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Yanagisawa R, Hirakawa T, Doki N, Ikegame K, Matsuoka KI, Fukuda T, Nakamae H, Ota S, Hiramoto N, Ishikawa J, Ara T, Tanaka M, Koga Y, Kawakita T, Maruyama Y, Kanda Y, Hino M, Atsuta Y, Yabe H, Tsukada N. Severe short-term adverse events in related bone marrow or peripheral blood stem cell donors. Int J Hematol 2023; 117:421-427. [PMID: 36403180 DOI: 10.1007/s12185-022-03489-4] [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: 08/12/2022] [Revised: 11/02/2022] [Accepted: 11/06/2022] [Indexed: 11/21/2022]
Abstract
The incidence of severe adverse events (SAEs) and associated risk factors in hematopoietic cell transplantation donors needs to be clarified for related donors (relatives of the transplant recipient), whose criteria for donation are more lenient than for unrelated donors. Data from related donors registered in the Japanese national data registry database between 2005 and 2021 were evaluated to determine the association of short-term SAE incidence with donor characteristics at registration.Fourteen of 4339 bone marrow (BM) donors (0.32%) and 54 of 10,684 peripheral blood stem cell (PBSC) donors (0.51%) experienced confirmed SAEs during the short donation period. No deaths were observed. Past medical history was a common risk factor for SAEs in both BM and PBSC donors. Age of 60 years or older and female sex were identified as risk factors for SAEs in PBSC donors. Female sex was also a risk factor for poor mobilization, which resulted in discontinuation of PBSC collection.Although donors should be selected carefully, a certain level of safety is ensured for related donors in Japan. Donor safety should be further increased by improving the selection method for related donors and extending the follow-up period.
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Affiliation(s)
- Ryu Yanagisawa
- Division of Blood Transfusion, Shinshu University Hospital, 3-1-1, Asahi, Matsumoto, 390-8621, Japan.
| | | | - Noriko Doki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Kazuhiro Ikegame
- Department of Hematology, Hyogo Medical University Hospital, Nishinomiya, Japan
| | - Ken-Ichi Matsuoka
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Takahiro Fukuda
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | | | - Shuichi Ota
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Nobuhiro Hiramoto
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Jun Ishikawa
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
| | - Takahide Ara
- Department of Hematology, Hokkaido University Hospital, Sapporo, Japan
| | - Masatsugu Tanaka
- Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan
| | - Yuhki Koga
- Department of Pediatrics, Kyushu University Hospital, Fukuoka, Japan
| | - Toshiro Kawakita
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Yumiko Maruyama
- Department of Hematology, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Masayuki Hino
- Hematology, Osaka Metropolitan University, Osaka, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan.,Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Hiromasa Yabe
- Department of Pediatrics, Tokai University School of Medicine, Isehara, Japan
| | - Nobuhiro Tsukada
- Department of Hematology, Japanese Red Cross Medical Center, Tokyo, Japan
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Basic characteristics and safety of donation in related and unrelated haematopoietic progenitor cell donors - first 10 years of prospective donor follow-up of Swiss donors. Bone Marrow Transplant 2022; 57:918-924. [PMID: 35379914 DOI: 10.1038/s41409-022-01656-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 03/17/2022] [Accepted: 03/22/2022] [Indexed: 11/08/2022]
Abstract
Since July 2007 prospective life-long follow-up (FU) for unrelated (URD) and related donors (RD) is mandatory in Switzerland and data on every allogeneic haematopoietic progenitor cell (HPC) donation are collected prospectively. We report the real-world experience of HPC donation during a 10-year study period (01.07.2007-30.06.2017) with basic characteristics and FU data. 1105 donors underwent 1155 HPC donation procedures. Eighty percent of first donations performed by 802 (73%) RDs and 303 (27%) URDs were peripheral blood stem cells (PBSC), 20% bone marrow (BM). Male donors were over-represented as URD (60% male vs 40% female). Main differences between RDs and URDs concerned age and pre-existing health disorders. RDs were significantly older at first donation (median age 48 years) compared to URD (34 years, p < 0.0001) and had more pre-existing health problems: 25% vs 9% in URD (p < 0.0001). No fatal complications occurred, collection related severe adverse events (SAE) after first donation were not significantly different between groups (RD 1.2%, URD 0.99%), incidence rates for neoplastic and autoimmune diseases did not exceed the rates of the general population. RDs are a more heterogeneous and potentially more vulnerable group, but if donor evaluation is performed appropriately, HPC donation is still safe.
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Seftel MD, Chitphakdithai P, Miller JP, Kobusingye H, Logan BR, Linenberger M, Artz AS, Haight AE, Jacobsohn DA, Litzow MR, Magalhaes-Silverman M, Selby GB, Vusirikala M, Horowitz MM, Switzer GE, Confer DL, Shaw BE, Pulsipher MA. Serious Adverse Events in Related Donors: A Report from the Related Donor Safe Study. Transplant Cell Ther 2021; 27:352.e1-352.e5. [PMID: 33836890 PMCID: PMC8036235 DOI: 10.1016/j.jtct.2021.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/05/2021] [Accepted: 01/11/2021] [Indexed: 11/30/2022]
Abstract
The incidence and risk factors for severe adverse events (SAEs) in related donors (RD) of hematopoietic cell transplants is unknown. The Related Donor Safe study is a prospective observational cohort of 1680 RDs and represents an opportunity to examine characteristics of SAEs in RDs. In this cohort, we found that SAEs were reported in a total 12 (0.71%) RDs. Of these, 5 SAEs occurred in bone marrow donors (5/404, 1.24%), and 7 (7/1276, 0.55%) were in donors of peripheral blood stem cells. All of the SAEs were considered to be related (definite, probable, or possible) to the donation process. There were no donor fatalities. Of the 12 RDs who experienced an SAE, 10 were either overweight or obese. Five of the 12 RDs had predonation medical conditions that would have resulted in either possible or definite ineligibility for donation were they being assessed as unrelated donors. These SAE data will be useful in the counseling of prospective RDs before planned donation and may be helpful in identifying donors who should be considered medically unsuitable for donation.
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Affiliation(s)
- Matthew D Seftel
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Pintip Chitphakdithai
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program, Minneapolis, Minnesota
| | - John P Miller
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Hati Kobusingye
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program, Minneapolis, Minnesota
| | - Brent R Logan
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | | | - Ann E Haight
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia
| | - David A Jacobsohn
- Children's National Medical Center, Washington, District of Columbia
| | | | | | - George B Selby
- HCA Health Services of Oklahoma, Inc., University of Oklahoma, Oklahoma City, Oklahoma
| | | | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Dennis L Confer
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program, Minneapolis, Minnesota; National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Michael A Pulsipher
- Children's Hospital Los Angeles Cancer and Blood Disease Institute, USC Keck School of Medicine, Los Angeles, California
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Zomerdijk N, Turner J, Hill GR, Gottlieb D. Experiences and unmet needs of family members requested to donate haematopoietic stem cells to an ill relative: findings from a prospective multi-centre study. Support Care Cancer 2020; 29:635-644. [PMID: 32424644 DOI: 10.1007/s00520-020-05520-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 05/06/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Despite well-documented physical effects of haematopoietic stem cell (HSC) donation, far less attention has been focused on the psychosocial impact for family donors. This study aimed to better understand the psychosocial aspects of HSC donation by family members, focusing, in particular on their needs for information and supportive care. METHODS Thirty-one adult HSC family donors from two clinical hospitals were interviewed before, during and 1 month after HSC donation. Interviews explored ambivalence, motivation, perceived pressure, preparedness, the donor-recipient relationship, information and support received and suggestions for improvement. RESULTS Three main themes about the donation experience were identified: 'call to arms' (focused on the recipient, stressful urgency, making meaning of being a donor, decisional ambivalence), 'proceeding with donation' (living in limbo, unsettling uncertainty, pervasive pain, feeling supported) and 'after the dust settles' (feeling discarded, downplaying role, residual symptoms, dealing with adverse recipient outcomes). Underlying system and communication issues included time for consideration prior to donor work-up, management of confidentiality, information inadequacy and access to support. Donors wanted information about the emotional challenges specific to being a family donor, such as ways in which previous donors coped with recipient death. For donors whose recipient had died, the priority for improved care was follow-up support. CONCLUSION Our findings emphasise a gap in information and supportive care for family donors and the need for a protocol specifically designed to inform and support family donors before, during and after HSC donation.
