Effect of Aging and Predonation Comorbidities on the Related Peripheral Blood Stem Cell Donor Experience: Report from the Related Donor Safety Study

Abstract

A B S T R A C TThe development of reduced-intensity approaches for allogeneic hematopoietic cell transplantation has resulted in growing numbers of older related donors (RDs) of peripheral blood stem cells (PBSCs). The effects of age on donation efficacy, toxicity, and long-term recovery in RDs are poorly understood. To address this we analyzed hematologic variables, pain, donation-related symptoms, and recovery in 1211 PBSC RDs aged 18 to 79 enrolled in the Related Donor Safety Study. RDs aged > 60 had a lower median CD34 + level before apheresis compared with younger RDs (age > 60, 59 £ 10 6 /L; age 41 to 60, 81 £ 10 6 /L; age 18 to 40, 121 £ 10 6 /L; P < .001). This resulted in older donors undergoing more apheresis procedures (49% versus 30% 2 collections, P < .001) and higher collection volumes (52% versus 32% > 24 L, P < .001), leading to high percentages of donors aged > 60 with postcollection thrombocytopenia <50 £ 10 9 /L (26% and 57% after 2 and 3 days of collection, respectively). RDs aged 18 to 40 had a higher risk of grades 2 to 4 pain and symptoms pericollection, but donors over age 40 had more persistent pain at 1, 6, and 12 months (odds ratio [OR], 1.7; P = 0.02) and a higher rate of nonrecovery to predonation levels (OR, 1.7; P = .01). Donors reporting comorbidities increased significantly with age, and those with comorbidities that would have led to deferral by National Marrow Donor Program unrelated donor standards had an increased risk for persistent grades 2 to 4 pain (OR, 2.41; P < .001) and failure to recover to predonation baseline for other symptoms (OR, 2.34; P = .004). This information should be used in counseling RDs regarding risk and can assist in developing practice approaches aimed at improving the RD experience for high-risk individuals.

Higher Risks of Toxicity and Incomplete Recovery in 13- to 17-Year-Old Females after Marrow Donation: RDSafe Peds Results

“…G-primed BM numbers were also low (n = 8), with 2 donors reporting grade 2-4 pain and 3 donors reporting grade 2-4 toxicities postdonation (data not shown). Of note, among PBSC donors age 18 to 25 years in the RDSafe study, 48% experienced grade 2-4 pain and 18% had MTC toxicity [18], and earlier studies have shown increasing side effects with PBSC donation with age [2,3], so our small PBSC donor population is likely not fully reflective of the experience of older children who donate PBSCs.…”

Supportive Care of Hematopoietic Stem Cell Donors

“…Donors older than 40 years of age and donors with co-morbidities are more likely to report persistent pain at 1, 3 or 12 months after the procedure, or a failure to return to a pre-donation level of wellness. 44 Equally, longer recovery times are experienced by donors who report psychosocial challenges in their health-related quality of life surveys beforehand. 45 Particularly, related donors may describe a failure to return to a baseline quality of life or protracted discomfort twelve months after the donation.…”