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Cai L, Jin D, Lai J, Li L, Luo Y, Shi J, Lai X, Liu L, Zhao Y, Yu J, Qiu Y, Song K, Yu F, Guo Q, Jin A, Huang H, Ding S, Ye Y. Psychological and physical side effects during G-CSF mobilization in related donors of allo-HCT. Ann Hematol 2024:10.1007/s00277-024-05753-5. [PMID: 38637333 DOI: 10.1007/s00277-024-05753-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 04/08/2024] [Indexed: 04/20/2024]
Abstract
The psychological side effects of granulocyte colony-stimulating factor mobilization in related donors of allogeneic hematopoietic cell transplantation (allo-HCT) and impacts of psychological/physical side effects on harvest outcomes remain largely unknown. We prospectively analyzed 349 consecutive related peripheral blood stem cell (PBSC) donors for allo-HCT at the First Affiliated Hospital, Zhejiang University, School of Medicine from March 2021 to August 2023. Higher baseline peripheral blood white blood cell counts (p = 0.046), monocyte counts (p < 0.001), platelet counts (p = 0.001), and hemoglobin (p < 0.001) had a positive correlation to CD34+ cell counts in the first leukapheresis, while female donors (male vs. female, p < 0.001) and older age (> 40 vs. < = 40, p = 0.003) were negatively related to CD34+ cell counts. Bone pain was the most observed physical side effect and was more frequent in female donors (p = 0.032). The incidence of fatigue was higher in female donors and older donors (female vs. male, p = 0.016; > 40 vs. < = 40, p = 0.015). Donor depression (pre vs. during mobilization, p < 0.001), anxiety (pre vs. during mobilization, p = 0.043) and insomnia (pre vs. during mobilization, p = 0.011) scores increased during the mobilization period. Donors with higher depression, anxiety and stress scores at admission were more likely to experience nausea. At 1 month after the last leukapheresis, the counts of white blood cell, neutrophil, monocyte and hemoglobin were significant lower than baseline counts, while the platelet counts recovered to baseline. The mobilization and harvest process can increase the depression, anxiety and insomnia scores. Poor psychological status of the donor can aggravate the occurrence of physical side effects.
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Affiliation(s)
- Lingxia Cai
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Diange Jin
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianbo Lai
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lin Li
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China
| | - Yi Luo
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China
| | - Jimin Shi
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoyu Lai
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China
| | - Lizhen Liu
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China
| | - Yanmin Zhao
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian Yu
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China
| | - Yunfei Qiu
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Kaixia Song
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fangquan Yu
- Department of Hematology, Jinhua People's Hospital, Jinhua, China
| | - Qinna Guo
- Department of Hematology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Aiyun Jin
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - He Huang
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
- Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China.
| | - Shuyi Ding
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Yishan Ye
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
- Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China.
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Murakami MA, Connelly-Smith L, Spitzer T, Kassim AA, Penza SL, Al Malki MM, Mason J, Tourville C, Magliocco B, Barten J, Guidry-Groves H, Margolis J, Devine SM, Rennert WP, Stefanski HE. Bone Marrow Harvest: A White Paper of Best Practices by the NMDP Marrow Alliance. Transplant Cell Ther 2024:S2666-6367(24)00349-X. [PMID: 38642840 DOI: 10.1016/j.jtct.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/12/2024] [Accepted: 04/14/2024] [Indexed: 04/22/2024]
Abstract
Data on recent bone marrow harvest (BMH) collections from the NMDP has shown that bone marrow (BM) quality has decreased based on total nucleated cell count in the product. To ensure that quality BM products are available to all recipients, the NMDP Marrow Alliance was formed in April 2021 to increase the capability of BM collection centers to safely deliver high-quality products consistently and to identify and disseminate guidelines for performing BMH. This white paper describes the best practices for BMH as defined by the NMDP Marrow Alliance.
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Affiliation(s)
| | - Laura Connelly-Smith
- Division of Hematology, Department of Medicine, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Thomas Spitzer
- Department of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Adetola A Kassim
- Department of Hematology and Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Sam L Penza
- Division of Hematology, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio
| | | | | | | | | | | | | | | | - Steven M Devine
- National Marrow Donor Program, Minneapolis, Minnesota; Center for International Blood and Marrow Transplant Research, National Marrow Donor Program, Minneapolis, Minnesota
| | - Wolfgang P Rennert
- Blood and Marrow Collection Program, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Heather E Stefanski
- National Marrow Donor Program, Minneapolis, Minnesota; Center for International Blood and Marrow Transplant Research, National Marrow Donor Program, Minneapolis, Minnesota.
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3
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Jones RJ, Bacigalupo A. The next horizon now that everyone has a donor: Precision allogeneic transplantation. Blood Rev 2023; 62:100990. [PMID: 35908981 DOI: 10.1016/j.blre.2022.100990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/28/2022] [Accepted: 07/07/2022] [Indexed: 11/23/2022]
Abstract
Post-transplant cyclophosphamide (PTCy) allows safe and effective partially matched donor allogeneic blood or marrow transplantation (alloBMT), so that almost everyone in need of the procedure now has a donor. Moreover, PTCy and other recent advances have lowered alloBMT mortality rates to less than half of that seen before the turn of the century, at costs that are substantially less than most newly approved anticancer agents. These advances also make tailoring BMT based on patients' unique diseases and characteristics now feasible for further improving outcomes. Personalizing every aspect of alloBMT, including conditioning, donor, graft type, and post-transplant maintenance is now possible. For example, alloBMT's antitumor activity historically was restricted to the allogeneic graft-versus-tumor effect directed against histocompatibility antigens. However, replacing exhausted immune systems with healthy non-exhausted, non-tolerant ones likely can enhance the activity of novel targeted therapies. The impressive results seen with tyrosine kinase inhibitors after alloBMT for patients with both Ph+ acute lymphoblastic leukemia and FLT/ITD+ acute myeloid leukemia herald the potential of precision BMT.