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Affiliation(s)
- Nienke Zomerdijk
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia. .,Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia. .,Bone Marrow Transplant Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia. .,School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia.
| | - Jane Turner
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Geoffrey R Hill
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Bone Marrow Transplant Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - David Gottlieb
- Blood and Bone Marrow Transplant Unit, Westmead Hospital, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Connelly-Smith LS. Donor Evaluation for Hematopoietic Stem and Progenitor Cell Collection. ADVANCES AND CONTROVERSIES IN HEMATOPOIETIC TRANSPLANTATION AND CELL THERAPY 2020. [PMCID: PMC7123736 DOI: 10.1007/978-3-319-55131-9_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
With the increasing incidence of hematopoietic allogeneic cell transplantation (allo-HCT), the importance of securing a cellular product, safely from a donor, and ensuring that the product is without additional risk to the recipient, continues to be of paramount importance. The evaluation of the donor’s medical eligibility and suitability is designed to identify and limit the risk of transmitting infectious, genetic, or neoplastic diseases to the recipient through the product. It also aims to ensure a maximum level of safety for the donor and informs them of the risks of donation. Several regulatory agencies, national and international registries, and accreditation bodies have facilitated the availability and safe provision of human cells, tissues, and cellular- and tissue-based products not only at local institutions but also through international exchange.
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6
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Polomeni A, Bompoint C, Labopin M, Badoglio M, Battipaglia G, Eeltink C, Liptrott SJ, Babik A, Murray J, Stringer J. Hematopoietic cell transplant nurse coordinators' perceptions of related donor care: a European survey from the EBMT Nurses Group. Bone Marrow Transplant 2019; 55:623-632. [PMID: 31578465 DOI: 10.1038/s41409-019-0686-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 08/06/2019] [Accepted: 08/21/2019] [Indexed: 11/09/2022]
Abstract
Allogeneic haematopoietic cell transplantation (HCT) is a curative procedure for patients with haematological malignancies and immune deficiencies. A human leukocyte antigen (HLA) identical sibling is only available for 25-35% of patients in need. The improvement in haplo-identical transplantation has led to a marked increase in cell donation from relatives. Despite international recommendations, discrepancies in related-donors (RD) care exist between centres, particularly regarding medical suitability criteria, consenting procedures and donor follow-up. This European survey aimed to explore hematopoietic cell transplantation coordinators nurses' (HCT-CNs) perceptions of RD care, in particular the association with the presence or not of an independent unit (IU). Ninety-three HCT-CNs from seventy-six EBMT centres responded, representing 19 countries (response rate: 27%). Our results did not show a significant association between IU and HCT-CNs perceptions of related-donors care. The practices for RD care vary among centres regarding presence or not of an IU (48%), person caring for RD (haematologist in 54%, HCT physician in 17%, HCT-CNs in 20%), person to whom the results of HLA typing are communicated, use of a booklet for RD, follow-up or not and periodicity of follow-up. Qualitative data highlight the related-donation ethical issues and the need for improvement in RD care. HCT-CNs' main concerns were: the necessary confidentiality to insure the voluntary status of RD, the perceived conflict of interest felt by professionals when managing both patients and RD, plus the psychosocial aspects of related-donation. Even if there is a variety of a practice among centres, the presence of an IU is not significantly associated with an improvement in RD care.
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Affiliation(s)
- A Polomeni
- Department of Hematology and Cell Therapy, Saint-Antoine Hospital, Paris, France.
| | - C Bompoint
- EBMT Nurses Group, Department of Hematology and Cell therapy, Saint Eloi Hospital, Montpellier, France
| | - M Labopin
- EBMT Paris Study Office/CEREST-TC, Department of Hematology and Cell Therapy, Saint-Antoine Hospital, INSERM UMR 938, Université Pierre et Marie Curie, Paris, France
| | - M Badoglio
- EBMT Paris Study Office/CEREST-TC, Department of Hematology and Cell Therapy, Saint-Antoine Hospital, INSERM UMR 938, Université Pierre et Marie Curie, Paris, France
| | - G Battipaglia
- Department of Hematology and Cell Therapy, Saint-Antoine Hospital, Paris, France
| | - C Eeltink
- EBMT Nurses Group, Amsterdam UMC, VU University Medical Center Department of Hematology, Amsterdam, The Netherlands
| | - S J Liptrott
- EBMT Nurses Group, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - A Babik
- EBMT Nurses Group, JACIE QM Inspector, IOSI-Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - J Murray
- EBMT Nurses Group, Haematology and Transplant Unit, Christie Hospital NHS Foundation Trust Manchester, Manchester, UK
| | - J Stringer
- EBMT Nurses Group, The Christie NHS Tust, The University of Manchester, Manchester, UK
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Zomerdijk N, Turner J, Hill GR, Gottlieb D. Adult related haematopoietic stem cell donor care: Views of Transplant Nurses. Eur J Oncol Nurs 2019; 41:56-63. [PMID: 31358258 DOI: 10.1016/j.ejon.2019.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 05/08/2019] [Accepted: 05/31/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE The objective of this mixed-methods study was to explore the experiences and perspectives of Transplant Nurses (TNs) in caring for related donors (RDs). METHOD In this mixed-methods study, both quantitative and qualitative data were collected from semi-structured interviews with seven TNs from two clinical hospitals. Closed and multiple-choice questions regarding the organisation of RD care were administered in addition to an in-depth exploration of TN experiences and perspectives of RD care. Interviews were audio-recorded, transcribed, and qualitative data was subjected to thematic analyses. RESULTS The analysis identified 5 themes relating to RD care: managing complex family dynamics and ambivalence; concerns about RD psychological adjustment; identifying and correcting RD misperceptions; limited guidelines and structured processes; limited training for the role and access to supervision. Five themes were identified describing the barriers to delivering RD care: RDs unwilling to express their concerns; language; time constraints; medical priority of clinicians; biomedical focus of TNs. All TNs agreed they would like additional training in the psychosocial management of RDs. TNs identified key areas for improvement, including psychosocial support and educational material. CONCLUSIONS Our results highlight the significant role of TNs in RD care, and underline issues specific to the current RD care environment. Lack of training for the role and limited guidelines addressing RD care management are key issues which may detrimentally affect RD care. The pivotal role of TNs must be acknowledged and supported by improving TN training and implementing clear guidelines for the management of RDs. The trial has been registered on the publicly accessible register: www.clinicaltrials.gov site with the identifier ACTRN12617000407392.
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Affiliation(s)
- Nienke Zomerdijk
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
| | - Jane Turner
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
| | - Geoffrey R Hill
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia; Fred Hutchinson Cancer Research Center, Sydney, NSW, Australia.
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8
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Polomeni A, Culat-Farhat M, Desbrosses Y, Andrianne C, Ainaoui M, Baillie E, Bancillon N, de Bentzmann N, Bouya S, Duteil E, Fraysse C, Issarni D, Ruscassie A, Sauze S, Thibert JB, Yakoub-Agha I, Faucher C. [Related donors follow-up: Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)]. Bull Cancer 2019; 107:S94-S103. [PMID: 31006487 DOI: 10.1016/j.bulcan.2019.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 02/13/2019] [Accepted: 02/18/2019] [Indexed: 11/15/2022]
Abstract
Since 2010 there has been an exponential increase of the number of transplants performed from related donors. The development of haploidentical transplants increases the resort to related-donation, which presents two main advantages: a less important financial cost and a faster availability of the graft. Standards for mandatory accreditation exist, but the adherence to these recommendations is not optimal: currently, different practices regarding the organizational modalities of care, recruitment criteria, qualification and follow-up of related donors have been observed among French transplant centers. The Francophone Society of Marrow Transplant and Cellular Therapy (SFGM-TC) has developed guidelines for the consent and the non-eligibility criteria for hematopoietic stem cell donors. A multidisciplinary group has devised a booklet as a medium to inform donors about hematopoietic cell donation and transplantation in a clear and accessible language. This paper provides recommendations on post-donation follow-up, taking into account both medical standards and organizational constraints of French centers. Some tools are proposed.
