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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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Ros-Soto J, Pryce A, Zoubek E, Burlton C, Szydlo R, Anthias C. Favorable recovery profiles and good reliability among youngest unrelated stem cell donors supports lowering the minimum donor registration age. J Clin Apher 2023; 38:562-572. [PMID: 37309733 DOI: 10.1002/jca.22066] [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: 01/27/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Younger donor age in hematopoietic cell transplantation has been associated with improved overall and disease-free survival. Safety data on peripheral blood stem cell (PBSC) and bone marrow (BM) donation is well established, including in the <18-year old age group in the related setting. In response, Anthony Nolan became the first stem cell donor registry to lower the minimum age for unrelated donors to 16-years. MATERIALS AND METHODS This retrospective study reviewed unrelated donors donating PBSC or BM for the first time between April 2015 and October 2017 since adoption of the lowered recruitment age. Data were collected from registry electronic database and structured follow-up questionnaires. Primary outcomes were turnaround time from VT to donation, optimal cell yield achievement, and physical and emotional recovery. RESULTS Out of a total of 1013 donors, there were no differences between the different age groups in proportion of donors achieving optimal CD34+ or TNC (PBSC and BM, respectively). There was no increased central line requirement for younger donors or increased emergency telephone support. Youngest donors were more likely to report physical recovery 2 and 7 days post-PBSC (P = .024 and P = .015, respectively) as well as an earlier emotional recovery (P = .001) and fewer physical symptoms 1 week BM donation (P = .04). CONCLUSION This study shows that younger donors are as reliable as older donors, and have favorable recovery profiles without need for increased support at any stage of the donation, supporting Anthony Nolan recruitment strategy and offering reassurance to donor registries considering the same.
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Affiliation(s)
- Jose Ros-Soto
- Anthony Nolan, London, UK
- Imperial College Healthcare Trust, London, UK
| | - Angharad Pryce
- Anthony Nolan, London, UK
- Imperial College Healthcare Trust, London, UK
| | | | | | - Richard Szydlo
- Anthony Nolan, London, UK
- Imperial College Healthcare Trust, London, UK
| | - Chloe Anthias
- Anthony Nolan, London, UK
- The Royal Marsden Healthcare Trust, London, UK
- Institute of Cancer Research London, London, UK
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Kalin J, Nguyen ATH, Oshrine B. Donor characteristics and intraoperative total nucleated cell count influence hematopoietic progenitor cell yield of healthy donor bone marrow grafts. Pediatr Blood Cancer 2021; 68:e28902. [PMID: 33484054 DOI: 10.1002/pbc.28902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/27/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Bone marrow graft cell content impacts engraftment potential after allogeneic hematopoietic cell transplantation (alloHCT). Surrogates, such as intraoperative total nucleated cell count (ioTNC), are of unclear utility in predicting final graft characteristics. In addition, demographic and clinical factors may influence graft cellular profile and recipient engraftment. PROCEDURE We retrospectively reviewed marrow harvests at our institution performed between 2009 and 2019. During this time, an ioTNC was measured after 50% of the projected final graft volume was collected. Regression models were used to assess associations between ioTNC (cells/µL) and final graft CD34+ (cells/mL), and between graft and donor characteristics and final graft CD34+ (cells/mL). RESULTS Fifty-three marrow harvests and donor-recipient pairs were analyzed. Median (range) donor and recipient ages were 13 (0.7-28) years and 9 (0.2-21) years, respectively. The median ratio of donor/recipient weight was 1.225 kg (range 0.31-7.13). Median total volume of harvested marrow was 15.3 mL/kg (range 4.3-20.4) of donor weight and 19.4 mL/kg (range 4.7-87.4) of recipient weight. Median ioTNC was 20 930/µL (range 6600-44310) or 2.1 × 109 /mL, corresponding to median predicted final graft TNC of 3.59 × 108 /kg recipient weight (range 1.28-19.42 × 108 ). Simple linear regression between ioTNC and CD34+ cells/mL resulted in an R2 of 0.42. Least absolute shrinkage and selection operator (LASSO) regression produced a moderately predictive model consisting of ioTNC, donor age, and donor weight (adjusted R2 = 0.7) of final graft CD34+ cells/mL. CONCLUSIONS ioTNC and certain donor characteristics correlate moderately well with marrow product CD34+ cells/mL, potentially informing donor selection and marrow procurement strategies.
