Modeling unrelated blood stem cell donor recruitment using simulated registrant cohorts: Assessment of <scp>human leukocyte antigen</scp> matching across ethnicity groups

Blake, John T.; Parmar, Gaganvir; Ganz, Kathy; Seftel, Matthew D.; Allan, David S.

doi:10.1111/trf.17310

Cited by 3 publications

(1 citation statement)

References 19 publications

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“…Our analysis also highlights the importance of prospective transplant center analyses of URD procurement and not relying on modeling and a pure focus on HLA match and other donor demographics such as age. 32 , 33 , 34 , 35 , 36 Now that mismatched URDs are feasible, donor availability becomes 1 of the highest priorities in URD selection. Furthermore, our study not only emphasizes the importance of real-world data but also begs the question of how many patients by recipient ancestry develop disease progression precluding transplantation during lengthy URD searches and whose responsibility it is to abandon futile URD searches.…”

Section: Discussionmentioning

confidence: 99%

Racial/ethnic disparities in availability of volunteer unrelated donors for allogeneic transplantation

Fingrut,

Davis,

Archer

et al. 2024

Blood Advances

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Despite the global unrelated donor (URD) registry size, the degree to which URD availability is a transplant barrier is not established. We evaluated the availability of 3,843 URDs requested for 455 diverse adult patients (predominantly with acute leukemia). URDs for non-Europeans were more likely to be domestic and had markedly lower Donor Readiness Scores. Of URDs requested for confirmatory HLA-typing (CT) alone (i.e. without simultaneous workup), 1,894/3,529 (54%) were available. Availability of domestic URDs was 45%. Donor Readiness Score was highly predictive of CT availability. Compared with Europeans (n=335), more non-European patients (n=120) had >10 URDs requested and <5 available. Of workup requests (after CT or CT-workup), <70% (604/889, 68%) were available. More non-Europeans had <2 URDs available. URD availability for CT was markedly worse for non-Europeans, with availabilities for African, non-Black Hispanic, and Asian patients of 150/458 (33%), 120/258 (47%) and 119/270 (44%), respectively, with further decrements in URD workup availability. Our data suggest the functional size of the URD pool is much smaller than appreciated, mandating major operational changes for transplant Centers and donor registries. Likelihood of donor availability should have a high priority in donor selection. Considering patient ancestry and URD Donor Readiness Scores, Centers should pursue, and registries permit, simultaneous pursuit of many URDs, and abandon futile searches. Patients should be informed about their likelihood of donor availability and alternative options. Finally, while registries should address high URD attrition and speed procurement, use of all HLA-disparate graft types is needed to facilitate timely transplantation for all.

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Section: Discussionmentioning

confidence: 99%

Racial/ethnic disparities in availability of volunteer unrelated donors for allogeneic transplantation

Fingrut,

Davis,

Archer

et al. 2024

Blood Advances

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Recruiting blood donors to the Canadian Blood Services Stem Cell Registry: A feasibility assessment

Parmar,

Green,

Ganz

et al. 2024

Transfusion

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BackgroundAllogeneic hematopoietic cell transplantation remains limited when stem cell registrants cannot be contacted, are not medically fit, are unavailable, or unwilling to proceed. In a recent report, registrants who were prior blood donors were more likely to be available for donation. In this study, we analyzed extent to which recruiting blood donors to the Canadian Blood Services Stem Cell Registry (CBS SCR) can meet targets for ethnic diversity, age, and proximity to collection facilities.Methods and ResultsWe analyzed 124,496 active blood donors on July 1, 2023 regarding the criteria for recruitment to the CBS SCR. A total of 40,518 (32%) were younger than 36 years of age and 49% were first‐time donors (potential new recruits year over year). The ethnicity of blood donors younger than 36 years aligns more closely with the 2021 Canadian census compared to stem cell donors who were also previous blood donors, and to the current total inventory of all registrants on the CBS SCR. Of the blood donors, certain ethnic groups, including Black, Chinese, and First Nations/Indigenous, remain underrepresented. A greater proportion of active whole blood donors live within 400 km of a stem cell collection center (91%) compared to stem cell donors who donated during the past 10 years (80%).ConclusionsRecruitment of blood donors offers an opportunity to improve the ethnic diversity of the CBS SCR and increase proximity of registrants to stem cell collection centers. The potential improved availability of registrants when matched to patients requires confirmation.

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Determining the impact of current Canadian stem cell registry policy on donor availability via dynamic registry simulation

Blake,

Ganz,

Seftel

et al. 2024

Vox Sanguinis

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Background and ObjectivesWhen a haematopoietic stem cell registry size is constrained by limits on recruiting, as in Canada, identifying the right person to recruit is a critical determinant of effectiveness. The aim of this study was to evaluate the impact of changes to donor recruitment effort, within ethnic groups, on the matching effectiveness of the Canadian registry as it evolves over time.Materials and MethodsSimulation methods are applied to create a cohort of donor recruits and patients over a 10‐year time horizon. New recruits are added to the registry each year, while some existing donors ‘age‐out’ upon reaching their 36th birthday. In a similar fashion, simulated patient lists are created. At the end of each simulated year, simulated patients are matched against the simulated registry.ResultsThere are increased matches in non‐White populations when diverse registrants are preferentially recruited, but there are larger decreases in the number of matches for Caucasian patients. Additionally, ethnic communities that have limited registrants in the Canadian registry in 2021 do not benefit from increased recruiting efforts as much as communities with a larger initial number of registrants.ConclusionPreferentially recruiting from non‐Caucasian populations reduces the number of matches from Canadian sources because increases in non‐Caucasian populations will not fully counterbalance decreases to Caucasian patient matches. Nevertheless, more than 80% of all matches are for Caucasian patients, regardless of the donor recruiting effort within ethnic groups.

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Modeling unrelated blood stem cell donor recruitment using simulated registrant cohorts: Assessment of human leukocyte antigen matching across ethnicity groups

Cited by 3 publications

References 19 publications

Racial/ethnic disparities in availability of volunteer unrelated donors for allogeneic transplantation

Racial/ethnic disparities in availability of volunteer unrelated donors for allogeneic transplantation

Recruiting blood donors to the Canadian Blood Services Stem Cell Registry: A feasibility assessment

Determining the impact of current Canadian stem cell registry policy on donor availability via dynamic registry simulation

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