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Affiliation(s)
- Alice Polomeni
- Assistance publique-Hôpitaux de Paris, hôpital Saint-Antoine, service d'hématologie clinique et thérapie cellulaire, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
| | - Marjorie Culat-Farhat
- CHRU Jean-Minjoz, service d'hématologie, 3, boulevard Fleming, 25030 Besançon cedex, France
| | - Yohan Desbrosses
- CHRU Jean-Minjoz, service d'hématologie, 3, boulevard Fleming, 25030 Besançon cedex, France
| | - Christelle Andrianne
- CHU de Liège, service d'hématologie clinique, avenue de l'Hôpital, B35, 4000 Liège, Belgique
| | - Malika Ainaoui
- CHRU de Lille, service des maladies du sang, rue Michel-Polorovski, 59037 Lille cedex, France
| | - Evelyne Baillie
- CHRU de Lille, service des maladies du sang, rue Michel-Polorovski, 59037 Lille cedex, France
| | - Nelly Bancillon
- CHU d'Angers, service des maladies du sang, 4, rue Larrey, 49933 Angers, France
| | - Natacha de Bentzmann
- IUCT-Oncopole, service d'hématologie hautement protégé (greffe de moelle osseuse), avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - Salaheddine Bouya
- Hôpital Saint-Éloi, service d'aphérèse thérapeutique et hémovigilance, 80, avenue Augustin-Fliche, 34295 Montpellier, France
| | - Elodie Duteil
- IUCT-Oncopole, service d'hématologie hautement protégé (greffe de moelle osseuse), avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - Christine Fraysse
- CHU de Montpellier, hôpital Saint-Éloi, centre de greffes adultes et pédiatriques, département d'hématologie clinique, 80, avenue Augustin-Fliche, 34925 Montpellier cedex 5, France
| | | | - Agnès Ruscassie
- IUCT-Oncopôle, service soins de support, avenue Irène-Joliot-Curie, 31100 Toulouse, France
| | - Séverine Sauze
- CHU d'Angers, service des maladies du sang, 4, rue Larrey, 49933 Angers, France
| | - Jean-Baptiste Thibert
- Établissement français du sang Bretagne, service de thérapie cellulaire, rue Pierre-Jean-Gineste, BP 91614, 35016 Rennes cedex, France
| | | | - Catherine Faucher
- Agence de la Biomédecine, pôle stratégie prélèvements greffes CSH, direction prélèvements/greffes CSH, direction générale médicale et scientifique, 1, avenue du Stade-de-France, 93212 Saint-Denis-la-Plaine cedex, France
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9
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Pulsipher MA, Logan BR, Kiefer DM, Chitphakdithai P, Riches ML, Rizzo JD, Anderlini P, Leitman OF, Kobusingye H, Besser RM, Miller JP, Drexler RJ, Abdel-Mageed A, Ahmed IA, Akard LP, Artz AS, Ball ED, Bayer RL, Bigelow C, Bolwell BJ, Broun ER, Delgado DC, Duckworth K, Dvorak CC, Hahn TE, Haight AE, Hari PN, Hayes-Lattin BM, Jacobsohn DA, Jakubowski AA, Kasow KA, Lazarus HM, Liesveld JL, Linenberger M, Litzow MR, Longo W, Magalhaes-Silverman M, McCarty JM, McGuirk JP, Mori S, Parameswaran V, Prasad VK, Rowley SD, Rybka WB, Sahdev I, Schriber JR, Selby GB, Shaughnessy PJ, Shenoy S, Spitzer T, Tse WT, Uberti JP, Vusirikala M, Waller EK, Weisdorf DJ, Yanik GA, Navarro WH, Horowitz MM, Switzer GE, Confer DL, Shaw BE. Related peripheral blood stem cell donors experience more severe symptoms and less complete recovery at one year compared to unrelated donors. Haematologica 2019; 104:844-854. [PMID: 30381298 PMCID: PMC6442962 DOI: 10.3324/haematol.2018.200121] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/30/2018] [Indexed: 11/26/2022] Open
Abstract
Unlike unrelated donor registries, transplant centers lack uniform approaches to related donor assessment and deferral. To test whether related donors are at increased risk for donation-related toxicities, we conducted a prospective observational trial of 11,942 related and unrelated donors aged 18-60 years. Bone marrow (BM) was collected at 37 transplant and 78 National Marrow Donor Program centers, and peripheral blood stem cells (PBSC) were collected at 42 transplant and 87 unrelated donor centers in North America. Possible presence of medical comorbidities was verified prior to donation, and standardized pain and toxicity measures were assessed pre-donation, peri-donation, and one year following. Multivariate analyses showed similar experiences for BM collection in related and unrelated donors; however, related stem cell donors had increased risk of moderate [odds ratios (ORs) 1.42; P<0.001] and severe (OR 8.91; P<0.001) pain and toxicities (OR 1.84; P<0.001) with collection. Related stem cell donors were at increased risk of persistent toxicities (OR 1.56; P=0.021) and non-recovery from pain (OR 1.42; P=0.001) at one year. Related donors with more significant comorbidities were at especially high risk for grade 2-4 pain (OR 3.43; P<0.001) and non-recovery from toxicities (OR 3.71; P<0.001) at one year. Related donors with more significant comorbidities were at especially high risk for grade 2-4 pain (OR 3.43; P<0.001) and non-recovery from toxicities (OR 3.71; P<0.001) at one year. Related donors reporting grade ≥2 pain had significant decreases in Health-Related Quality of Life (HR-QoL) scores at one month and one year post donation (P=0.004). In conclusion, related PBSC donors with comorbidities are at increased risk for pain, toxicity, and non-recovery at one year after donation. Risk profiles described in this study should be used for donor education, planning studies to improve the related donor experience, and decisions regarding donor deferral. Registered at clinicaltrials.gov identifier:00948636.
