Unrelated Donor Hematopoietic Cell Transplantation: Factors Associated with a Better HLA Match

Dehn, Jason; Arora, Mukta; Spellman, Stephen R.; Setterholm, Michelle; Horowitz, Mary; Confer, Dennis L.; Weisdorf, DJ

doi:10.1016/j.bbmt.2008.09.009

Cited by 46 publications

(38 citation statements)

References 15 publications

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“…These differences indicate a lack of HLA-matched donors for African Americans, as has been previously reported. [39][40][41] According to data reported by the National Marrow Donor Program (NMDP), the likelihood of finding an HLA-A, -B, -C and -DRB1 high-resolution matched unrelated donor is 75% for whites, but only 19% for African Americans. 42 This difference is attributed not only to a smaller donor pool but also to a greater degree of HLA polymorphisms with large numbers of HLA haplotypes specific to blacks, as well as a higher donor attrition rate from the NMDP registry.…”

Section: Discussionmentioning

confidence: 99%

Racial differences in allogeneic hematopoietic cell transplantation outcomes among African Americans and whites

Hamilton

Rybicki

Sekeres

et al. 2015

Bone Marrow Transplant

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The impact of race on outcome has been identified in a number of cancers, with African Americans having poorer survival compared with whites. We conducted a study to investigate the association of race with allogeneic hematopoietic cell transplant (HCT) outcomes. We identified 789 patients (58 African Americans and 731 whites) who underwent allogeneic HCT for hematologic disorders. There were no significant differences between African Americans and white patients in gender, performance status or comorbidity score. However, African Americans were younger than whites (median 40 years versus 47 years, P = 0.003) and were more likely to be in remission at HCT (74% versus 57%, P = 0.011), to have an HLA-mismatched donor (36% versus 14%, P o 0.001), to have positive donor or recipient CMV serostatus (90% versus 69%, P o 0.001) and to have received a cord blood transplant (21% versus 6%, Po 0.001). In univariate analysis, African Americans had worse overall survival (OS) (HR 1.41, P = 0.026) compared with whites, with no significant differences in acute or chronic GvHD, non-CMV infection or relapse. However, after adjusting for several transplant and disease-related factors in multivariate analysis, the OS difference between African Americans and whites became nonsignificant (HR 1.27, P = 0.18). These results suggest that race in and of itself does not lead to worse survival post HCT.

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Section: Discussionmentioning

confidence: 99%

Racial differences in allogeneic hematopoietic cell transplantation outcomes among African Americans and whites

Hamilton

Rybicki

Sekeres

et al. 2015

Bone Marrow Transplant

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“…The questions assessed (1) knowledge about the health benefits of HSCT, (2) knowledge about available information about stem cell banks and volunteer donation in Turkey, (3) knowledge about the HSCT procedure, and (4) experience and willingness about volunteering for blood and stem cell donation. A question about blood donation was included because blood donors among university students may have a more positive attitude about organ donation and transplantation.…”

Section: Lecture and Testingmentioning

confidence: 99%

“…However, in most nonindustrialized countries, the likelihood of finding such donors is low because of insufficient or nonexistent national donor programs. [2][3][4][5] Therefore, HSCT waiting lists worldwide are expanding because the need is greater than the number of voluntary stem cell donors. The gap between need and donation is especially wide for unrelated HSCT in many developing countries.…”

Section: Introductionmentioning

confidence: 99%

Untitled

Kaya

Gültekin²,

Demirtaş³

et al. 2015

Exp Clin Transplant

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Objectives: Hematopoietic stem cell transplantation is a life-saving treatment, but donor numbers are lacking in Turkey and elsewhere. Increased awareness of hematopoietic stem cell transplantation among university students might help expand donation. We evaluated the effect of a brief targeted educational intervention on knowledge and attitudes about hematopoietic stem cell transplantation and donation among first-year university students in Turkey. Materials and Methods: There were 301 first-year university students (median age, 18 y) who volunteered: 163 medical students (54%) and 138 law students (46%). Before and after a brief lecture about hematopoietic stem cell transplantation, students answered a 5-item yes-or-no questionnaire regarding (1) knowledge about health benefits of hematopoietic stem cell transplantation; (2) knowledge about stem cell banking and donation in Turkey; (3) knowledge about the transplantation procedure; (4) prior experience and/or willingness to donate blood; and (5) willingness to donate stem cells. Reasons for motivation to donate blood and/or stem cells were categorized. Results before and after the lecture were evaluated with univariate and multivariate analyses. Results: The response rate was 100%. Significantly greater proportions of students had knowledge about hematopoietic stem cell transplantation and willingness to donate blood and stem cells after the lecture. There were no differences between medical and law students before the lecture. After the lecture, a significantly greater proportion of medical students indicated knowledge about health benefits of hematopoietic stem cell transplantation, stem cell banking and donation in Turkey, and the transplantation procedure. Conclusions: Brief education about hematopoietic stem cell transplantation for university students can increase knowledge and awareness about hematopoietic stem cell transplantation and cause more positive attitudes about stem cell donation.