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Affiliation(s)
- Richard J Jones
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, John Hopkins University, Baltimore, MD, United States of America.
| | - Andrea Bacigalupo
- Hematology and Bone Marrow Transplant Unit, Fondazione Universitario Policlinico Gemelli IRCCS, Rome, Italy
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Should We Stop Collecting the Preoperative Autologous Blood before Bone Marrow Harvest? J Clin Med 2021; 10:jcm10102134. [PMID: 34069241 PMCID: PMC8156284 DOI: 10.3390/jcm10102134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/02/2021] [Accepted: 05/10/2021] [Indexed: 01/05/2023] Open
Abstract
Preoperative autologous blood donation (PAD) in bone marrow (BM) donors is performed to meet potential post-harvest transfusion needs and to avoid the risk of allogeneic transfusions. We reviewed retrospectively bone marrow harvests in 216 healthy donors during a ten-year period to determine the use of autologous blood. All donors except four had undergone PAD. The initial hemoglobin level of 153 g/L (male donors) and 135 g/L (female donors), respectively, decreased by about 8 g/L after preoperative blood donation and by 23 g/L after bone marrow harvest (medians). Autologous blood was administered to 70% of donors, 30% of the units remained unused. The evaluation of the risk of reaching transfusion threshold (<115 g/L males, <105 g/L females) revealed that donors with initial hemoglobin above 145 g/L and those weighing above 75 kg have minimal risk of requiring blood substitution (about 10%). A larger volume of bone marrow was obtained from male compared to female donors (1300 vs. 1100 mL) because of their higher body weight, which resulted in a higher number of procured nucleated cells (362 vs. 307 × 106/kg TNC, ns). The donor-recipient weight difference predicted the probability of sufficient collection. Only 1.5% of donors weighing ≥ 20 kg more than recipients failed to reach ≥3 × 108/kg TNC recipient. Our findings affirm previous data that PAD is unnecessary for healthy marrow donors and may be indicated individually after considering the pre-collection hemoglobin level, donor and recipient weight, and expected blood loss. Reasonable substitution cut-offs have to be set together with clinical symptom evaluation. The effective use of PAD also requires an adequate time interval between PAD and BM harvest.
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Switzer GE, Bruce JG, Kiefer DM, Kobusingye H, Abebe KZ, Drexler R, Besser RM, Confer DL, Horowitz MM, King RJ, Shaw BE, Riches M, Hayes-Lattin B, Linenberger M, Bolwell B, Rowley SD, Litzow MR, Pulsipher MA. Health-Related Quality-of-Life Comparison of Adult Related and Unrelated HSC Donors: An RDSafe Study. Biol Blood Marrow Transplant 2020; 26:2365-2371. [PMID: 32829080 DOI: 10.1016/j.bbmt.2020.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 08/11/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
Multiple investigations have documented the health-related quality-of-life (HRQoL) and donation-related experiences of unrelated donors (URDs), but similar investigations of the related donor (RD) experience have been less common. The central goal of this study was to longitudinally examine and compare HRQoL of RD and URD hematopoietic stem cell (HSC) donors from predonation through 1 year postdonation. This prospective investigation included adult HSC donors ages 18 to 60 years who donated bone marrow or peripheral blood stem cells at one of 48 geographically diverse US transplant/donor centers and completed HRQoL interviews at predonation and 4 weeks and 1 year postdonation. At predonation, related donors were less ambivalent about donation (t = -3.30; P = .001), more satisfied with their decision to donate (t = 2.65; P = .009), and more likely to define themselves as donors (t = 2.94; P = .004) than were URDs. However, related donors were more concerned about the use of needles (odds ratio [OR] = 2.19; P = .012), about who would pay for the procedure (OR = 2.80; P = .011), and the possibility that they would feel responsible if the transplant failed (t = 2.31; P = .022). Shortly postdonation, related donors were more likely to report donation-related pain (t = 2.50; P = .013) and lightheadedness (OR = 3.63; P = .028). At 1 year postdonation, related donors were less likely to be fully recovered from donation (OR = 0.10; P = .010) and more likely to report a longer recovery period following donation (t = 2.57; P = .011), although this latter finding was primarily due to the percentage of related versus unrelated donors not fully recovered at 1 year postdonation (10% versus 1%). Taken together, these findings suggest that current related donor management practices may be sufficient in preparing related donors for the psychological aspects of donation but that there may be more to do in terms of calibrating the description of donation-related experiences and recovery time to the related donor group (i.e., descriptions of donation experiences based on unrelated donation may not provide best estimates of experience for this group).
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Affiliation(s)
- Galen E Switzer
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Clinical and Translational Science, University of Pittsburgh, Pittsburgh, Pennsylvania; Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
| | - Jessica G Bruce
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Deidre M Kiefer
- National Marrow Donor Program/Be The Match, CIBMTR (Center for International Blood and Marrow Transplant Research), Minneapolis, Minnesota
| | - Hati Kobusingye
- National Marrow Donor Program/Be The Match, CIBMTR (Center for International Blood and Marrow Transplant Research), Minneapolis, Minnesota
| | - Kaleab Z Abebe
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Rebecca Drexler
- National Marrow Donor Program/Be The Match, CIBMTR (Center for International Blood and Marrow Transplant Research), Minneapolis, Minnesota
| | - RaeAnne M Besser
- National Marrow Donor Program/Be The Match, CIBMTR (Center for International Blood and Marrow Transplant Research), Minneapolis, Minnesota
| | - Dennis L Confer
- National Marrow Donor Program/Be The Match, CIBMTR (Center for International Blood and Marrow Transplant Research), Minneapolis, Minnesota
| | - Mary M Horowitz
- Department of Medicine, Medical College of Wisconsin, CIBMTR (Center for International Blood and Marrow Transplant Research), Milwaukee, Wisconsin
| | - Roberta J King
- National Marrow Donor Program/Be The Match, CIBMTR (Center for International Blood and Marrow Transplant Research), Minneapolis, Minnesota
| | - Bronwen E Shaw
- Department of Medicine, Medical College of Wisconsin, CIBMTR (Center for International Blood and Marrow Transplant Research), Milwaukee, Wisconsin
| | - Marcie Riches
- Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brandon Hayes-Lattin
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | | | - Brian Bolwell
- Cleveland Clinic Lerner School of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Scott D Rowley
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey; Department of Medicine, Georgetown University School of Medicine, Washington, DC
| | - Mark R Litzow
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Michael A Pulsipher
- Division of Hematology, Oncology, and BMT, Children's Hospital Los Angeles, Los Angeles, California
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6
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Kim-Wanner SZ, Luxembourg B, Schmidt AH, Schäfer R, Möller N, Herbert E, Poppe C, Hümmer C, Bunos M, Seifried E, Bonig H. Introduction of principles of blood management to healthy donor bone marrow harvesting. Vox Sang 2020; 115:802-812. [PMID: 32633825 DOI: 10.1111/vox.12972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/20/2020] [Accepted: 06/09/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Patient blood (more accurately: haemoglobin, Hb) management (PBM) aims to optimize endogenous Hb production and to minimize iatrogenic Hb loss while maintaining patient safety and optimal effectiveness of medical interventions. PBM was adopted as policy for patients by the World Health Organization (WHO), and, all the more, should be applied to healthy donors. MATERIALS AND METHODS Observational data from 489 bone marrow (BM) donors were retrospectively analysed, and principles of patient blood management were applied to healthy volunteer BM donations. RESULTS AND CONCLUSION We managed to render BM aspiration safe for donors, notably completely avoiding the collection of autologous blood units and blood transfusions through iron management, establishment and curation of high-yield aspiration technique, limitation of collection volume to 1·5% of donor body weight and development of volume prediction algorithms for the requested cell dose.