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Affiliation(s)
| | - Brent R Logan
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | - Deidre M Kiefer
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN
| | - Pintip Chitphakdithai
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN
| | - Marcie L Riches
- University of North Carolina Hospitals, Division of Hematology and Oncology Chapel Hill, NC
| | - J Douglas Rizzo
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | - Paolo Anderlini
- Department of Stem Cell Transplantation and Cell Transplantation and Cellular Therapy, Division of Cancer Medicine, MD Anderson Cancer Center, Houston, TX
| | - O'Susan F Leitman
- Department of Transfusion Medicine, National Institutes of Health Clinical Center, Bethesda, MD
| | - Hati Kobusingye
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN
| | - RaeAnne M Besser
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN
| | - John P Miller
- National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Rebecca J Drexler
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN
| | - Aly Abdel-Mageed
- Department of Pediatrics and Human Development, Helen DeVos Children's Hospital, Grand Rapids, MI
| | - Ibrahim A Ahmed
- Department of Hematology and Oncology, Children's Mercy Hospitals and Clinics, Kansas City, MO
| | - Luke P Akard
- Indiana Blood and Marrow Transplantation, Indianapolis, IN
| | | | - Edward D Ball
- University of California, San Diego Medical Center, La Jolla, CA
| | | | | | | | | | | | | | - Christopher C Dvorak
- Division of Pediatric Blood and Marrow Transplantation, University of California San Francisco Benioff Children's Hospital, CA
| | | | - Ann E Haight
- Aflac Cancer and Blood Disorders Center, Division of Hematology/Oncology-Bone Marrow Pediatric Hematology & Medical Oncology, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA
| | | | | | | | | | - Kimberly A Kasow
- Pediatric Hematology Oncology Program, Bone Marrow and Stem Cell Transplantation Program, University of North Carolina Healthcare, Chapel Hill, NC
| | - Hillard M Lazarus
- Seidman Cancer Center-University Hospitals Cleveland Medical Center, OH
| | - Jane L Liesveld
- Strong Memorial Hospital - University of Rochester Medical Center, NY
| | | | | | - Walter Longo
- University of Wisconsin Hospital and Clinics, Madison, WI
| | | | - John M McCarty
- Virginia Commonwealth University Massey Cancer Center Bone Marrow Transplant Program, Richmond, VA
| | | | - Shahram Mori
- Florida Hospital Cancer Institute, Florida Center for Cellular Therapy, Orlando, FL
| | | | - Vinod K Prasad
- Duke Cancer Institute, Duke University Medical Center, Durham, NC
| | | | | | - Indira Sahdev
- Cohen Children's Medical Center of New York, New Hyde Park, NY
| | | | - George B Selby
- HCA Health Services of Oklahoma, Inc., University of Oklahoma, Oklahoma City, OK
| | | | - Shalini Shenoy
- Division of Hematology/Oncology, St. Louis Children's Hospital, MO
| | | | - William T Tse
- Ann & Robert H. Lurie Children's Hospital of Chicago, IL
| | | | - Madhuri Vusirikala
- Division of Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | | | - Willis H Navarro
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | - Galen E Switzer
- Division of General Internal Medicine, University of Pittsburgh, PA, USA
| | - Dennis L Confer
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN
- National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
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10
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Fabrizio V, Wahlquist A, Hill E, Williams E, Kramer C, Jaroscak J, Duong A, Garrett-Mayer E, Hudspeth M. The effect of bone marrow graft composition on pediatric bone marrow transplantation outcomes. Pediatr Transplant 2018; 22:e13287. [PMID: 30159974 PMCID: PMC8361848 DOI: 10.1111/petr.13287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 07/07/2018] [Accepted: 07/30/2018] [Indexed: 11/29/2022]
Abstract
Hematopoietic stem cell graft cellular composition has been generally accepted to impact outcomes. Recent studies question this hypothesis. We conducted a single-center retrospective study of sixty-one pediatric BMT recipients for malignant (68%) and nonmalignant diseases (32%) examining effects of graft composition on engraftment, acute GVHD, chronic GVHD, and survival at day 100 and 1 year. Grafts contained a median of 3.63 x 08 TNC/kg (range: 0.031-10.31 x 108 TNC/kg) and 4.09 x 106 CD34+ /kg (range: 0.76-24.15 x 106 CD34+ /kg) with median neutrophil and platelet engraftment times of 17 and 29 days, respectively. A univariate analysis showed a trend for increasing TNC and increasing time to neutrophil engraftment HR: 0.875; CI: 0.075-1.001). Increasing CD34+ counts shortened time to platelet engraftment (HR: 1.085; CI: 1.015-1.161). No significant relationship was found between TNC, CD34+ , or CD3+ and acute or chronic GVHD. TNC or CD34+ did not affect day 100, 1-year survival, or 2-year survival. Increasing CD3+ counts demonstrated a negative trend on day 100 survival (HR: 1.108; CI: 1.001-1.036) but not 1-year survival or 2-year survival. These results add additional data questioning the effect of graft composition on outcomes in pediatric BMT patients with important ramifications for the management of donors.
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Affiliation(s)
- Vanessa Fabrizio
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Amy Wahlquist
- Division of Biostatistics, Medical University of South Carolina, Charleston, South Carolina
| | - Elise Hill
- Medical University of South Carolina, Charleston, South Carolina
| | - Elizabeth Williams
- Blood and Marrow Transplant Program, Medical University of South Carolina, Charleston, South Carolina
| | - Cindy Kramer
- Blood and Marrow Transplant Program, Medical University of South Carolina, Charleston, South Carolina
| | - Jennifer Jaroscak
- Division of Pediatric Hematology/Oncology, Medical University of South Carolina, Charleston, South Carolina
| | - Angie Duong
- Department of Pathology, Medical University of South Carolina, Charleston, South Carolina
| | | | - Michelle Hudspeth
- Division of Pediatric Hematology/Oncology, Medical University of South Carolina, Charleston, South Carolina
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11
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Zomerdijk N, Turner JM, Hill GR. Adult-related haematopoietic stem cell donor experiences and the provision of information and psychosocial support: A systematic literature review. Eur J Cancer Care (Engl) 2018; 28:e12932. [PMID: 30277290 DOI: 10.1111/ecc.12932] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 08/26/2018] [Accepted: 08/31/2018] [Indexed: 01/12/2023]
Abstract
For blood cancer patients, haematopoietic stem cells (HSC) donated by a relative can be lifesaving. However, related donors can face significant physical and psychosocial challenges. As the demand for adult-related HSC donors is increasing, it is important to review our understanding of adult-related HSC donors' need for and availability of information and psychosocial support with a view to identifying gaps in the literature. A systematic review of relevant studies (2000-2017) was conducted using five databases with supplementary hand searching. Sixteen studies involving 1,024 related HSC donors met the following criteria: English or Dutch language, peer-reviewed, sampled first-time-related HSC donors, ≥18 years, haematological malignancies, assessed psychosocial aspects, retrospective or prospective and with or without comparison group. Data were abstracted, and study quality was assessed using the PRISMA criteria. Studies contained limited information on the provision of information and psychosocial support. Most studies addressed pre-donation information, and none reported providing information or support to donors post-donation. Additionally, few studies formally assessed unmet needs. Recommendations include improved transparency of reporting for the availability, sources and timing of information and psychosocial support, and the identification of unmet needs to enable the development of educational and psychosocial interventions for this invaluable donor population.
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Affiliation(s)
- Nienke Zomerdijk
- Faculty of Medicine, Mental Health Centre, University of Queensland, Brisbane, Qld, Australia.,Royal Brisbane & Women's Hospital, Brisbane, Qld, Australia.,Bone Marrow Transplantation Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Qld, Australia
| | - Jane M Turner
- Faculty of Medicine, Mental Health Centre, University of Queensland, Brisbane, Qld, Australia.,Royal Brisbane & Women's Hospital, Brisbane, Qld, Australia
| | - Geoffrey R Hill
- Faculty of Medicine, Mental Health Centre, University of Queensland, Brisbane, Qld, Australia.,Royal Brisbane & Women's Hospital, Brisbane, Qld, Australia.,Bone Marrow Transplantation Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Qld, Australia
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12
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Practical Aspects of Hematologic Stem Cell Harvesting and Mobilization. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00095-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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13
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[Non eligibility criteria for hematopoietic stem cell donors: Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)]. Bull Cancer 2017; 104:S76-S83. [PMID: 29173975 DOI: 10.1016/j.bulcan.2017.06.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 06/10/2017] [Indexed: 11/22/2022]
Abstract
The evolution of HLA typing and transplantation techniques makes it easier to identify a donor for hematopoietic stem cell (HSC) transplantation. This activity, strongly regulated by regulatory or normative texts, implies in addition biological, medical, para-medical and sometimes psychological evaluations. The benefit/risk discussion is complicated because it must take into account the benefit/risk ratio for the recipient, and the donor risk. No Evidence-Based Medicine data is available and serious events are very rare situations. Biovigilance declarations and their analysis are of fundamental importance. Certain obvious and definite contraindications could be detected very early in the process. It is important to assess whether a risk factor or pathology contributes to increasing the risk associated with collection. In case of recipient risk, the situation should be discussed with the patient team. These recommendations focus on adult peripheral blood HSC donors. They refer to donor information, confidentiality of exchanges, the impact of moral or material pressures, declarations of biovigilance, collegiality and traceability of difficult decisions, desirable experience and training for doctors in charge, use of expert advice informed by an explicit exchange on the possible risks, parsimony of therapeutic interventions and minimization of risks for the donor. We also recommend creation, availability and use by the community of tools and documents (registries, questionnaires, synthetic recommendations, feedback, and collegial qualification meetings) useful for practice.