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Affiliation(s)
- Jacob Kalin
- Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida
| | - Anh Thy H Nguyen
- Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida
| | - Benjamin Oshrine
- Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida
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4
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Rennert W, Sobh L, Cormier K, Smith J, Gonzalez C. The impact of donor total estimated blood volume on nucleated cell yield in bone marrow harvests for hematopoietic stem cell transplantation. Transfusion 2021; 61:1533-1541. [PMID: 33768535 DOI: 10.1111/trf.16374] [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: 10/26/2020] [Revised: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nucleated cell yields of marrow harvests depend on factors related to donors, the procedure itself, and the volume of marrow harvested. Few attempts have been made to relate donor characteristics to harvest volume. We hypothesize that the percentage of total donor blood volume accessed for harvesting impacts the nucleated cell yield per ml of marrow collected. METHODS AND MATERIALS We investigated 481 consecutive unrelated marrow harvests from a single center. Donor characteristics including weight, body mass index (BMI), white blood cells (WBCs), hemoglobin (Hgb), and platelet counts, as well as estimated total blood volume, were recorded and compared with nucleated cell yields and harvest volumes. RESULTS The percentage of donor blood volume accessed for marrow harvesting was inversely related to nucleated cell yields (r = -0.57). The donor-recipient weight differential impacted cell yields as well (r = 0.35), with heavier recipients requiring increased marrow volumes from smaller donors to satisfy their nucleated cell needs. 3.73 × 108 /kg of recipient weight could be collected with 95% certainty when harvest volumes did not exceed 16.1% of donor total blood volume. In a stepwise multiple regression analysis, 45.4% of cell yield variance was explained by blood volume percentage accessed for harvesting, donor weight, and WBC. Donor sex, BMI, and platelet counts did not contribute further to cell yield variance. Smokers had higher cell yields than nonsmokers (20.4 vs. 18.3 × 106 /ml; 95% confidence interval 0.62, 3.47) independent of other parameters. CONCLUSION Establishing the relationship between percentage of estimated donor total blood volume and recipient cell needs can facilitate donor selection for successful hematopoietic cell (HPC) transplants.
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Affiliation(s)
- Wolfgang Rennert
- Blood and Marrow Collection Program, Georgetown University Medical Center, Washington, DC, USA
| | - Lina Sobh
- Blood and Marrow Collection Program, Georgetown University Medical Center, Washington, DC, USA
| | - Katie Cormier
- Blood and Marrow Collection Program, Georgetown University Medical Center, Washington, DC, USA
| | - Jenna Smith
- Blood and Marrow Collection Program, Georgetown University Medical Center, Washington, DC, USA
| | - Corina Gonzalez
- Blood and Marrow Collection Program, Georgetown University Medical Center, Washington, DC, USA
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5
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Getta BM, Tong D, Deren S, Huang G, Hogg M, Collins D, Bhattacharyya A, Panicker S, Micklethwaite K, Blyth E, Bilmon I, Kwan J, Antonenas V, Gottlieb DJ. Pre- and post-bone marrow harvest anaemia is associated with lower CD34+ stem cell collection, high harvest volume and female gender. Intern Med J 2019; 50:299-306. [PMID: 31276271 DOI: 10.1111/imj.14419] [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: 12/08/2018] [Revised: 05/21/2019] [Accepted: 07/01/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Donor safety is paramount when performing bone marrow stem cell harvest. The incidence of full blood count (FBC) abnormalities among donors and variables associated with anaemia after marrow harvest are not well established. AIMS To describe the frequency of FBC abnormalities prior to bone marrow stem cell harvest and to identify variables associated with post harvest anaemia. METHODS Outcomes of 80 consecutive adult marrow harvests performed at our centre were analysed retrospectively. RESULTS FBC abnormalities were present in 28% of donors prior to marrow harvest with normocytic anaemia the most common abnormality in 13%. Reduced donor haemoglobin (Hb) was independently correlated with lower CD34+ cell count per kg of recipient body weight. Anaemia (Hb < 100 g/L) was seen in 20% of donors after harvest with median decrease in Hb of 19 g/L. Variables independently associated with anaemia after harvest included donor to recipient weight ratio (P = 0.011), high collection volume (P = 0.044) and female gender (P = 0.023). Total nucleated cell and CD34 concentration in the final collected product were associated with the inverse of harvested marrow volume (P < 0.001). CONCLUSIONS Pre-harvest anaemia should be corrected where possible particularly in female donors. Marrow collection volume should be minimised to reduce post-harvest anaemia, optimise CD34+ cell number and improve nucleated and stem cell concentrations in the harvest product.