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Affiliation(s)
- Soo-Zin Kim-Wanner
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt, Frankfurt, Germany
| | - Beate Luxembourg
- Department of Hemostaseology, Justus Liebig University, Giessen, Germany
| | | | - Richard Schäfer
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt, Frankfurt, Germany
| | - Nadine Möller
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt, Frankfurt, Germany
| | - Eva Herbert
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt, Frankfurt, Germany
| | - Carolin Poppe
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt, Frankfurt, Germany
| | - Christiane Hümmer
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt, Frankfurt, Germany
| | - Milica Bunos
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt, Frankfurt, Germany
| | - Erhard Seifried
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt, Frankfurt, Germany.,Goethe University, Institute for Transfusion Medicine and Immunohematology, Frankfurt, Germany
| | - Halvard Bonig
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt, Frankfurt, Germany.,Goethe University, Institute for Transfusion Medicine and Immunohematology, Frankfurt, Germany.,Department of Medicine/Hematology, University of Washington, Seattle, WA, USA
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7
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Fujimoto A, Suzuki R, Orihara K, Iida M, Yamashita T, Nagafuji K, Kanamori H, Kodera Y, Miyamura K, Okamoto S, Hino M. Health-related quality of life in peripheral blood stem cell donors and bone marrow donors: a prospective study in Japan. Int J Hematol 2020; 111:840-850. [PMID: 32172446 DOI: 10.1007/s12185-020-02852-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 03/02/2020] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
Understanding of the impact of stem cell donation on donors' health-related quality of life (HRQOL) remains limited. A prospective observational study of eligible unrelated donors enrolled in the Japan Marrow Donor Program was conducted to compare HRQOL and adverse events (AEs) between peripheral blood stem cell (PBSC) and bone marrow (BM) donors. In total, 107 PBSC donors and 108 BM donors were enrolled. HRQOL scores for physical status were significantly lower in BM donors 1 week post-harvest (P < 0.001), but there were no significant differences between the two groups at baseline or 3 months post-harvest. PBSC donors were more likely to experience AEs before harvest (P < 0.001). However, at harvest, moderate-to-severe AEs were more common in BM donors (P = 0.001). After harvest, all grades of AEs were significantly higher in BM donors (P < 0.001). Among BM donors, a lower total physical score at baseline [odds ratio (OR) 1.21], female sex [OR 2.71], and young donors (OR 3.08) were risk factors for moderate-to-severe AEs at harvest, while among PBSC donors, only female sex (OR 4.86) was a risk factor. Our findings show better HRQOL during PBSC donation. These data help support decision-making by potential donors.
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Affiliation(s)
- Ayumi Fujimoto
- Department of Oncology and Hematology, Shimane University Hospital, Izumo, Japan
| | - Ritsuro Suzuki
- Department of Oncology and Hematology, Shimane University Hospital, Izumo, Japan
| | | | - Minako Iida
- Department of Promotion for Blood and Marrow Transplantation, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Takuya Yamashita
- Department of Hematology, St. Luke's International Hospital, Tokyo, Japan
| | - Koji Nagafuji
- Division of Hematology and Oncology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Heiwa Kanamori
- Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan
| | - Yoshihisa Kodera
- Department of Promotion for Blood and Marrow Transplantation, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Koichi Miyamura
- Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Shinichiro Okamoto
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Masayuki Hino
- Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
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Amouzegar A, Dey BR, Spitzer TR. Peripheral Blood or Bone Marrow Stem Cells? Practical Considerations in Hematopoietic Stem Cell Transplantation. Transfus Med Rev 2018; 33:43-50. [PMID: 30528986 DOI: 10.1016/j.tmrv.2018.11.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/02/2018] [Accepted: 11/06/2018] [Indexed: 01/10/2023]
Abstract
Although peripheral blood stem cells (PBSC) have worldwide become the predominant source of progenitor cells for hematopoietic stem cell transplantation (HSCT), debate about their role compared with bone marrow (BM) has recently intensified, in large part based on the results of a multicenter Clinical Trials Network study which showed lower incidence of chronic graft-versus-host disease (cGVHD) and improved quality of life in recipients of myeloablative HLA-matched unrelated BM compared with PBSC transplants. However, in certain patient populations, PBSC may lead to improved clinical outcomes due to faster hematologic recovery, a lower risk of graft failure, and possibly a lower probability of relapse. This review will provide a comprehensive summary of studies comparing PBSC with BM as the graft source in terms of acute and chronic GVHD incidence, time to engraftment, and disease-free and overall survival probabilities after HLA-matched related and unrelated donor transplantation and haploidentical donor transplantation. Recommendations based on these studies regarding the use of PBSC versus BM for HSCT are offered.
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Affiliation(s)
- Afsaneh Amouzegar
- Department of Medicine, Bone Marrow Transplant Unit, Massachusetts General Hospital, Boston, MA
| | - Bimalangshu R Dey
- Department of Medicine, Bone Marrow Transplant Unit, Massachusetts General Hospital, Boston, MA
| | - Thomas R Spitzer
- Department of Medicine, Bone Marrow Transplant Unit, Massachusetts General Hospital, Boston, MA.
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9
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Providing Level-of-Match Information to Perfectly Matched Unrelated Stem Cell Donors: Evaluating Acceptability and Potential Changes in Donor Availability. Biol Blood Marrow Transplant 2018; 24:2110-2118. [PMID: 29574124 DOI: 10.1016/j.bbmt.2018.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 03/16/2018] [Indexed: 11/21/2022]
Abstract
Patients with blood-related diseases often cannot identify a matched related donor and must seek donors in unrelated donor registries. These registries face the challenge of ensuring that potential donors are available when contacted. Donor attrition is especially problematic when there is only a single perfectly matched potential donor. One way to improve donor availability might be to present perfectly matched donors (high-priority donors [HPDs]) with more precise information about their match status. This project evaluated the impact of providing such information to HPDs at the National Marrow Donor Program (NMDP)/Be The Match. Objectives were to determine the acceptability of the new messaging to both HPDs and the donor contact representatives (DCRs) who delivered the message, consistency of message delivery, and whether the new messaging was associated with improved donor availability. Mixed methods were used to collect telephone interview data from HPDs, matched samples of non-HPDs, and DCRs. Donor availability data came from NMDP records. Key findings were as follows: (1) the HPD message was acceptable to potential donors and did not seem to produce undue pressure, (2) the message was acceptable to DCRs who became more comfortable and consistent in delivering the message over time, but (3) the new messaging did not significantly increase availability. Despite the lack of evidence for increased availability, there may be ethical benefits and little harm to providing well-matched donors with more information about their degree of matching. Research should examine stronger match status messages and delivery of new messaging to additional highly-matched donor groups.