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14
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Riezzo I, Pascale N, La Russa R, Liso A, Salerno M, Turillazzi E. Donor Selection for Allogenic Hemopoietic Stem Cell Transplantation: Clinical and Ethical Considerations. Stem Cells Int 2017; 2017:5250790. [PMID: 28680446 PMCID: PMC5478865 DOI: 10.1155/2017/5250790] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/03/2017] [Indexed: 11/18/2022] Open
Abstract
Allogenic hematopoietic progenitor cell transplantation (allo-HSCT) is an established treatment for many diseases. Stem cells may be obtained from different sources: mobilized peripheral blood stem cells, bone marrow, and umbilical cord blood. The progress in transplantation procedures, the establishment of experienced transplant centres, and the creation of unrelated adult donor registries and cord blood banks gave those without an human leucocyte antigen- (HLA-) identical sibling donor the opportunity to find a donor and cord blood units worldwide. HSCT imposes operative cautions so that the entire donation/transplantation procedure is safe for both donors and recipients; it carries with it significant clinical, moral, and ethical concerns, mostly when donors are minors. The following points have been stressed: the donation should be excluded when excessive risks for the donor are reasonable, donors must receive an accurate information regarding eventual adverse events and health burden for the donors themselves, a valid consent is required, and the recipient's risks must be outweighed by the expected benefits. The issue of conflict of interest, when the same physician has the responsibility for both donor selection and recipient care, is highlighted as well as the need of an adequate insurance protection for all the parties involved.
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Affiliation(s)
- Irene Riezzo
- Institute of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Ospedale “Colonnello D'Avanzo”, Viale Degli Aviatori, 1, 71122 Foggia, Italy
| | - Natascha Pascale
- Institute of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Ospedale “Colonnello D'Avanzo”, Viale Degli Aviatori, 1, 71122 Foggia, Italy
| | - Raffaele La Russa
- Istituto Clinico-Scientifico Malzoni, 83100 Avellino, Italy
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00185 Rome, Italy
| | - Arcangelo Liso
- Institute of Hematology, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
| | - Monica Salerno
- Institute of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Ospedale “Colonnello D'Avanzo”, Viale Degli Aviatori, 1, 71122 Foggia, Italy
| | - Emanuela Turillazzi
- Institute of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Ospedale “Colonnello D'Avanzo”, Viale Degli Aviatori, 1, 71122 Foggia, Italy
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15
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Polomeni A, Bompoint C, Gomez A, Brissot E, Ruggeri A, Belhocine R, Mohty M. Current practices for screening, consent and care of related donors in France: Haematopoietic stem cell transplantation coordinator nurses’ perceptions. Eur J Cancer Care (Engl) 2016; 26. [DOI: 10.1111/ecc.12612] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2016] [Indexed: 01/15/2023]
Affiliation(s)
- A. Polomeni
- Service d'Hématologie Clinique et thérapie cellulaire; Hôpital Saint Antoine; Assistance Publique-Hôpitaux de Paris; Paris France
| | - C. Bompoint
- Service d'Hématologie Clinique et thérapie cellulaire; Hôpital Saint Antoine; Assistance Publique-Hôpitaux de Paris; Paris France
| | - A. Gomez
- Service d'Hématologie Clinique et thérapie cellulaire; Hôpital Saint Antoine; Assistance Publique-Hôpitaux de Paris; Paris France
| | - E. Brissot
- Service d'Hématologie Clinique et thérapie cellulaire; Hôpital Saint Antoine; Assistance Publique-Hôpitaux de Paris; Paris France
| | - A. Ruggeri
- Service d'Hématologie Clinique et thérapie cellulaire; Hôpital Saint Antoine; Assistance Publique-Hôpitaux de Paris; Paris France
| | - R. Belhocine
- Service d'Hématologie Clinique et thérapie cellulaire; Hôpital Saint Antoine; Assistance Publique-Hôpitaux de Paris; Paris France
| | - M. Mohty
- Service d'Hématologie Clinique et thérapie cellulaire; Hôpital Saint Antoine; Assistance Publique-Hôpitaux de Paris; Paris France
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16
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Anderlini P. Sixty as the new forty: considerations on older related stem cell donors. Bone Marrow Transplant 2016; 52:15-19. [PMID: 27500950 DOI: 10.1038/bmt.2016.201] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 06/12/2016] [Accepted: 06/20/2016] [Indexed: 11/09/2022]
Abstract
The era of reduced-intensity allogeneic stem cell transplantation, with its emphasis on older patients, has created new challenges in the management of what is now an older related stem cell donor population. These donors are now on average no less than 10 years older than in the mid-1990s. Donors over 70 years of age are no longer isolated or exceptional cases. They may still be considered eligible for donation but many of them, based on the older age and their medical history, may no longer fully qualify as 'healthy' or 'normal'. The older the donor, the more likely that hematologic abnormalities, comorbidities and treated malignancies will complicate the picture. Assessing the risk-benefit ratio for both donor and recipient can now be more challenging than ever.
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Affiliation(s)
- P Anderlini
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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17
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Bitan M, van Walraven SM, Worel N, Ball LM, Styczynski J, Torrabadella M, Witt V, Shaw BE, Seber A, Yabe H, Greinix HT, Peters C, Gluckman E, Rocha V, Halter J, Pulsipher MA. Determination of Eligibility in Related Pediatric Hematopoietic Cell Donors: Ethical and Clinical Considerations. Recommendations from a Working Group of the Worldwide Network for Blood and Marrow Transplantation Association. Biol Blood Marrow Transplant 2016; 22:96-103. [DOI: 10.1016/j.bbmt.2015.08.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 08/12/2015] [Indexed: 11/27/2022]
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18
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Then SN. Pressure placed on paediatric haematopoietic stem cell donors: Views from health professionals. J Paediatr Child Health 2015; 51:1182-7. [PMID: 26059420 DOI: 10.1111/jpc.12934] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2015] [Indexed: 12/01/2022]
Abstract
AIM Paediatric haematopoietic stem cell donors undergo non-therapeutic procedures and endure known and unknown physical and psychosocial risks for the benefit of a family member. One ethical concern is the risk that they may be pressured by parents or health professionals to act as a donor. This paper adds to what is known about this topic by presenting the views of health professionals. METHODS This qualitative study involved semi-structured interviews with 14 health professionals in Australasia experienced in dealing with paediatric donors. Transcripts were analysed using established qualitative methodologies. RESULTS Health professionals considered that some paediatric donors experience pressure to donate. Situations that were likely to increase the risk of pressure being placed on donors were identified, and views were expressed about the ethical 'appropriateness' of these practices within the family setting. CONCLUSIONS Children may be subject to pressure from family and health professionals to be tested and act as donors, Therefore, our ethical obligation to these children extends to implementing donor-focused processes - including independent health professionals and the appointment of a donor advocate - to assist in detecting and addressing instances of inappropriate pressure being placed on a child.
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Affiliation(s)
- Shih-Ning Then
- Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, Queensland, Australia.,Law School, University of Sydney, Sydney, New South Wales, Australia
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19
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Anthias C, Shaw BE, Kiefer DM, Liesveld JL, Yared J, Kamble RT, D'Souza A, Hematti P, Seftel MD, Norkin M, DeFilipp Z, Kasow KA, Abidi MH, Savani BN, Shah NN, Anderlini P, Diaz MA, Malone AK, Halter JP, Lazarus HM, Logan BR, Switzer GE, Pulsipher MA, Confer DL, O'Donnell PV. Significant Improvements in the Practice Patterns of Adult Related Donor Care in US Transplantation Centers. Biol Blood Marrow Transplant 2015; 22:520-7. [PMID: 26597080 DOI: 10.1016/j.bbmt.2015.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 11/10/2015] [Indexed: 01/10/2023]
Abstract
Recent investigations have found a higher incidence of adverse events associated with hematopoietic cell donation in related donors (RDs) who have morbidities that if present in an unrelated donor (UD) would preclude donation. In the UD setting, regulatory standards ensure independent assessment of donors, one of several crucial measures to safeguard donor health and safety. A survey conducted by the Center for International Blood and Marrow Transplant Research (CIBMTR) Donor Health and Safety Working Committee in 2007 reported a potential conflict of interest in >70% of US centers, where physicians had simultaneous responsibility for RDs and their recipients. Consequently, several international organizations have endeavored to improve practice through regulations and consensus recommendations. We hypothesized that the changes in the 2012 Foundation for the Accreditation of Cellular Therapy and the Joint Accreditation Committee-International Society for Cellular Therapy and European Society for Blood and Marrow Transplantation standards resulting from the CIBMTR study would have significantly impacted practice. Accordingly, we conducted a follow-up survey of US transplantation centers to assess practice changes since 2007, and to investigate additional areas where RD care was predicted to differ from UD care. A total of 73 centers (53%), performing 79% of RD transplantations in the United States, responded. Significant improvements were observed since the earlier survey; 62% centers now ensure separation of RD and recipient care (P < .0001). This study identifies several areas where RD management does not meet international donor care standards, however. Particular concerns include counseling and assessment of donors before HLA typing, with 61% centers first disclosing donor HLA results to an individual other than the donor, the use of unlicensed mobilization agents, and the absence of long-term donor follow-up. Recommendations for improvement are made.
