Related peripheral blood stem cell donors experience more severe symptoms and less complete recovery at one year compared to unrelated donors

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

Donor Clonal Hematopoiesis and Recipient Outcomes After Transplantation

“…We sequenced 46 genes mutated recurrently in CH and myeloid malignancies (Data Supplement). 5,6,[19][20][21] We included samples with average unique molecular identifierdeduplicated consensus coverage of at least 1,0003 and considered all variants with a variant allele fraction (VAF) $ 0.005. We classified variants as pathogenic on the basis of published genetic criteria.…”

“…Although HLA-matched adult donors can be identified in the NMDP registry for 75% of White patients, far fewer patients of color will find matched donors (16%-19% of African Americans, 33%-42% of Asian Americans, and 34%-40% of Hispanic Americans). 5 The best available graft for many patients may thus be from an older donor such as an HLA-identical sibling or haploidentical relative, 6 , 7 highlighting the importance of understanding characteristics of older donors that influence recipient outcomes.…”

Physical and Psychological Discomfort Experienced by Hematopoietic Stem-Cell Donors

“…The present study also found that 35.1% of donors reported disruption to their daily lives due to physical discomfort. Some donors experienced pain up to one year after donation [17]. Healthcare providers should conduct risk assessments of the donors to identify high-risk donors who require special follow-up monitoring or self-management [14].…”

Assessing the cognition, attitudes and intentions of volunteers regarding unrelated peripheral blood stem cell donation: The UPBSC-DQ instrument in Chinese

“…For other patients, the only available option is an unrelated HLA-matched donor that can be identified through volunteers [ 5 ]. Michael et al’s study (2019) showed that related PBSC donors are at increased risk for donation-related toxicities compared with unrelated donors one year after donation [ 6 ]. However, the likelihood of finding such donors is low because of insufficient or nonexistent national donor programmes in many developing countries [ 7 ].…”