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10
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Takami A. Hematopoietic stem cell transplantation for acute myeloid leukemia. Int J Hematol 2018; 107:513-518. [PMID: 29374826 DOI: 10.1007/s12185-018-2412-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 01/03/2023]
Abstract
Although allogeneic hematopoietic stem cell transplantation (allo-HSCT) yields a high rate of curability for acute myeloid leukemia (AML), it is also associated with transplant-related morbidity and mortality (TRM). The risk and severity of TRM increase with the use of an alternative donor graft in the absence of an HLA-matched sibling donor (MSD). With the declining birthrate and aging of the population, the numbers of patients with an MSD are decreasing, and alternative donor transplants, including the post-transplant cyclophosphamide method using haplo-identical donors, are increasing. Autologous (auto)-HSCT, which enables the intensification of chemotherapy, has the advantage of high availability of a transplant graft, and is associated with a lower TRM, but these benefits may be offset by a higher rate of relapse due to the lack of a graft-versus-leukemia (GVL) effect. Although allo-HSCT remains the first-line treatment for poor and very-poor-risk patients, auto-HSCT is again gaining increased attention. It has also recently been suggested that cord blood grafts may induce a stronger GVL effect than other grafts; as such, the positioning of cord blood transplantation should also be reconsidered for AML patients.
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Affiliation(s)
- Akiyoshi Takami
- Division of Hematology, Department of Internal Medicine, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, 480-1195, Japan.
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11
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Billen A, Madrigal JA, Scior K, Shaw BE, Strydom A. Donation of peripheral blood stem cells to unrelated strangers: A thematic analysis. PLoS One 2017; 12:e0186438. [PMID: 29069088 PMCID: PMC5656410 DOI: 10.1371/journal.pone.0186438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 10/02/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Donation of haematopoietic stem cells, either through bone marrow (BM) or peripheral blood stem cell (PBSC) collection, is a generally safe procedure for healthy donors, although side effects are a known risk. Previous research, including our recent quantitative study, has shown that the psychosocial response to donating is usually a positive one and most donors would be willing to donate again in the future. This is often despite experiencing significant side effects during the donation process. Due to the relative recent introduction of PBSC, a comprehensive understanding of the range of physical and emotional issues donors may experience is lacking, as well as an understanding of specific donor characteristics Qualitative research can provide rich narrative data into these areas. This study was set up in order to identify specific donor characteristics and to further explore the relationship between pre-donation physical health and the donation experience, as previously identified in our quantitative study. METHODS It involved in-depth telephone interviews with 14 PBSC donors who participated in our original quantitative study. Thematic analysis was used to analyse the findings and the results provide a summary of participants' characteristics using themes and constituent codes. RESULTS We identified several donor characteristics, including strong intrinsic motivation, altruism, sense of duty, determination, low levels of ambivalence and the ability to develop a strong emotional relationship with an (unknown/anonymous) recipient whilst being able to manage strong feelings and emotions. CONCLUSIONS These personality traits may explain the resilience that has been observed previously in haematopoietic stem cells donors. Significant feelings of grief were reported after a recipient's death. Possibilities to alleviate these symptoms may include raising awareness of potential poor outcomes in the recipient and offering improved counselling services if the recipient dies. We acknowledge several limitations including the sampling frame.
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Affiliation(s)
- Annelies Billen
- Anthony Nolan, London, United Kingdom
- UCL Cancer Institute, London, United Kingdom
| | | | - Katrina Scior
- UCL Research Department of Clinical, Educational and Health Psychology, London, United Kingdom
| | - Bronwen E. Shaw
- Anthony Nolan, London, United Kingdom
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Andre Strydom
- UCL Mental Health Sciences Unit, London, United Kingdom
- * E-mail:
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12
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Pahnke S, Larfors G, Axdorph-Nygell U, Fischer-Nielsen A, Haastrup E, Heldal D, Itälä-Remes M, Johansson JE, Kauppila M, Lenhoff S, Ljungman P, Niittyvuopio R, Sandstedt A, Hägglund H. Short-term side effects and attitudes towards second donation: A comparison of related and unrelated haematopoietic stem cell donors. J Clin Apher 2017; 33:226-235. [PMID: 28833474 DOI: 10.1002/jca.21576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/02/2017] [Accepted: 08/01/2017] [Indexed: 11/11/2022]
Abstract
The Nordic Register of Haematopoietic Stem Cell Donors (NRHSD) has registered related and unrelated donors from 10 transplant centres in Sweden, Norway, Finland and Denmark since 1998. We present a prospective, observational study of 1,957 donors, focusing mainly on the differences between related and unrelated donors. Related donors are reported to have more comorbidities, but similar side effects compared with unrelated donors. Side effects after BM or PBSC donation are generally of short duration and in this study no deaths, myocardial infarctions, splenic ruptures, or thromboembolic events are reported. Interestingly, related donors express more hesitancy towards donating again when asked 1 month after donation.
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Affiliation(s)
- Simon Pahnke
- Department of Haematology, Uppsala University Hospital, Uppsala, Sweden.,Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Gunnar Larfors
- Department of Haematology, Uppsala University Hospital, Uppsala, Sweden
| | - Ulla Axdorph-Nygell
- Centre for Apheresis and Stem Cell Processing (CASH), Clinical Immunology/Transfusion Medicine, and Department of Haematology, Karolinska University Hospital, Stockholm, Sweden
| | - Anne Fischer-Nielsen
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Eva Haastrup
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Dag Heldal
- Department of Haematology, Oslo University Hospital, Oslo, Norway
| | - Maija Itälä-Remes
- Stem Cell Transplantation Unit, Turku University Hospital, Turku, Finland
| | - Jan-Erik Johansson
- Department of Haematology and Coagulation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marjut Kauppila
- Department of Haematology, Turku University Hospital, Turku, Finland
| | - Stig Lenhoff
- Department of Haematology, Skåne University Hospital, Lund, Sweden
| | - Per Ljungman
- Department of Haematology, Karolinska University Hospital, Division of Haematology, Karolinska Institutet, Stockholm, Sweden.,Department of Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Division of Haematology, Karolinska Institutet, Stockholm, Sweden.,Department of Medicine Huddinge, Karolinska University Hospital, Division of Haematology, Karolinska Institutet, Stockholm, Sweden
| | - Riita Niittyvuopio
- Stem Cell Transplantation Unit, Helsinki University Hospital, Helsinki, Finland
| | - Anna Sandstedt
- Department of Haematology, Linköping University Hospital, Linköping, Sweden
| | - Hans Hägglund
- Department of Haematology, Uppsala University Hospital, Uppsala, Sweden
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13
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Retrospective Analysis of 37,287 Observation Years after Peripheral Blood Stem Cell Donation. Biol Blood Marrow Transplant 2017; 23:1011-1020. [DOI: 10.1016/j.bbmt.2017.02.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/20/2017] [Indexed: 11/19/2022]
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14
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Panch SR, Szymanski J, Savani BN, Stroncek DF. Sources of Hematopoietic Stem and Progenitor Cells and Methods to Optimize Yields for Clinical Cell Therapy. Biol Blood Marrow Transplant 2017; 23:1241-1249. [PMID: 28495640 DOI: 10.1016/j.bbmt.2017.05.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 05/03/2017] [Indexed: 11/26/2022]
Abstract
Bone marrow (BM) aspirates, mobilized peripheral blood, and umbilical cord blood (UCB) have developed as graft sources for hematopoietic stem and progenitor cells (HSPCs) for stem cell transplantation and other cellular therapeutics. Individualized techniques are necessary to enhance graft HSPC yields and cell quality from each graft source. BM aspirates yield adequate CD34+ cells but can result in relative delays in engraftment. Granulocyte colony-stimulating factor (G-CSF)-primed BM HSPCs may facilitate faster engraftment while minimizing graft-versus-host disease in certain patient subsets. The levels of circulating HSPCs are enhanced using mobilizing agents, such as G-CSF and/or plerixafor, which act via the stromal cell-derived factor 1/C-X-C chemokine receptor type 4 axis. Alternate niche pathway mediators, including very late antigen-4/vascular cell adhesion molecule-1, heparan sulfate proteoglycans, parathyroid hormone, and coagulation cascade intermediates, may offer promising alternatives for graft enhancement. UCB grafts have been expanded ex vivo with cytokines, notch-ligand, or mesenchymal stromal cells, and most studies demonstrated greater quantities of CD34+ cells ex vivo and improved short-term engraftment. No significant changes were observed in long-term repopulating potential or in patient survival. Early phase clinical trials using nicotinamide and StemReginin1 may offer improved short- and long-term repopulating ability. Breakthroughs in genome editing and stem cell reprogramming technologies may hasten the generation of pooled, third-party HSPC grafts. This review elucidates past, present, and potential future approaches to HSPC graft optimization.