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Affiliation(s)
| | - Bronwen E Shaw
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Deidre M Kiefer
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
| | - Jane L Liesveld
- Department of Medicine, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Jean Yared
- Department of Medicine, Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Rammurti T Kamble
- Division of Hematology and Oncology, Baylor College of Medicine Center for Cell and Gene Therapy, Houston, TX, USA
| | - Anita D'Souza
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Peiman Hematti
- Division of Hematology/Oncology/Bone Marrow Transplantation, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Matthew D Seftel
- Department of Medical Oncology and Haematology, CancerCare Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Maxim Norkin
- Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | | | - Kimberly A Kasow
- Division of Hematology-Oncology, Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA
| | - Muneer H Abidi
- Department of Oncology, Spectrum Health, Michigan State University, Grand Rapids, MI, USA
| | - Bipin N Savani
- Division of Hematology/Oncology, Vanderbilt Medical Center, Nashville, TN, USA
| | - Nirali N Shah
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Paolo Anderlini
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Miguel A Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Adriana K Malone
- Tisch Cancer Institute, Mount Sinai Medical Center, New York, NY, USA
| | - Joerg P Halter
- Department of Hematology, University Hospital Basel, Switzerland
| | - Hillard M Lazarus
- Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Brent R Logan
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Galen E Switzer
- University of Pittsburgh, VA Medical Healthcare System, Pittsburgh, PA, USA
| | - Michael A Pulsipher
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital of Los Angeles, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Dennis L Confer
- National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
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20
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Anthias C, O'Donnell PV, Kiefer DM, Yared J, Norkin M, Anderlini P, Savani BN, Diaz MA, Bitan M, Halter JP, Logan BR, Switzer GE, Pulsipher MA, Confer DL, Shaw BE. European Group for Blood and Marrow Transplantation Centers with FACT-JACIE Accreditation Have Significantly Better Compliance with Related Donor Care Standards. Biol Blood Marrow Transplant 2015; 22:514-9. [PMID: 26597079 DOI: 10.1016/j.bbmt.2015.11.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 11/10/2015] [Indexed: 10/22/2022]
Abstract
Previous studies have identified healthcare practices that may place undue pressure on related donors (RDs) of hematopoietic cell products and an increase in serious adverse events associated with morbidities in this population. As a result, specific requirements to safeguard RD health have been introduced to Foundation for the Accreditation of Cellular Therapy/The Joint Accreditation Committee ISCT and EBMT (FACT-JACIE) Standards, but the impact of accreditation on RD care has not previously been evaluated. A survey of transplant program directors of European Group for Blood and Marrow Transplantation member centers was conducted by the Donor Health and Safety Working Committee of the Center for International Blood and Marrow Transplant Research to test the hypothesis that RD care in FACT-JACIE accredited centers is more closely aligned with international consensus donor care recommendations than RD care delivered in centers without accreditation. Responses were received from 39% of 304 centers. Our results show that practice in accredited centers was much closer to recommended standards as compared with nonaccredited centers. Specifically, a higher percentage of accredited centers use eligibility criteria to assess RDs (93% versus 78%; P = .02), and a lower percentage have a single physician simultaneously responsible for an RD and their recipient (14% versus 35%; P = .008). In contrast, where regulatory standards do not exist, both accredited and nonaccredited centers fell short of accepted best practice. These results raise concerns that despite improvements in care, current practice can place undue pressure on donors and may increase the risk of donation-associated adverse events. We recommend measures to address these issues through enhancement of regulatory standards as well as national initiatives to standardize RD care.
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Affiliation(s)
- Chloe Anthias
- Anthony Nolan Research Institute, London, United Kingdom.
| | | | - Deidre M Kiefer
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
| | - Jean Yared
- Department of Medicine, Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Maxim Norkin
- Division of Hematology/Oncology, University of Florida, Florida College of Medicine, Gainesville, FL, USA
| | - Paolo Anderlini
- The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Bipin N Savani
- Division of Hematology/Oncology, Vanderbilt Medical Center, Nashville, TN, USA
| | - Miguel A Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | | | - Joerg P Halter
- Department of Haematology, University Hospital Basel, Switzerland
| | - Brent R Logan
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Galen E Switzer
- University of Pittsburgh, VA Medical Healthcare System, Pittsburgh, PA, USA
| | - Michael A Pulsipher
- Children's Hospital of Los Angeles, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Dennis L Confer
- National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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21
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Worel N, Buser A, Greinix HT, Hägglund H, Navarro W, Pulsipher MA, Nicoloso de Faveri G, Bengtsson M, Billen A, Espino G, Fechter M, Giudice V, Hölig K, Kanamori H, Kodera Y, Leitner G, Netelenbos T, Niederwieser D, van Walraven SM, Rocha V, Torosian T, Vergueiro C, Weisdorf D, Yabe H, Halter JP. Suitability Criteria for Adult Related Donors: A Consensus Statement from the Worldwide Network for Blood and Marrow Transplantation Standing Committee on Donor Issues. Biol Blood Marrow Transplant 2015; 21:2052-2060. [PMID: 26271194 DOI: 10.1016/j.bbmt.2015.08.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 08/05/2015] [Indexed: 12/20/2022]
Abstract
The number of allogeneic hematopoietic stem cell (HSC) transplants performed globally each year continues to increase. Advances in HLA typing, better supportive care, and administration of reduced-intensity conditioning regimens allow treatment of older patients with older sibling donors. Pretransplant donor assessment and testing are very important processes affecting the quality and safety of donation. For unrelated HSC donors detailed recommendations for health assessment have been published, allowing donation only if they are unrestrictedly healthy. Eligibility criteria for related donors are less strict and vary significantly between centers. In situations where a family donor does not meet the suitability criteria for unrelated donors, involved physicians often struggle with the decision whether the matched relative is suitable for donation or not. On behalf of the Worldwide Network for Blood and Marrow Transplantation Standing Committee on Donor Issues, we intended to develop a consensus document with recommendations for donor workup and final clearance of family donors who would not be able to serve as unrelated donors because of their age or pre-existing diseases. This article covers different topics intending to support decision-making, with the goal of minimizing medical risk to the donor and protection of the recipient from transmissible diseases.
