The importance of identifying a back-up donor for unrelated stem cell transplantation

Abstract

Summary:The importance of identifying a back-up donor, once a primary suitable unrelated stem cell donor has been found, is often underestimated. Transplant centres erroneously count on the unrelated volunteer donors to be willing, available and medically fit for actual donation. According to our data, which includes 502 unrelated donor work-up procedures performed for 425 Dutch patients between 1987 and 2002, one of 11 work-ups ended in the primary requested donor failing to donate. Of all donor-related cancellations (N ¼ 46), 78% of the procedures were deferred due to medical reasons and 22% due to nonmedical reasons. Most of the donors deferred for medical reasons were female (P ¼ 0.005). In 50% of the cases for which a back-up donor was already identified, the patients were transplanted with a delay of less then 2 weeks; when no back-up donor was available, the median delay increased to 18 weeks. We strongly encourage implementing a search for at least one back-up donor in the primary search. Identifying a back-up donor can save precious time and complicated logistic rescheduling.

How to improve the search for an unrelated haematopoietic stem cell donor. Faster is better than more!

“…Moreover, if possible a back-up donor was selected, who was used in case the best donor failed to donate. 15 Then the work-up of the chosen donor was started.…”

Hematopoietic Stem Cell Donor Selection: the Europdonor Experience

“…Next to the preferred donor a second donor is selected to function as a backup in case the preferred donor is unable or unwilling to donate. The reason for this is that almost 10% of donors are canceled during the workup procedure [18]. If a backup donor was available, the patient was transplanted with a delay of less than 2 weeks; when no backup donor was available, the median delay increased to 18 weeks.…”

Eleven million donors in Bone Marrow Donors Worldwide! Time for reassessment?

“…19 Another way to effectively prevent delay before the transplant is the back-up donor. Van Walraven et al 28 have shown that if a back-up donor is available, delay to transplant is only 7 days if the first choice donor is unable to donate, while without a back-up donor it is on average 79 days ( Table 2). Note that 11% of the first choice donors can in the end not donate!…”