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Affiliation(s)
- Sandhya R Panch
- Cell Processing Section, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland.
| | - James Szymanski
- Cell Processing Section, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Bipin N Savani
- Department of Hematology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - David F Stroncek
- Cell Processing Section, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
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15
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Lee SJ, Logan B, Westervelt P, Cutler C, Woolfrey A, Khan SP, Waller EK, Maziarz RT, Wu J, Shaw BE, Confer D, Horowitz MM, Anasetti C. Comparison of Patient-Reported Outcomes in 5-Year Survivors Who Received Bone Marrow vs Peripheral Blood Unrelated Donor Transplantation: Long-term Follow-up of a Randomized Clinical Trial. JAMA Oncol 2017; 2:1583-1589. [PMID: 27532508 DOI: 10.1001/jamaoncol.2016.2520] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Bone marrow or peripheral blood from unrelated donors may be used for hematopoietic cell transplantation. Information about the relative success of transplantation with these 2 graft sources would help physicians and patients choose between them. Objective To compare patient-reported outcomes between patients randomized to receive 1 of 2 graft types for unrelated donor transplantation. Design, Setting, and Participants This follow-up of a randomized clinical trial included English- or Spanish-speaking patients 16 years or older participating in a multicenter randomized clinical trial of unrelated donor bone marrow (BM) vs peripheral blood (PB) (N = 551) in hematopoietic cell transplantation for hematologic neoplasms. Patient-reported outcomes were collected from patients at enrollment and 0.5, 1, 2, and 5 years after transplantation. Interventions Unrelated donor BM or PB hematopoietic cell transplantation. Main Outcomes and Measures Functional Assessment of Cancer Therapy-Bone Marrow Transplant, Mental Health Inventory, occupational functioning, Lee Chronic Graft-vs-Host Disease Symptom Scale. Results At 5 years after transplantation, 102 BM and 93 PB participants were alive and eligible for assessment (age ≥40 years or older: 104 [53.5%] male: 101 [51.8%]). The mean (SE) Mental Health Inventory Psychological Well-Being scores (78.9 [1.7] vs 72.2 [1.9]; P = .01; higher better) and Lee chronic graft-vs-host disease symptom scores (13.1 [1.5] vs 19.3 [1.6]; P = .004; lower better) were significantly better for BM recipients, adjusting for baseline scores and missing data. Recipients of BM were also more likely to be working full or part-time than recipients of PB (odds ratio, 1.5; 95% CI, 1.2-2.0; P = .002), adjusting for work status before transplantation. With a median follow-up of 73 months (range, 30-121 months) for survivors, no differences in survival (40% vs 39%; P = .84), relapse (32% vs 29%; P = .47), or treatment-related mortality (29% vs 32%; P = .44) between BM and PB were observed. Conclusions and Relevance Recipients of unrelated donor BM had better psychological well-being, less burdensome chronic GVHD symptoms, and were more likely to return to work than recipients of PB at 5 years after transplantation. Bone marrow should be the standard of care for these types of transplant procedures. Trial Registration clinicaltrials.gov Identifier: NCT00075816.
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Affiliation(s)
- Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Brent Logan
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee
| | - Peter Westervelt
- Department of Medicine, Division of Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Corey Cutler
- Division of Hematologic Malignancies and Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Ann Woolfrey
- Transplantation Biology Department, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Shakila P Khan
- Division of Pediatric Hematology-Oncology, Mayo Clinic, Rochester, Minnesota
| | - Edmund K Waller
- Winship Cancer Institute, Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Richard T Maziarz
- Adult Blood and Marrow Stem Cell Transplant Program, Knight Cancer Institute, Oregon Health and Science University, Portland
| | - Juan Wu
- Emmes Corporation, Rockville, Maryland
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee
| | - Dennis Confer
- National Marrow Donor Program, Minneapolis, Minnesota
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee
| | - Claudio Anasetti
- Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, Florida
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16
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Switzer GE, Bruce J, Kiefer DM, Kobusingye H, Drexler R, Besser RM, Confer DL, Horowitz MM, King RJ, Shaw BE, Riches M, Hayes-Lattin B, Linenberger M, Bolwell B, Rowley SD, Litzow MR, Pulsipher MA. Health-Related Quality of Life among Older Related Hematopoietic Stem Cell Donors (>60 Years) Is Equivalent to That of Younger Related Donors (18 to 60 Years): A Related Donor Safety Study. Biol Blood Marrow Transplant 2017; 23:165-171. [PMID: 27751935 PMCID: PMC5182103 DOI: 10.1016/j.bbmt.2016.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 10/13/2016] [Indexed: 11/20/2022]
Abstract
The increasing number of older adults with blood-related disorders and the introduction of reduced-intensity conditioning regimens has led to increases in hematopoietic stem cell (HSC) transplantation among older adults and a corresponding increase in the age of siblings who donate HSCs to these patients. Data regarding the donation-related experiences of older donors are lacking. The Related Donor Safety Study aimed to examine/compare health-related quality of life (HRQoL) of older versus younger HSC donors. Sixty peripheral blood stem cell (PBSC) donors ages 18 to 60 years and 104 PBSC donors age >60 years completed validated questionnaires before donation and 4 weeks and 1 year after donation. Before donation, older donors had poorer general physical health (t = -3.27; P = .001) but better mental health (t = 2.11; P < .05). There were no age differences in multiple other donation-related factors. At 4 weeks after donation, there were no group differences in general physical/mental health, but older donors were less likely to report donation-related pain (t = -2.26; P < .05) and concerns (t = -3.38; P = .001). At both 4 weeks and 1 year after donation, there were no significant differences in the percentage of each age group feeling physically back to normal or in the number of days it took donors to feel completely well. There was no evidence that increasing age within the older donor group was associated with poorer donation-related HRQoL. Taken together, these data support the current practice of HSC donation by sibling donors above age 60, providing no evidence of worsening HRQoL up to 1 year after donation in individuals up to age 76.