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Affiliation(s)
- Nina Worel
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria.
| | - Andreas Buser
- Blood Transfusion Centre, Swiss Red Cross, Basel, Switzerland; Department of Hematology, University Hospital Basel, Basel, Switzerland
| | | | - Hans Hägglund
- Division of Hematology, Department of Medical Sciences Uppsala University, Uppsala, Sweden
| | | | - Michael A Pulsipher
- Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute/University of Utah, Primary Children's Hospital, Salt Lake City, Utah
| | | | - Mats Bengtsson
- Tobias Registry of Swedish Bone Marrow Donors and Uppsala University, Department of Immunology, Genetics and Pathology, Uppsala, Sweden
| | | | - German Espino
- Department of Internal Medicine, Hematology and Bone Marrow Transplantation Section, University Hospital Caja del Seguro Social, Panama City, Panama
| | - Mirjam Fechter
- Europdonor Foundation Leiden, Leiden University Medical Centre, Leiden, The Netherlands
| | - Valeria Giudice
- Department of Immunohematology and Transfusion Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Kristina Hölig
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Heiwa Kanamori
- Department of Hematology, Kanagawa Cancer Center, Kanagawa, Japan
| | - Yoshihisa Kodera
- Asia-Pacific Blood and Marrow Transplantation Group and Department of Promotion for Blood and Marrow Transplantation, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Gerda Leitner
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
| | - Tanja Netelenbos
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Suzanna M van Walraven
- Europdonor Foundation Leiden, Leiden University Medical Centre, Leiden, The Netherlands; Ethics Working Group of the World Marrow Donor Association, Leiden, The Netherlands
| | - Vanderson Rocha
- Oxford University Hospitals NHS Trust, British Bone Marrow Donor Registry and Cord Blood Banks, NHS-BT, Oxford, United Kingdom
| | | | - Carmen Vergueiro
- FCM Santa Casa de São Paulo, Disciplina de Hematologia e Oncologia, São Paulo, Brasil
| | - Daniel Weisdorf
- Bone Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Hiromasa Yabe
- Department of Cell Transplantation and Regenerative Medicine, Tokai University School of Medicine, Tokyo, Japan
| | - Jörg P Halter
- Department of Hematology, University Hospital Basel, Basel, Switzerland
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22
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Stroncek DF, England L. Protecting the Health and Safety of Cell and Tissue Donors. ACTA ACUST UNITED AC 2015; 10:108-114. [PMID: 25937830 DOI: 10.1111/voxs.12150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Centers involved with collecting the starting material for cell and tissue therapies are obligated to protect the recipient's and donor's health and safety. All donors face risks during and after the collection which can be minimized by prescreening donors and excluding those that the collection would place at increased risk of physical harm. Another important part of protecting donors is the use of appropriate collection facilities. Donor risk can also be reduced by using specially designed collection devices and ancillary equipment, using only trained collection staff and limiting the volume or quantity of biologic material collected. Donors should be monitored during and after the collection for adverse events, and should adverse events occur, they should be promptly and appropriately treated. Protecting the safety of cell, gene and tissue donors is particularly difficult because of the wide variety in the types of donors and material collected. Biological material used to manufacture cell and tissue therapies is collected from healthy volunteers, matched-related, matched-unrelated and autologous donors. Precautions should be taken to ensure that the team of medical professionals evaluating related donors is not the same as the team caring for the transplant recipient in order to be sure that the donor evaluation is not biased and the donor is not coerced into donating. In conclusion, protecting cell and tissue donors requires the use of the practices developed to protect blood donors and the implementation of many other measures.
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Affiliation(s)
- David F Stroncek
- Cell Processing Section, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland USA
| | - Lee England
- Cell Processing Section, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland USA
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Being a haematopoietic stem cell donor for a sick sibling: Adult donors' experiences prior to donation. Eur J Oncol Nurs 2015; 19:529-35. [PMID: 25813531 DOI: 10.1016/j.ejon.2015.02.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 02/23/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is a lack of knowledge about sibling stem cell donors' experiences pre-donation and the waiting period before the donation might have been long. The donors and their corresponding sibling recipients were simultaneously included in two different interview studies. The results from the recipient study have been presented in a separate paper. PURPOSE The aim was to explore the experiences of being a stem cell donor for a sibling, prior to donation. METHOD Ten adult sibling donors were interviewed prior to stem cell donation. The interviews were digitally recorded, transcribed verbatim and subjected to qualitative content analysis. RESULTS The main theme Being a cog in a big wheel describes the complex process of being a sibling donor prior to donation, covering a mixture of emotions and thoughts. The four subthemes Being available, Being anxious, Being concerned and Being obliged cover the various experiences. The sibling donors' experiences are influenced by the quality of the relationship with the sick sibling. CONCLUSIONS Sibling stem cell donors go through a complex process once they have accidentally got involved in. They have been asked to become a donor; it was not a voluntary choice. In caring for sibling stem cell donors the nurses should be aware of the complexity of the process they experience and take into consideration their personal situation and needs. Providing optimal care for both sibling donors and their corresponding recipients is a challenge, and further improvement and exploration are needed.
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Related hematopoietic cell donor care: is there a role for unrelated donor registries? Bone Marrow Transplant 2015; 50:637-41. [PMID: 25730182 DOI: 10.1038/bmt.2015.15] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 12/28/2014] [Accepted: 12/31/2014] [Indexed: 11/08/2022]
Abstract
In almost half of allogeneic hematopoietic progenitor cell (HPC) transplants, a related donor (RD) is used, yet a lack of standardized guidelines means that their care is heterogeneous. Changes to regulatory standards aim to improve uniformity, but adherence to these regulations can prove logistically difficult for the transplant centers (TCs) managing RDs. Discussion has ensued around possible alternative models of related donor care and a session at the European Society for Blood and Marrow Transplantation (EBMT) annual meeting in 2013 debated the question of whether a role exists for unrelated donor registries in the management of 'related' donors. In this overview, we discuss the issues raised at this debate and the pros and cons of donor registry involvement in various aspects of RD management. By examining existing models of related donor care that have been adopted by members of the World Marrow Donor Association (WMDA), we look for ways to enhance and homogenize RD care, while also enabling transplant centers to meet standards required for mandatory accreditation.
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Anthias C, Ethell ME, Potter MN, Madrigal A, Shaw BE. The impact of improved JACIE standards on the care of related BM and PBSC donors. Bone Marrow Transplant 2014; 50:244-7. [DOI: 10.1038/bmt.2014.260] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 09/27/2014] [Accepted: 09/30/2014] [Indexed: 11/09/2022]
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Ross LF, Antommaria AHM. The need to promote all pediatric stem cell donors' understanding and interests. Pediatrics 2014; 133:e1356-7. [PMID: 24777208 PMCID: PMC8194466 DOI: 10.1542/peds.2014-0375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Lainie Friedman Ross
- Carolyn and Matthew Bucksbaum Professor of Clinical Ethics, Associate Director, MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago Illinois; and
| | - Armand H. Matheny Antommaria
- Lee Ault Carter Chair of Pediatric Ethics, Director, Ethics Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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27
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A review of the haematopoietic stem cell donation experience: is there room for improvement? Bone Marrow Transplant 2014; 49:729-36. [DOI: 10.1038/bmt.2013.227] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 11/29/2013] [Accepted: 12/02/2013] [Indexed: 11/08/2022]
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28
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Garcia MC, Chapman JR, Shaw PJ, Gottlieb DJ, Ralph A, Craig JC, Tong A. Motivations, Experiences, and Perspectives of Bone Marrow and Peripheral Blood Stem Cell Donors: Thematic Synthesis of Qualitative Studies. Biol Blood Marrow Transplant 2013; 19:1046-58. [DOI: 10.1016/j.bbmt.2013.04.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 04/12/2013] [Indexed: 11/16/2022]
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29
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Potential adult sibling stem cell donors’ perceptions and opinions regarding an information and care model. Bone Marrow Transplant 2013; 48:1133-7. [DOI: 10.1038/bmt.2012.283] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 10/12/2012] [Accepted: 12/18/2012] [Indexed: 12/29/2022]
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We have a specific duty to maximise the safety of related donors. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2012; 10:407-10. [PMID: 22871822 DOI: 10.2450/2012.0042-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 06/26/2012] [Indexed: 11/21/2022]
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Screening of related donors and peripheral blood stem cell collection practices at different Italian apheresis centres. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2012; 10:440-7. [PMID: 22871823 DOI: 10.2450/2012.0140-11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 01/17/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND Recommendations on eligibility criteria for donation of haematopoietic stem cells, management of collection of the cells and follow-up mainly concern unrelated donors. The aim of this study was to analyse the screening of related donors and collection practices at different Italian apheresis centres. MATERIALS AND METHODS A questionnaire regarding eligibility criteria for related haematopoietic stem cell donors, their peripheral blood collections and early follow-up was sent to several apheresis units. Data from the full charts of 500 candidates, screened between May 2005 and December 2009, were retrospectively evaluated. RESULTS The donors' records, eligibility criteria, collections and follow-up are managed differently in each centre. Of the 500 evaluable candidates (51.2% male, 49.8% female; median age 47 years, range 13-77), 26.4% underwent thorough screening according to Italian Bone Marrow Donor Registry standards, while local protocols were applied to 73.6%; 91 candidates (18.2%) proved ineligible for donation. In the end, 352 donors (53.4% male, 46.6% female; median age 45 years, range 16-76) underwent 508 leukaphereses. Central venous catheters were used in 8.0% of donors, mainly in one centre. Unsuitable pre-apheresis peripheral blood parameters were reported in 38.7% of the aphereses. Leukapheresis-related adverse events were recorded in 23.0% of the procedures, with a drop-out rate of 0.2% for severe events. No donation-related fatalities occurred. The CD34+ cell yield was <2×10(6)/kg of recipient's body weight from 1.1% of donors ≥70 years old. DISCUSSION More uniformity in donor screening procedures, management of peripheral blood collection and follow-up should be planned at a national level to maximise the safety of related donors.