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Section: Who Should Get a Formal Cb Search With Confirmatory Hla Typimentioning

confidence: 99%

“…Prolonged URD searches are unlikely to result in acquisition of a suitably matched URD if one is not identified early in the search. 5,6 Knowledge of the patient's ancestry is critical given that patients from racial and ethnic minorities (including all those with nonEuropean ancestry) frequently do not have suitably matched URDs, 7 a result of extensive HLA polymorphisms and limited volunteer donor availability.At MSKCC, 10 of 10 HLA-A, -B, -C, -DRB1, -DQ allelematched URD grafts are currently our first choice for patients without HLA-identical sibling donors if time permits. However, simultaneous CB searches are frequently performed, especially if the transplantation is urgent.…”

mentioning

confidence: 99%

How I treat: the selection and acquisition of unrelated cord blood grafts

Barker

Byam

Scaradavou

2011

Blood

145

112

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Use of unrelated donor cord blood (CB) as an alternative stem cell source is increasing, and yet there is little information to guide transplant centers in the unique aspects of the search and selection of CB grafts. There is no mechanism to easily access the global inventory of CB units, nor is the product information provided by all banks standardized. To address these challenges, this manuscript reviews the logistics of the search, selection process, and acquisition of CB grafts as practiced by our center. Topics include who should be considered for a CB search, how to access the global CB inventory, and how to balance total nucleated cell dose and human leukocyte antigen match in unit selection. We discuss aspects of unit quality and other graft characteristics (processing methods, unit age, availability of attached segments, infectious disease, and hemoglobinopathy screening) to be considered. We incorporate these considerations into a unit selection algorithm, including how to select double-unit grafts. We also describe how we plan for unit shipment and the role of backup grafts. This review aims to provide a framework for CB unit selection and help transplantation centers perform efficient CB searches. (Blood. 2011;117(8):2332-2339) IntroductionUnrelated donor cord blood transplantation (CBT) has become a widely accepted treatment for lethal hematologic diseases. Both the number of CB transplantations 1 and the global inventory of CB units (estimated at 400 000) 2 are growing rapidly. Therefore, it is critically important that transplantation centers (TCs) have a thorough understanding of how to perform a CB search as well as the challenges encountered in the selection and acquisition of CB grafts. This article is a practical guide for the TCs, especially those new to the field of CBT, and is based on our daily experience of searching the global CB inventory, our knowledge of CB banking and CB testing standards, and evaluation of recently published data. Thus, we outline our search practices at Memorial SloanKettering Cancer Center (MSKCC). Who should get a formal CB search with confirmatory HLA typing of CB unitsThere is a progressive decrease in post-transplantation survival with each human leukocyte antigen (HLA) or allele mismatch at HLA-A, -B, -C, -DRB1 loci of adult unrelated donor (URD) grafts, with donor-recipient HLA-DQ disparity being detrimental when present with other mismatches. 3 Therefore, TCs must decide what level of HLA disparity will be tolerated with a URD before alternative hematopoietic stem cell sources such as CB are sought. In addition, as CB grafts are available faster than URD, 4 transplantation urgency may be an additional reason to use CB. Prolonged URD searches are unlikely to result in acquisition of a suitably matched URD if one is not identified early in the search. 5,6 Knowledge of the patient's ancestry is critical given that patients from racial and ethnic minorities (including all those with nonEuropean ancestry) frequently do not have suitably matched URDs, 7 a result...

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Unrelated Donor Hematopoietic Cell Transplantation: Factors Associated with a Better HLA Match

Cited by 46 publications

References 15 publications

Racial differences in allogeneic hematopoietic cell transplantation outcomes among African Americans and whites

Racial differences in allogeneic hematopoietic cell transplantation outcomes among African Americans and whites

Untitled

How I treat: the selection and acquisition of unrelated cord blood grafts

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