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Affiliation(s)
- Bartlomiej M Getta
- Blood and Marrow Transplantation Program, Westmead Hospital, Sydney, New South Wales, Australia
| | - Daochen Tong
- Sydney Cellular Therapies Laboratory, Westmead Hospital, Sydney, New South Wales, Australia
| | - Stephanie Deren
- Blood and Marrow Transplantation Program, Westmead Hospital, Sydney, New South Wales, Australia
| | - Gillian Huang
- Blood and Marrow Transplantation Program, Westmead Hospital, Sydney, New South Wales, Australia
| | - Megan Hogg
- Blood and Marrow Transplantation Program, Westmead Hospital, Sydney, New South Wales, Australia
| | - David Collins
- Blood and Marrow Transplantation Program, Westmead Hospital, Sydney, New South Wales, Australia
| | - Abir Bhattacharyya
- Blood and Marrow Transplantation Program, Westmead Hospital, Sydney, New South Wales, Australia
| | - Shyam Panicker
- Blood and Marrow Transplantation Program, Westmead Hospital, Sydney, New South Wales, Australia
| | - Kenneth Micklethwaite
- Blood and Marrow Transplantation Program, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Cellular Therapies Laboratory, Westmead Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia.,Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Emily Blyth
- Blood and Marrow Transplantation Program, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Cellular Therapies Laboratory, Westmead Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia.,Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Ian Bilmon
- Blood and Marrow Transplantation Program, Westmead Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - John Kwan
- Blood and Marrow Transplantation Program, Westmead Hospital, Sydney, New South Wales, Australia
| | - Vicki Antonenas
- Sydney Cellular Therapies Laboratory, Westmead Hospital, Sydney, New South Wales, Australia
| | - David J Gottlieb
- Blood and Marrow Transplantation Program, Westmead Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia.,Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
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6
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Prokopishyn NL, Logan BR, Kiefer DM, Sees JA, Chitphakdithai P, Ahmed IA, Anderlini PN, Beitinjaneh AM, Bredeson C, Cerny J, Chhabra S, Daly A, Diaz MA, Farhadfar N, Frangoul HA, Ganguly S, Gastineau DA, Gergis U, Hale GA, Hematti P, Kamble RT, Kasow KA, Lazarus HM, Liesveld JL, Murthy HS, Norkin M, Olsson RF, Papari M, Savani BN, Szer J, Waller EK, Wirk B, Yared JA, Pulsipher MA, Shah NN, Switzer GE, O'Donnell PV, Confer DL, Shaw BE. The Concentration of Total Nucleated Cells in Harvested Bone Marrow for Transplantation Has Decreased over Time. Biol Blood Marrow Transplant 2019; 25:1325-1330. [PMID: 30716454 PMCID: PMC6615955 DOI: 10.1016/j.bbmt.2019.01.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/29/2019] [Indexed: 10/27/2022]
Abstract
Bone marrow (BM) is an essential source of hematopoietic stem cell grafts for many allogeneic hematopoietic cell transplant (HCT) recipients, including adult patients (for specific diseases and transplantation strategies) and the majority of pediatric recipient. However, since the advent of granulocyte colony-stimulating factor-mobilized peripheral blood stem cell (PBSC) grafts, there has been a significant decrease in the use of BM in HCT, thought to be due mainly to the increased logistical challenges in harvesting BM compared with PBSCs, as well as generally no significant survival advantage of BM over PBSCs. The decreased frequency of collection has the potential to impact the quality of BM harvests. In this study, we examined >15,000 BM donations collected at National Marrow Donor Program centers between 1994 and 2016 and found a significant decline in the quality of BM products, as defined by the concentration of total nucleated cells (TNCs). The mean TNC concentration in BM donations dropped from 21.8 × 106 cells/mL in the earliest era (1994 to 1996) to 18.7 × 106 cells/mL in the most recent era (2012 to 2016) (means ratio, .83; P < .001). This decline in BM quality was seen despite the selection of more donors perceived to be optimal (eg, younger and male). Multivariate regression analysis showed that higher-volume centers (performing >30 collections per era) had better-quality harvests with higher concentrations of TNCs collected. In conclusion, we have identified a significant decrease in the quality of BM collections over time, and lower-volume collection centers had poorer-quality harvests. In this analysis, we could not elucidate the direct cause for this finding, suggesting the need for further studies to investigate the key factors responsible and to explore the impact on transplant recipients.