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Affiliation(s)
- Galen E Switzer
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Clinical and Translational Science, University of Pittsburgh, Pittsburgh, Pennsylvania; Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
| | - Jessica Bruce
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Deidre M Kiefer
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match®, Minneapolis, Minnesota
| | - Hati Kobusingye
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match®, Minneapolis, Minnesota
| | - Rebecca Drexler
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match®, Minneapolis, Minnesota
| | - RaeAnne M Besser
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match®, Minneapolis, Minnesota
| | - Dennis L Confer
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match®, Minneapolis, Minnesota
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Roberta J King
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match®, Minneapolis, Minnesota
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Marcie Riches
- Division of Hematology/Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brandon Hayes-Lattin
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | | | - Brian Bolwell
- Cleveland Clinic Lerner School of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Scott D Rowley
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey; Department of Medicine, Georgetown University School of Medicine, Washington, District of Columbia
| | | | - Michael A Pulsipher
- Division of Hematology, Oncology, and BMT, Children's Hospital Los Angeles, Los Angeles, California
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17
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Lee SJ, Logan B, Westervelt P, Cutler C, Woolfrey A, Khan SP, Waller EK, Maziarz RT, Wu J, Shaw BE, Confer D, Horowitz MM, Anasetti C. Comparison of Patient-Reported Outcomes in 5-Year Survivors Who Received Bone Marrow vs Peripheral Blood Unrelated Donor Transplantation: Long-term Follow-up of a Randomized Clinical Trial. JAMA Oncol 2016. [PMID: 27532508 DOI: 10.1001/jamaoncol.2016.2520.pmid:27532508;pmcid:pmc5145732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
IMPORTANCE Bone marrow or peripheral blood from unrelated donors may be used for hematopoietic cell transplantation. Information about the relative success of transplantation with these 2 graft sources would help physicians and patients choose between them. OBJECTIVE To compare patient-reported outcomes between patients randomized to receive 1 of 2 graft types for unrelated donor transplantation. DESIGN, SETTING, AND PARTICIPANTS This follow-up of a randomized clinical trial included English- or Spanish-speaking patients 16 years or older participating in a multicenter randomized clinical trial of unrelated donor bone marrow (BM) vs peripheral blood (PB) (N = 551) in hematopoietic cell transplantation for hematologic neoplasms. Patient-reported outcomes were collected from patients at enrollment and 0.5, 1, 2, and 5 years after transplantation. INTERVENTIONS Unrelated donor BM or PB hematopoietic cell transplantation. MAIN OUTCOMES AND MEASURES Functional Assessment of Cancer Therapy-Bone Marrow Transplant, Mental Health Inventory, occupational functioning, Lee Chronic Graft-vs-Host Disease Symptom Scale. RESULTS At 5 years after transplantation, 102 BM and 93 PB participants were alive and eligible for assessment (age ≥40 years or older: 104 [53.5%] male: 101 [51.8%]). The mean (SE) Mental Health Inventory Psychological Well-Being scores (78.9 [1.7] vs 72.2 [1.9]; P = .01; higher better) and Lee chronic graft-vs-host disease symptom scores (13.1 [1.5] vs 19.3 [1.6]; P = .004; lower better) were significantly better for BM recipients, adjusting for baseline scores and missing data. Recipients of BM were also more likely to be working full or part-time than recipients of PB (odds ratio, 1.5; 95% CI, 1.2-2.0; P = .002), adjusting for work status before transplantation. With a median follow-up of 73 months (range, 30-121 months) for survivors, no differences in survival (40% vs 39%; P = .84), relapse (32% vs 29%; P = .47), or treatment-related mortality (29% vs 32%; P = .44) between BM and PB were observed. CONCLUSIONS AND RELEVANCE Recipients of unrelated donor BM had better psychological well-being, less burdensome chronic GVHD symptoms, and were more likely to return to work than recipients of PB at 5 years after transplantation. Bone marrow should be the standard of care for these types of transplant procedures. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00075816.
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Affiliation(s)
- Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Brent Logan
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee
| | - Peter Westervelt
- Department of Medicine, Division of Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Corey Cutler
- Division of Hematologic Malignancies and Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Ann Woolfrey
- Transplantation Biology Department, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Shakila P Khan
- Division of Pediatric Hematology-Oncology, Mayo Clinic, Rochester, Minnesota
| | - Edmund K Waller
- Winship Cancer Institute, Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Richard T Maziarz
- Adult Blood and Marrow Stem Cell Transplant Program, Knight Cancer Institute, Oregon Health and Science University, Portland
| | - Juan Wu
- Emmes Corporation, Rockville, Maryland
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee
| | - Dennis Confer
- National Marrow Donor Program, Minneapolis, Minnesota
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee
| | - Claudio Anasetti
- Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, Florida
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18
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Steering Committee Of The Blood And Marrow Transplant Clinical Trials Network. The Blood and Marrow Transplant Clinical Trials Network: An Effective Infrastructure for Addressing Important Issues in Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2016; 22:1747-1757. [PMID: 27418009 PMCID: PMC5027144 DOI: 10.1016/j.bbmt.2016.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 07/08/2016] [Indexed: 12/01/2022]
Abstract
Hematopoietic cell transplantation (HCT) is a rapidly evolving field with active preclinical and clinical development of new strategies for patient assessment, graft selection and manipulation, and pre- and post-transplantation drug and cell therapy. New strategies require evaluation in definitive clinical trials; however, HCT trials face unique challenges, including the relatively small number of transplantations performed at any single center, the diverse indications for HCT requiring dissimilar approaches, the complex nature of the intervention itself, the risk of multiple complications in the immediate post-transplantation period, and the risk of important, though infrequent, late effects. The Blood and Marrow Transplant Clinical Trials Network (BMT CTN) was established by the US National Heart Lung and Blood Institute and the National Cancer Institute to meet these challenges. In its 15 years as a network, the BMT CTN has proven to be a successful infrastructure for planning, implementing, and completing such trials and for providing definitive answers to questions leading to improvements in the understanding and practice of HCT. It has opened 37 trials, about one-half phase 2 and one-half phase 3, enrolled more than 8000 patients, and published 57 papers addressing important issues in the treatment of patients with life-threatening malignant and nonmalignant blood disorders. This review describes the network's accomplishments, key components of its success, lessons learned over the past 15 years, and challenges for the future.
