J, Kasner M, Martinez-Outschoorn U, Wagner JL, O'Hara W, Rudolph S, Chervoneva I, Colombe B, Farley PC, Flomenberg P, Pro B, Sharma M, Shi W, Weiss M, Flomenberg N. A Two-Step Approach to Myeloablative Haploidentical Transplantation: Low Nonrelapse Mortality and High Survival Confirmed in Patients with Earlier Stage Disease. Biol Blood Marrow Transplant 2015; 21:646-52. [DOI: 10.1016/j.bbmt.2014.12.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 12/17/2014] [Indexed: 10/24/2022]
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Ricci MJ, Medin JA, Foley RS. Advances in haplo-identical stem cell transplantation in adults with high-risk hematological malignancies. World J Stem Cells 2014; 6:380-390. [PMID: 25258660 PMCID: PMC4172667 DOI: 10.4252/wjsc.v6.i4.380] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 04/24/2014] [Accepted: 07/15/2014] [Indexed: 02/06/2023] Open
Abstract
Allogeneic bone marrow transplant is a life-saving procedure for adults and children that have high-risk or relapsed hematological malignancies. Incremental advances in the procedure, as well as expanded sources of donor hematopoietic cell grafts have significantly improved overall rates of success. Yet, the outcomes for patients for whom suitable donors cannot be found remain a significant limitation. These patients may benefit from a hematopoietic cell transplant wherein a relative donor is fully haplotype mismatched. Previously this procedure was limited by graft rejection, lethal graft-versus-host disease, and increased treatment-related toxicity. Recent approaches in haplo-identical transplantation have demonstrated significantly improved outcomes. Based on years of incremental pre-clinical research into this unique form of bone marrow transplant, a range of approaches have now been studied in patients in relatively large phase II trials that will be summarized in this review.
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Akyurekli C, Chan JY, Elmoazzen H, Tay J, Allan DS. Impact of ethnicity on human umbilical cord blood banking: a systematic review. Transfusion 2014; 54:2122-7. [DOI: 10.1111/trf.12630] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 01/09/2014] [Accepted: 01/13/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Celine Akyurekli
- Blood and Marrow Transplant Program; Department of Medicine; University of Ottawa; Ottawa Ontario Canada
- Regenerative Medicine; Ottawa Hospital Research Institute; Ottawa Ontario Canada
| | - Joshua Y.S. Chan
- Blood and Marrow Transplant Program; Department of Medicine; University of Ottawa; Ottawa Ontario Canada
| | - Heidi Elmoazzen
- National Public Cord Blood Bank; Canadian Blood Services; Ottawa Ontario Canada
| | - Jason Tay
- Blood and Marrow Transplant Program; Department of Medicine; University of Ottawa; Ottawa Ontario Canada
- Clinical Epidemiology Programs; Ottawa Hospital Research Institute; Ottawa Ontario Canada
| | - David S. Allan
- Blood and Marrow Transplant Program; Department of Medicine; University of Ottawa; Ottawa Ontario Canada
- Regenerative Medicine; Ottawa Hospital Research Institute; Ottawa Ontario Canada
- National Public Cord Blood Bank; Canadian Blood Services; Ottawa Ontario Canada
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Importance of factors influencing the decision to proceed with cord blood transplantation in adults: results of a Web-based survey of the Canadian transplant community. Bone Marrow Transplant 2013; 48:1482-3. [PMID: 23727749 DOI: 10.1038/bmt.2013.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Modelling improvements in cell yield of banked umbilical cord blood and the impact on availability of donor units for transplantation into adults. Stem Cells Int 2013; 2013:124834. [PMID: 23509469 PMCID: PMC3590636 DOI: 10.1155/2013/124834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 01/11/2013] [Indexed: 11/26/2022] Open
Abstract
Umbilical cord blood (UCB) is used increasingly in allogeneic transplantation. The size of units remains limiting, especially for adult recipients. Whether modest improvements in the yield of cells surviving storage and thawing allow more patients to proceed to transplant was examined. The impact of improved cell yield on the number of available UCB units was simulated using 21 consecutive anonymous searches. The number of suitable UCB units was calculated based on hypothetical recipient weight of 50 kg, 70 kg, and 90 kg and was repeated for a 10%, 20%, and 30% increase in the fraction of cells surviving storage. Increasing the percentage of cells that survive storage by 30% lowered the threshold of cells needed to achieve similar engraftment rates and increased numbers of UCB units available for patients weighing 50 (P = 0.011), 70 (P = 0.014), and 90 kg (P = 0.003), controlling for differences in HLA compatibility. Moreover, if recipients were 90 kg, 12 out of 21 patients had access to at least one UCB unit that met standard criteria, which increased to 19 out of 21 patients (P = 0.035) when the fraction of cells surviving storage and thawing increased by 30%. Modest increases in the yield of cells in banked UCB units can significantly increase donor options for adult patients undergoing HSCT.
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Tay J, Allan D, Tinmouth A, Coyle D, Hébert P. Donor selection for patients undergoing allogeneic hematopoietic SCT: assessment of the priorities of Canadian hematopoietic SCT physicians. Bone Marrow Transplant 2012; 48:314-6. [DOI: 10.1038/bmt.2012.137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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