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Halter JP, van Walraven SM, Worel N, Bengtsson M, Hägglund H, Nicoloso de Faveri G, Shaw BE, Schmidt AH, Fechter M, Madrigal A, Szer J, Aljurf MD, Weisdorf D, Horowitz MM, Greinix H, Niederwieser D, Gratwohl A, Kodera Y, Confer D. Allogeneic hematopoietic stem cell donation-standardized assessment of donor outcome data: a consensus statement from the Worldwide Network for Blood and Marrow Transplantation (WBMT). Bone Marrow Transplant 2012; 48:220-5. [PMID: 22773129 DOI: 10.1038/bmt.2012.119] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The number of allogeneic hematopoietic SCTs performed globally each year continues to increase, paralleled by an increased demand for donors of therapeutic cells. Donor characteristics and collection procedures have undergone major changes during recent decades, and further changes are foreseen. Information on short- and long-term donor outcomes is of crucial importance to ensure maximal donor safety and availability. Current data, predominantly from unrelated donors, give reliable information on the frequent early events associated with donation-most of them of mild-to-moderate intensity. Information on the type and relative risk of serious adverse reactions is more limited. Moreover, only few data exist on long-term donor outcome. On the basis of this need, recommendations for a minimum data set for prospective donor follow-up were developed in a workshop with the participation of an international group of investigators actively involved in allogeneic stem cell donation under the auspices of and approved by the Worldwide Network for Blood and Marrow Transplantation. Establishment of a standardized global follow-up for both, related and unrelated, donors will enable monitoring of the short- and long-term safety profiles of hematopoietic cell donation and form a solid basis for future donor selection and counseling.
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Affiliation(s)
- J P Halter
- Department of Hematology, University Hospital Basel, Basel, Switzerland.
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van Walraven SM, Straathof LM, Switzer GE, Lankester A, Korthof ET, Brand A, Ball LM. Immediate and long-term somatic effects, and health-related quality of life of BM donation during early childhood. A single-center report in 210 pediatric donors. Bone Marrow Transplant 2012; 48:40-5. [PMID: 22705802 DOI: 10.1038/bmt.2012.102] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Since 1968, when Leiden undertook the first successful European pediatric BM transplantation with a 7-year-old sibling donor, more than 300 young children have donated BM in our unit. We first retrospectively studied a cohort of 210 donors, younger than 13 years at donation, to survey procedures of donor eligibility and study immediate effects of BM donation. We then performed a long-term follow-up (FU) and health-related quality of life (HRQoL) study. Despite documentation of previous medical conditions, no child was declared unfit to donate. We found that iron deficiency anemia or low-iron stores in BM did not result in treatment or extended FU. Harvest volumes exceeded 15 mL/kg in 65% of donors, with more than half requiring allogeneic blood transfusions. Donors had no structured FU after their first post-donation control. In this study, 25% of donors reported at least one somatic complaint at long-term FU. Finally long-term HRQoL revealed high scores in most subdomains (representing a higher QoL), compared to norm groups. These results indicate the need for development of (inter)national guidelines for pediatric stem cell donor care management.
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Affiliation(s)
- S M van Walraven
- Department of Pediatric SCT, Leiden University Medical Centre, Leiden, The Netherlands.
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Stroncek D, McCullough J. Safeguarding the long-term health of hematopoietic stem cell donors: a continuous and evolving process to maintain donor safety and trust. Expert Rev Hematol 2012; 5:1-3. [PMID: 22272697 DOI: 10.1586/ehm.11.78] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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35
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Amrein K, Valentin A, Lanzer G, Drexler C. Adverse events and safety issues in blood donation--a comprehensive review. Blood Rev 2011; 26:33-42. [PMID: 21996651 DOI: 10.1016/j.blre.2011.09.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Although blood donation is generally safe, a variety of risks and complications exist, the most common being iron deficiency, vasovagal reactions and citrate-related events. In the last decades, extensive efforts have significantly improved recipient and product safety, but there is still great potential to optimise donor care. Many therapies in modern medicine depend on the prompt availability of blood products, therefore it is crucial to maintain a motivated and healthy donor pool in view of a limited number of healthy volunteers willing and able to give blood or blood components. We present a comprehensive review on adverse events addressing all types of blood donation including whole blood, plasma, platelet, peripheral blood stem cell, leucocyte and bone marrow donation. In addition, we outline strategies for the prevention and treatment of these events and give a blueprint for future research in this field.
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Affiliation(s)
- Karin Amrein
- Medical University of Graz, Department of Internal Medicine, Auenbruggerplatz 15, 8036 Graz, Austria.
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36
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Joffe S, Kodish E. Protecting the rights and interests of pediatric stem cell donors. Pediatr Blood Cancer 2011; 56:517-9. [PMID: 21298734 DOI: 10.1002/pbc.23028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 12/16/2010] [Indexed: 11/09/2022]
Affiliation(s)
- Steven Joffe
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts 02215, USA.
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37
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Ross LF. In defense of the American Academy of Pediatrics policy statement--children as hematopoietic stem cell donors. Pediatr Blood Cancer 2011; 56:520-3. [PMID: 21298735 DOI: 10.1002/pbc.23027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 12/16/2010] [Indexed: 11/06/2022]
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38
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Revera GH, Frangoul H. A parent's point of view on the American Academy of Pediatrics policy statement: Children as hematopoietic stem cell donors. Pediatr Blood Cancer 2011; 56:515-6. [PMID: 21298733 DOI: 10.1002/pbc.23029] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 12/16/2010] [Indexed: 11/08/2022]
Affiliation(s)
- Greg H Revera
- Leo & Brooks, LLC, 200 Randolph Avenue Huntsville, AL 35801, USA
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40
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van Walraven SM, Ball LM, Koopman HM, Switzer GE, Ropes-de Jong CMH, de Jong A, Bredius RGM, Egeler RM. Managing a dual role-experiences and coping strategies of parents donating haploidentical G-CSF mobilized peripheral blood stem cells to their children. Psychooncology 2010; 21:168-75. [DOI: 10.1002/pon.1885] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 10/18/2010] [Accepted: 10/18/2010] [Indexed: 11/09/2022]
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Abstract
In the past half-century, hematopoietic stem cell transplantation has become standard treatment for a variety of diseases in children and adults, including selected hematologic malignancies, immunodeficiencies, hemoglobinopathies, bone marrow failure syndromes, and congenital metabolic disorders. There are 3 sources of allogeneic hematopoietic stem cells: bone marrow, peripheral blood, and umbilical cord blood; each has its own benefits and risks. Children often serve as hematopoietic stem cell donors, most commonly for their siblings. HLA-matched biological siblings are generally preferred as donors because of reduced risks of transplant-related complications as compared with unrelated donors. This statement includes a discussion of the ethical considerations regarding minors serving as stem cell donors, using the traditional benefit/burden calculation from the perspectives of both the donor and the recipient. The statement also includes an examination of the circumstances under which a minor may ethically participate as a hematopoietic stem cell donor, how the risks can be minimized, what the informed-consent process should entail, the role for a donor advocate (or some similar mechanism), and other ethical concerns. The American Academy of Pediatrics holds that minors can ethically serve as stem cell donors when specific criteria are fulfilled.
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