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19
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Korur A, Kozanoglu I, Buyukkurt N, Yeral M, Kandemir F, Gereklioglu C, Sariturk C, Asma S, Solmaz S, Boga C, Ozdogu H. QTc prolongation during peripheral stem cell apheresis in healthy volunteers. J Clin Apher 2016; 32:240-245. [PMID: 27543914 DOI: 10.1002/jca.21504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 07/14/2016] [Accepted: 08/10/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND AIM Today, voluntary donation of peripheral blood stem cells by healthy donors for allogeneic hemopoietic cell transplantation is common worldwide. Such donations are associated with small but measurable risks of morbidity and mortality. Most complications are associated with citrate infusion during cell collection. We studied the effects of citrate infusion on the QTc and other vital parameters during and after peripheral stem cell apheresis in volunteers. METHOD To ensure that donors were healthy, screening included taking a detailed medical history, physical examination, and laboratory measurements of plasma calcium and magnesium. Corrected QT (QTc) values were assessed using a 12-lead electrocardiographic platform that derived QTc values automatically. RESULTS In all, 141 apheresis procedures were performed. The mean QTc values at baseline, at 2 and 4 h during the procedure, and at 30 min after the procedure, were 347.6 ± 59.5, 349.9 ± 52.8, 391.8 ± 54.0, and 404.8 ± 59.2 ms, respectively. The baseline and 2 h QTcs did not differ significantly, but the baseline QTc did differ significantly from the 4 h and 30 min after the procedure values. The plasma levels of calcium and magnesium did not significantly differ before and after the procedure. CONCLUSION QTc prolongation may develop during leukopheresis, particularly if the procedure takes more than 2 h. Thus, to enhance donor safety, QTc measurement should be standard for all donors. In addition, any family history of sudden death should be noted, to prevent the development of possible fatal arrhythmia in susceptible donors.
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Affiliation(s)
- Aslı Korur
- Baskent University Adana Adult Bone Marrow Transplantation Center Clinical Unit.,Department of Family Medicine, Baskent University Medical Faculty
| | - Ilknur Kozanoglu
- Baskent University Adana Adult Bone Marrow Transplantation Center Apheresis and Cell Collecting Unit.,Department of Physiology, Baskent University Medical Faculty
| | - Nurhilal Buyukkurt
- Baskent University Adana Adult Bone Marrow Transplantation Center Clinical Unit
| | - Mahmut Yeral
- Baskent University Adana Adult Bone Marrow Transplantation Center Clinical Unit
| | - Fatih Kandemir
- Baskent University Adana Adult Bone Marrow Transplantation Center Apheresis and Cell Collecting Unit
| | - Cigdem Gereklioglu
- Baskent University Adana Adult Bone Marrow Transplantation Center Clinical Unit.,Department of Family Medicine, Baskent University Medical Faculty
| | | | - Suheyl Asma
- Baskent University Adana Adult Bone Marrow Transplantation Center Clinical Unit.,Department of Family Medicine, Baskent University Medical Faculty
| | - Soner Solmaz
- Baskent University Adana Adult Bone Marrow Transplantation Center Clinical Unit
| | - Can Boga
- Baskent University Adana Adult Bone Marrow Transplantation Center Clinical Unit
| | - Hakan Ozdogu
- Baskent University Adana Adult Bone Marrow Transplantation Center Clinical Unit
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20
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Burns LJ, Logan BR, Chitphakdithai P, Miller JP, Drexler R, Spellman S, Switzer GE, Wingard JR, Anasetti C, Confer DL. Recovery of Unrelated Donors of Peripheral Blood Stem Cells versus Recovery of Unrelated Donors of Bone Marrow: A Prespecified Analysis from the Phase III Blood and Marrow Transplant Clinical Trials Network Protocol 0201. Biol Blood Marrow Transplant 2016; 22:1108-1116. [PMID: 27013014 DOI: 10.1016/j.bbmt.2016.02.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 02/27/2016] [Indexed: 10/22/2022]
Abstract
We report a comparison of time to recovery, side effects, and change in blood counts from baseline to after donation from unrelated donors who participated in the Blood and Marrow Transplant Clinical Trials Network phase III randomized, multicenter trial (0201) in which donor-recipient pairs were randomized to either peripheral blood stem cell (PBSC) or bone marrow (BM) donation. Of the entire cohort, 262 donated PBSC and 264 donated BM; 372 (71%) donors were from domestic and 154 (29%) were from international centers (145 German and 9 Canadian). PBSC donors recovered in less time, with a median time to recovery of 1 week compared with 2.3 weeks for BM donors. The number of donors reporting full recovery was significantly greater for donors of PBSC than of BM at 1, 2, and 3 weeks and 3 months after donation. Multivariate analysis showed that PBSC donors were more likely to recover at any time after donation compared with BM donors (hazard ratio, 2.08; 95% confidence interval [CI], 1.73 to 2.50; P < .001). Other characteristics that significantly increased the likelihood of complete recovery were being an international donor and donation in more recent years. Donors of BM were more likely to report grades 2 to 4 skeletal pain, body symptoms, and fatigue at 1 week after donation. In logistic regression analysis of domestic donors only in which toxicities at peri-collection time points (day 5 filgrastim for PBSC donors and day 2 after collection of BM donors) could be analyzed, no variable was significantly associated with grades 2 to 4 skeletal pain, including product donated (BM versus PBSC; odds ratio, 1.13; 95% CI, .74 to 1.74; P = .556). Blood counts were affected by product donated, with greater mean change from baseline to after donation for white blood cells, neutrophils, mononuclear cells, and platelets in PBSC donors whereas BM donors experienced a greater mean change in hemoglobin. This analysis provided an enhanced understanding of donor events as product donated was independent of physician bias or donor preference.
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Affiliation(s)
- Linda J Burns
- National Marrow Donor Program/Be the Match, Minneapolis, Minnesota; Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota.
| | - Brent R Logan
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Pintip Chitphakdithai
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - John P Miller
- National Marrow Donor Program/Be the Match, Minneapolis, Minnesota; Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Rebecca Drexler
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Stephen Spellman
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | | | - John R Wingard
- University of Florida College of Medicine, Gainesville, Florida
| | | | - Dennis L Confer
- National Marrow Donor Program/Be the Match, Minneapolis, Minnesota; Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
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21
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Weaver MS, Diekema DS, Carr A, Triplett B. Matched Marrow, Sibling Shadow: The Epidemiology, Experience, and Ethics of Sibling Donors of Stem Cells. J Adolesc Young Adult Oncol 2016; 4:100-4. [PMID: 26812663 DOI: 10.1089/jayao.2014.0051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Meaghann S Weaver
- 1 Department of Oncology, St. Jude Children's Research Hospital , Memphis, Tennessee
| | - Douglas S Diekema
- 2 Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute , Seattle, Washington
| | - Ashley Carr
- 3 Child Life Program, St. Jude Children's Research Hospital , Memphis, Tennessee
| | - Brandon Triplett
- 4 Department of Bone Marrow Transplant, St. Jude Children's Research Hospital , Memphis, Tennessee
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22
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Deotare U, Al-Dawsari G, Couban S, Lipton JH. G-CSF-primed bone marrow as a source of stem cells for allografting: revisiting the concept. Bone Marrow Transplant 2015; 50:1150-6. [PMID: 25915812 DOI: 10.1038/bmt.2015.80] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/10/2015] [Accepted: 03/12/2015] [Indexed: 12/23/2022]
Abstract
The source of hematopoietic stem cells (HSCs) for allogeneic transplantation has evolved over the last decades, from the sole use of unstimulated bone marrow (BM) to the use of G-CSF (filgrastim)-mobilized peripheral blood, G-CSF-primed BM (G-BM) and cord blood. G-CSF-mobilized PBSC has replaced BM as the most commonly used source of allogeneic stem cells. G-BM is a source of HSCs, with studies demonstrating the safety and feasibility of this strategy with the potential for reducing GvHD, while retaining the speed of engraftment. Although the G-BM had lost its use as the optimal source of stem cells, after the widespread use of haploidentical transplantation, their use has resurfaced in 2010. This source can still be used in today's world of transplantation in aplastic anemia and other benign diseases, as well as in children donors. This study intends to review the evidence for this approach and whether this approach still has merit in the ever-evolving field of allogenic HSC transplantation. The merit of G-BM is its ability to offer speed of engraftment with reduced GvHD.