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Affiliation(s)
- Nicole L Prokopishyn
- Department of Pathology and Laboratory Medicine,University of Calgary, Calgary, Alberta, Canada
| | - Brent R Logan
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Deidre M Kiefer
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Jennifer A Sees
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Pintip Chitphakdithai
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Ibrahim A Ahmed
- Department of Hematology Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Paolo N Anderlini
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | | | - Christopher Bredeson
- The Ottawa Hospital Blood and Marrow Transplant Program and the Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jan Cerny
- Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - Saurabh Chhabra
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Andrew Daly
- Tom Baker Cancer Center, Calgary, Alberta, Canada
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Nosha Farhadfar
- Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, Florida
| | - Haydar A Frangoul
- Division of Pediatric-Hematology and Oncology, The Children's Hospital at TriStar Centennial and Sarah Cannon Research Institute, Nashville, Tennessee
| | - Siddhartha Ganguly
- Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, Kansas
| | | | - Usama Gergis
- Hematolgic Malignancies & Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Gregory A Hale
- Department of Hematology/Oncology, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Peiman Hematti
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas
| | - Kimberly A Kasow
- Department of Pediatrics in the Division of Hematology-Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Hillard M Lazarus
- Seidman Cancer Center-University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jane L Liesveld
- Strong Memorial Hospital-University of Rochester Medical Center, Rochester, New York
| | - Hemant S Murthy
- Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, Florida
| | - Maxim Norkin
- Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, Florida
| | - Richard F Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden; Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Mona Papari
- ITxM Clinical Services Cord Blood Lab, Rosemont, Illinois
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jeffrey Szer
- Clinical Haematology at Peter MacCalluma Cancer Centre and The Royal Melbourne Hospital, Victoria, Australia
| | - Edmund K Waller
- Department of Hematology and Meidcal Oncology, Emory University Hospital, Atlanta, Georgia
| | - Baldeep Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, Washington
| | - Jean A Yared
- Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Cancer Center, University of Maryland, Baltimore, Maryland
| | - Michael A Pulsipher
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, California
| | - Nirali N Shah
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Galen E Switzer
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Paul V O'Donnell
- Department of Hematology/Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dennis L Confer
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota; National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
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Amouzegar A, Dey BR, Spitzer TR. Peripheral Blood or Bone Marrow Stem Cells? Practical Considerations in Hematopoietic Stem Cell Transplantation. Transfus Med Rev 2018; 33:43-50. [PMID: 30528986 DOI: 10.1016/j.tmrv.2018.11.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/02/2018] [Accepted: 11/06/2018] [Indexed: 01/10/2023]
Abstract
Although peripheral blood stem cells (PBSC) have worldwide become the predominant source of progenitor cells for hematopoietic stem cell transplantation (HSCT), debate about their role compared with bone marrow (BM) has recently intensified, in large part based on the results of a multicenter Clinical Trials Network study which showed lower incidence of chronic graft-versus-host disease (cGVHD) and improved quality of life in recipients of myeloablative HLA-matched unrelated BM compared with PBSC transplants. However, in certain patient populations, PBSC may lead to improved clinical outcomes due to faster hematologic recovery, a lower risk of graft failure, and possibly a lower probability of relapse. This review will provide a comprehensive summary of studies comparing PBSC with BM as the graft source in terms of acute and chronic GVHD incidence, time to engraftment, and disease-free and overall survival probabilities after HLA-matched related and unrelated donor transplantation and haploidentical donor transplantation. Recommendations based on these studies regarding the use of PBSC versus BM for HSCT are offered.
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Affiliation(s)
- Afsaneh Amouzegar
- Department of Medicine, Bone Marrow Transplant Unit, Massachusetts General Hospital, Boston, MA
| | - Bimalangshu R Dey
- Department of Medicine, Bone Marrow Transplant Unit, Massachusetts General Hospital, Boston, MA
| | - Thomas R Spitzer
- Department of Medicine, Bone Marrow Transplant Unit, Massachusetts General Hospital, Boston, MA.
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8
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Bartnik K, Pruszczyk K, Skwierawska K, Król M, Płachta M, Moskowicz A, Zakrzewski T, Urbanowska E, Jędrzejczak WW, Snarski E. Bone marrow harvest in donors with anaemia. Vox Sang 2018; 113:795-802. [PMID: 30191563 DOI: 10.1111/vox.12709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 07/19/2018] [Accepted: 08/07/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Bone marrow harvest (BMH) for haematopoietic stem cell transplantation is a well-established procedure. The guidelines of World Marrow Donor Association provide information on donor selection. However, some of the guidelines regarding donors with anaemia prior to harvest lack in supporting data from clinical studies. With this study, we aimed to provide such data. MATERIAL AND METHODS In this retrospective, single-centre study, we analysed the interplay between haemoglobin levels and BMH and BMH impact on haemoglobin levels in a cohort of 149 unrelated BM donors, including 13 subjects with mild anaemia. RESULTS The BMH led to significantly lower decrease in haemoglobin levels in donors with anaemia than in control group (1·79 g/dl vs. 2·56 g/dl, P < 0·0001). The following parameters: BMH volume (ml), BMH volume/donor body weight (ml/kg), total nucleated cells (TNC) in product (×108 ) and TNC/kg recipient body weight in product (×108 /kg) did not differ significantly between those two analysed groups (P > 0·05). Median BM volume harvested from anaemic donors was 16·34 ml/kg; none of them required blood transfusion after BMH. CONCLUSION Mild anaemia prior to BMH does not significantly impact the collection results. The BMH is safe and feasible in donors with mild anaemia.
