The Concentration of Total Nucleated Cells in Harvested Bone Marrow for Transplantation Has Decreased over Time

Abstract

Bone marrow (BM) is an essential source of hematopoietic stem cell grafts for many allogeneic hematopoietic cell transplant (HCT) recipients, including adult patients (for specific diseases and transplantation strategies) and the majority of pediatric recipient. However, since the advent of granulocyte colony-stimulating factor-mobilized peripheral blood stem cell (PBSC) grafts, there has been a significant decrease in the use of BM in HCT, thought to be due mainly to the increased logistical challenges in harvesting BM compared with PBSCs, as well as generally no significant survival advantage of BM over PBSCs. The decreased frequency of collection has the potential to impact the quality of BM harvests. In this study, we examined >15,000 BM donations collected at National Marrow Donor Program centers between 1994 and 2016 and found a significant decline in the quality of BM products, as defined by the concentration of total nucleated cells (TNCs). The mean TNC concentration in BM donations dropped from 21.8 £ 10 6 cells/mL in the earliest era (1994 to 1996) to 18.7 £ 10 6 cells/mL in the most recent era (2012 to 2016) (means ratio, .83; P < .001). This decline in BM quality was seen despite the selection of more donors perceived to be optimal (eg, younger and male). Multivariate regression analysis showed that highervolume centers (performing >30 collections per era) had better-quality harvests with higher concentrations of TNCs collected. In conclusion, we have identified a significant decrease in the quality of BM collections over time, and lower-volume collection centers had poorer-quality harvests. In this analysis, we could not elucidate the direct cause for this finding, suggesting the need for further studies to investigate the key factors responsible and to explore the impact on transplant recipients.

The impact of donor total estimated blood volume on nucleated cell yield in bone marrow harvests for hematopoietic stem cell transplantation

“…On the other side, Oliver et al 12 found no cell yield difference between single and multiple entry points while noticing fewer postprocedure complications with a single‐entry method. In addition, the cell yields of our donors were exactly within the average observed across all participating NMDP programs 6 . We agree that there is space for future research to further improve on procedure methodology.…”

“…In addition, the cell yields of our donors were exactly within the average observed across all participating NMDP programs. 6 We agree that there is space for future research to further improve on procedure methodology.…”

“…Nevertheless, marrow remains the preferred stem cell source for specific diagnoses like aplastic anemia, for pediatric patients, and for situations in which chronic graft versus host disease remains an important concern 2–5 . Fewer centers are available today that perform at least 30 marrow collections per year, a quality threshold identified by Prokopishyn et al 6 in a recent review of 15,000 marrow collections in centers affiliated with the National Marrow Donor Program (NMDP). Other markers to predict marrow stem cell product quality, measured as total nucleated cell (TNC) concentration per ml of marrow, include donor characteristics like age, weight, body mass index (BMI) and baseline white blood cell (WBC) and blood platelet counts, technical procedure aspects like the kind of aspiration needle used, the volume of individual aspirations, and—finally—the total volume of marrow collected 7–12 …”

Stem cell donor registry activities during the COVID-19 pandemic: a field report by DKMS

“…3). The corresponding values for donations from DKMS Germany donors were almost identical, namely 21.2% (CW 2-12) and 30.5% (CW [13][14][15][16][17][18][19][20][21][22][23][24][25]. The reason for this observation is most probably due to actual or presumed simpler logistics associated with a domestic donation in the crisis situation (see paragraph Transport of stem cell products).…”

“…1; Table 1). Corresponding values for DKMS Germany donors were 113.2/week (CW 2-12) and 97.5/week (CW [13][14][15][16][17][18][19][20][21][22][23][24][25], indicating a 13.8% decrease. Even though the beginning of the crisis was somewhat arbitrarily defined for this analysis, it reflects the significant drop in collections from CW 12 (March [16][17][18][19][20][21][22] to CW 13 (March 23-29).…”