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Affiliation(s)
- U Deotare
- Allogeneic Bone Marrow Transplant Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - G Al-Dawsari
- Allogeneic Bone Marrow Transplant Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - S Couban
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - J H Lipton
- Allogeneic Bone Marrow Transplant Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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23
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Billen A, Madrigal JA, Strydom A, Szydlo RM, Switzer GE, Shaw BE. Predonation health-related quality of life scores predict time to recovery in hematopoietic stem cell donors. Biol Blood Marrow Transplant 2014; 21:350-6. [PMID: 25452034 DOI: 10.1016/j.bbmt.2014.10.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 10/29/2014] [Indexed: 01/09/2023]
Abstract
The physical reactions to hematopoietic stem cell donation have been extensively studied, but less is known about factors that predict poorer donation experiences. The aim of this prospective study was to examine demographic and health-related quality of life (HRQOL) factors that might be associated with recovery and side effects. We also described the changes in HRQOL during the donation process. In total, 275 peripheral blood stem cell (PBSC) and 37 bone marrow (BM) consecutive donors completed the SF-36 questionnaire predonation and 4 weeks, and 3 months postdonation. Predonation HRQOL markers were the strongest predictors of time to recovery. Poorer predonation physical health was associated with longer recovery (P = .017) and certain side effects in PBSC donors. Poorer predonation mental health was associated with longer recovery in BM donors (P = .03) and pain after PBSC donation (P = .003). Physical HRQOL scores declined significantly from predonation to 4 weeks postdonation. This was shown both for PBSC and BM donors (P < .001 and P = .009, respectively), but the decline was much greater for BM donors. There was a return to predonation HRQOL values 3 months after donation in both groups with values well above the mean of the general population (P < .001).
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Affiliation(s)
- Annelies Billen
- UCL Cancer Institute and Anthony Nolan Research Institute, London, United Kingdom.
| | - J Alejandro Madrigal
- UCL Cancer Institute and Anthony Nolan Research Institute, London, United Kingdom
| | - Andre Strydom
- UCL Mental Health Sciences Unit, London, United Kingdom
| | - Richard M Szydlo
- Department of Medicine, Imperial College London, London, United Kingdom
| | - Galen E Switzer
- Department of General Internal Medicine, University of Pittsburgh and Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Bronwen E Shaw
- UCL Cancer Institute and Anthony Nolan Research Institute, London, United Kingdom; Department of Haematology, Royal Marsden Hospital, London, United Kingdom
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24
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Eapen M. Unrelated donor transplantation: Peripheral blood or bone marrow – Does it matter? Best Pract Res Clin Haematol 2014; 27:278-82. [DOI: 10.1016/j.beha.2014.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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26
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Lower risk for serious adverse events and no increased risk for cancer after PBSC vs BM donation. Blood 2014; 123:3655-63. [PMID: 24735965 DOI: 10.1182/blood-2013-12-542464] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We compared serious early and late events experienced by 2726 bone marrow (BM) and 6768 peripheral blood stem cell (PBSC) donors who underwent collection of PBSC or BM between 2004 and 2009 as part of a prospective study through the National Marrow Donor Program. Standardized FDA definitions for serious adverse events (SAEs) were used, and all events were reviewed by an independent physician panel. BM donors had an increased risk for SAEs (2.38% for BM vs 0.56% for PBSC; odds ratio [OR], 4.13; P < .001), and women were twice as likely to experience an SAE (OR for men, 0.50; P = .005). Restricting the analysis to life-threatening, unexpected, or chronic/disabling events, BM donors maintained an increased risk for SAEs (0.99% for BM vs 0.31% for PBSC; OR, 3.20; P < .001). Notably, the incidence of cancer, autoimmune illness, and thrombosis after donation was similar in BM vs PBSC donors. In addition, cancer incidence in PBSC donors was less than that reported in the general population (Surveillance, Epidemiology, and End Results Program database). In conclusion, SAEs after donation are rare but more often occurred in BM donors and women. In addition, there was no evidence of increased risk for cancer, autoimmune illness, and stroke in donors receiving granulocyte colony-stimulating factor during this period of observation.
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27
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Cheuk DKL. Optimal stem cell source for allogeneic stem cell transplantation for hematological malignancies. World J Transplant 2013; 3:99-112. [PMID: 24392314 PMCID: PMC3879529 DOI: 10.5500/wjt.v3.i4.99] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 11/15/2013] [Accepted: 12/11/2013] [Indexed: 02/05/2023] Open
Abstract
Hematopoietic stem cell transplant (HSCT) is a standard treatment for many hematological malignancies. Three different sources of stem cells, namely bone marrow (BM), peripheral blood stem cells (PBSC) and cord blood (CB) can be used for HSCT, and each has its own advantages and disadvantages. Randomized controlled trials (RCTs) suggest that there is no significant survival advantage of PBSC over BM in Human Leukocyte Antigen-matched sibling transplant for adult patients with hematological malignancies. PBSC transplant probably results in lower risk of relapse and hence better disease-free survival, especially in patients with high risk disease at the expense of higher risks of both severe acute and chronic graft-versus-host disease (GVHD). In the unrelated donor setting, the only RCT available suggests that PBSC and BM result in comparable overall and disease-free survivals in patients with hematological malignancies; and PBSC transplant results in lower risk of graft failure and higher risk of chronic GVHD. High level evidence is not available for CB in comparison to BM or PBSC. The risks and benefits of different sources of stem cells likely change with different conditioning regimen, strategies for prophylaxis and treatment of GVHD and manipulation of grafts. The recent success and rapid advance of double CB transplant and haploidentical BM and PBSC transplants further complicate the selection of stem cell source. Optimal selection requires careful weighing of the risks and benefits of different stem cell source for each individual recipient and donor. Detailed counseling of patient and donor regarding risks and benefits in the specific context of the patient and transplant method is essential for informed decision making.
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