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Affiliation(s)
- Krzysztof Bartnik
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Pruszczyk
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Kamila Skwierawska
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Małgorzata Król
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Milena Płachta
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Albert Moskowicz
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Zakrzewski
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Elżbieta Urbanowska
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | - Emilian Snarski
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
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9
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Pruszczyk K, Skwierawska K, Król M, Moskowicz A, Jabłoński D, Torosian T, Piotrowska I, Urbanowska E, Wiktor-Jędrzejczak W, Snarski E. Bone marrow harvest from unrelated donors-up-to-date methodology. Eur J Haematol 2018; 99:357-365. [PMID: 28719093 DOI: 10.1111/ejh.12929] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Bone marrow harvesting is one of the essential sources of stem cells for hematopoietic stem cell transplantation. We describe here the current "up-to-date" standard of the bone marrow harvest in unrelated stem cell donors. METHODS We analyzed medical data of 187 unrelated hematopoietic stem cell donors who underwent bone marrow harvest without previous peripheral blood stem collection at the center between 2011 and 2015. The methodology of marrow collection includes multiple cells aimed at safety of the procedure, for example, educational movie, modified skin disinfection protocol, cell enumeration during the procedure, reduction of the contamination surfaces, and ongoing monitoring of the quality of work of the doctors. RESULTS The total nucleated cell count over 2×108 per kg of recipient has been reached in 93.6% of harvests. All of the donors harvested more than 1×108 per kg of the recipient. There were no donors who required transfusions or had serious adverse events during and after the harvest. CONCLUSION We describe here the current up-to-date standard of bone marrow harvest, which leads to excellent results in majority of donors without causing significant complications during the donation.
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Affiliation(s)
- Katarzyna Pruszczyk
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Kamila Skwierawska
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Małgorzata Król
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Albert Moskowicz
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | | | | | - Elżbieta Urbanowska
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | - Emilian Snarski
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
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10
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Development of an Unrelated Donor Selection Score Predictive of Survival after HCT: Donor Age Matters Most. Biol Blood Marrow Transplant 2018; 24:1049-1056. [PMID: 29454040 DOI: 10.1016/j.bbmt.2018.02.006] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 02/08/2018] [Indexed: 12/23/2022]
Abstract
Donor factors, in addition to HLA matching status, have been associated with recipient survival in unrelated donor (URD) hematopoietic cell transplantation (HCT); however, there is no hierarchical algorithm that weights the characteristics of individual donors against each other in a quantitative manner to facilitate donor selection. The goal of this study was to develop and validate a donor selection score that prioritizes donor characteristics associated with better survival in 8/8 HLA-matched URDs. Two separate patient/donor cohorts, the first receiving HCT between 1999 and 2011 (n = 5952, c1), and the second between 2012 and 2014 (n = 4510, c2) were included in the analysis. Both cohorts were randomly spilt, 2:1, into training and testing sets. Despite studying over 10,000 URD transplants, we were unable to validate a donor selection score. The only donor characteristic associated with better survival was younger age, with 2-year survival being 3% better when a donor 10 years younger is selected. These results support previous studies suggesting prioritization of a younger 8/8 HLA-matched donor. This large dataset also shows that none of the other donor clinical factors tested were reproducibly associated with survival, and hence flexibility in selecting URDs based on other characteristics is justified. These data support a simplified URD selection process and have significant implications for URD registries.
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Furey A, Rastogi S, Prince R, Jin Z, Smilow E, Briamonte C, Kahn JM, Tanhehco Y, Patel N, George D, Garvin J, Bhatia M, Satwani P. Bone Marrow Harvest in Pediatric Sibling Donors: Role of Granulocyte Colony-Stimulating Factor Priming and CD34+ Cell Dose. Biol Blood Marrow Transplant 2018; 24:324-329. [DOI: 10.1016/j.bbmt.2017.10.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 10/14/2017] [Indexed: 10/18/2022]
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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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Nemecek ER. Marrow harvesting: practice makes perfect. Transfusion 2016; 56:1005. [DOI: 10.1111/trf.13597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/01/2016] [Indexed: 11/30/2022]
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