Probability of Finding Marrow Unrelated Donor (MUD) for an Indian patient in a Multi-national Human Leukocyte Antigen (HLA) Registry

Abstract

With an increase in the number of transplants happening globally, hematopoietic stem cells (HSC) transplantation from matched unrelated donor (MUD) has begun. The increasing trend of MUD transplants across countries has been largely facilitated with the conspicuous growth of volunteer HSC donor noted in the last decade i.e. 8 million HSC donors in 2002 to more than 22 million in 2013 registered in 71 member registries of the Bone Marrow Donor Worldwide (BMDW). Some populations of the world are still very poorly represented in these registries. Since, the chances of successful engraftment and disease free survival are directly proportional to the HLA compatibility between the recipient and the prospective donor, the diversity of the HLA system at the antigenic and allelic level and the heterogeneity of HLA data of the registered donors has a bearing on the probability of finding a volunteer unrelated HSC donor for patients from such populations. In the present study 126 patients were identified suffering from hematological diseases requiring MUD transplant. Their HLA typing was performed and search was done using BMDW database. The search results for these Indian patients in the multinational registry as well as in the Indian Registries were analyzed using mean, range, standard deviation and finally evaluated in terms of probability for finding matched donor (MUD). Total Asian population is only 11 % in the BMDW making it difficult to find a MUD for an Asian patient. The current study supports this, experimentally; revealing that the probability of finding an allele match for an Indian patient in the multinational Human Leukocyte Antigen (HLA) registries is 16 % and a dismal 0.008 % in the Indian registries (donors in Indian registries is just 33,678 as compared to 22.5 million in BMDW). This greatly, emphasizes on enhancing the number of Indian donors in Indian and multi-national registries.

Myeloablative haploidentical t‐cell replete hematopoietic cell transplantation with post‐transplant cyclophosphamide in high‐risk hematological malignancies: Bending the learning curve in a middle‐income setting

“…Allogeneic hematopoietic cell transplant is an important strategy for the curative treatment of high‐risk hematological malignancies 1 . A matched‐related donor (MRD), the first choice, is available only in 20%‐30% cases 2,3 . Probability of Indian patients finding a donor from worldwide marrow registries, is less than 10%.…”

“…Probability of Indian patients finding a donor from worldwide marrow registries, is less than 10%. Similarly, accredited public cord blood banking facilities are very few in India 2,4,5 . In such circumstances, haploidentical donor(HID) Allogeneic‐hematopoietic cell transplant (Allo‐HCT) is a valuable and often the only treatment option, for patients with high‐risk hematological malignancies 5‐7 .…”

Matched unrelated donor hematopoietic progenitor cell transplantation: A report based on a single registry in India

“…Because ethnicity plays a major role in identifying a suitable MUD for subsequent successful HPCT [4] , finding an HLA-matched donor in India is difficult due to its large patient population and vast ethnic diversity. A study published in 2014 revealed that the probability of finding an HLA match for an Indian patient from all the accessible global registry data was 16%; however the probability of finding a match from the Indian registries was a dismal 0.008% (donors in Indian registries were only 33,678 in 2014 compared with 22.5 million in a global HLA database called Bone Marrow Donor Worldwide) [5] . In 2008, a report revealed that 1540 Bone Marrow Transplants (BMTs) were performed at six BMT centers between 1986 and 2006 across India, but no record for MUD was available [6] .…”

A guide to organize voluntary stem cell donors recruitment drive for hematopoietic progenitor stem cell transplant

“…These significantly emphasizing on enhancing the number of Indian donors in both Indian and global registries. [5] In another study in 2014 reveals in a group of 18,000 donors, only 19% of patients found a MUD at 10/10 low-resolution level. The chances of finding a donor at high-resolution 10/10 level were even less.…”