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Donor Identification

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

Summary:

Many patients do not reach haematopoietic stem cell transplantation. Shortage of unrelated donors (UDs) is still seen as the main cause. However, with a worldwide UD pool containing more than 8 million donors, it is possible that other impediments are becoming more important. We analysed 549 UD searches for Dutch patients, performed between 1987 and 2000, in order to find the reasons for failure or success to reach transplantation. Between 1996 and 2000, 59% of the patients of Northwest European origin received a graft from an UD with a median time span of 4.4 months from the start of the search. In all, 11% of the patients lacked a compatible donor, while 30% became medically unfit for transplantation. This is in contrast to the patients of non-Northwest European origin for whom UD shortage is still the most important impediment; only 32% were transplanted while 50% lacked a compatible donor. We conclude that the shortage of donors is no longer the biggest constraint in unrelated stem cell transplantation for patients of Northwest European origin. It may be more effective to optimize the chance on transplantation by making the search process more efficient.

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References

  1. Gratwohl A, Baldomero H, Horisberger B et al. Current trends in hematopoietic stem cell transplantation in Europe. Blood 2002; 100: 2374–2386.

    Article  CAS  Google Scholar 

  2. World Marrow Donor Association. Donor Registries Annual Report, 6th edn. World Marrow Donor Association Donor Registries Working group: Leiden, 2002.

  3. Bone Marrow Donors Worldwide. www.bmdw.org.

  4. Ottinger H, Grosse-Wilde M, Schmitz A, Grosse-Wilde H . Immunogenetic marrow donor search for 1012 patients: a retrospective analysis of strategies, outcome and costs. Bone Marrow Transplant 1994; 14 (Suppl. 4): S34–S38.

    PubMed  Google Scholar 

  5. Dini G, Lanino E, Lamparelli T, et al. Unrelated donor marrow transplantation: initial experience of the Italian bone marrow transplant group (GITMO). Bone Marrow Transplant 1996; 17: 55–62.

    CAS  Google Scholar 

  6. Oudshoorn M, Cornelissen JJ, Fibbe WE et al. Problems and possible solutions in finding an unrelated bone marrow donor. Results of consecutive searches for 240 Dutch patients. Bone Marrow Transplant 1997; 20: 1011–1017.

    Article  CAS  Google Scholar 

  7. Howe CWS, Radde-Stepaniak T . Hematopoietic cell donor registries. In: Thomas ED, Blume KG, Forman SJ (eds). Hematopoietic Cell Transplantation, 2nd edn. Blackwell Science: Malden, MA, USA, 1999, pp. 503–512.

    Google Scholar 

  8. Dini G, Cancedda R, Locatelli F et al. Unrelated donor marrow transplantation: an update of the experience of the Italian Bone Marrow Transplant Group (GITMO). Haematologica 2000; 85 (Suppl.): 30–36.

    CAS  PubMed  Google Scholar 

  9. Barker JN, Krepski TP, DeFor TE et al. Searching for unrelated donor hematopoietic stem cells: availability and speed of umbilical cord blood versus bone marrow. Biol Blood Marrow Transplant 2002; 8: 257–260.

    Article  Google Scholar 

  10. Hurley CK, Vina MF, Setterholm M . Maximizing optimal hematopoietic stem cell donor selection from registries of unrelated adult volunteers. Tissue Antigens 2003; 61: 415–424.

    Article  CAS  Google Scholar 

  11. Dini G, Valsecchi MG, Micalizzi C et al. Impact of marrow unrelated donor search duration on outcome of children with acute lymphoblastic leukemia in second remission. Bone Marrow Transplant 2003; 32: 325–331.

    Article  CAS  Google Scholar 

  12. Schipper RF, D'Amaro J, Oudshoorn M . The probability of finding a suitable related donor for bone marrow transplantation in extended families. Blood 1996; 87: 800–804.

    CAS  PubMed  Google Scholar 

  13. van der Meer A, Joosten I, Schattenberg AV et al. Cytotoxic T-lymphocyte precursor frequency (CTLp-f) as a tool for distinguishing permissible from non-permissible class I mismatches in T-cell-depleted allogeneic bone marrow transplantation. Br J Haematol 2000; 111: 685–694.

    Article  CAS  Google Scholar 

  14. Oudshoorn M, Doxiadis II, van den Berg-Loonen PM et al. Functional vs structural matching: can the CTLp test be replaced by HLA allele typing? Hum Immunol 2002; 63: 176–184.

    Article  CAS  Google Scholar 

  15. van Walraven SM, Heemskerk MBA, Lie JLWTj et al. The importance of identifying a back-up donor for unrelated stem cell transplantation. Bone Marrow Transplant 2005; 35: 437–440.

    Article  CAS  Google Scholar 

  16. Klein JP, Rizzo JD, Zhang MJ, Keiding N . Statistical methods for the analysis and presentation of the results of bone marrow transplants. Part I: unadjusted analysis. Bone Marrow Transplant 2001; 28: 909–915.

    Article  CAS  Google Scholar 

  17. Confer DL . The National Marrow Donor Program. Meeting the needs of the medically underserved. Cancer 2001; 91 (Suppl.): 274–278.

    Article  CAS  Google Scholar 

  18. Müller CR, Ehninger G, Goldmann SF . Gene and haplotype frequencies for the loci HLA-A, HLA-B, and HLA-DR based on over 13,000 German blood donors. Hum Immunol 2003; 64: 137–151.

    Article  Google Scholar 

  19. Petersdorf EW, Gooley TA, Anasetti C, et al. Optimizing outcome after unrelated marrow transplantation by comprehensive matching of HLA class I and II alleles in the donor and recipient. Blood 1998; 92: 3515–3520.

    CAS  Google Scholar 

  20. Petersdorf EW, Anasetti C, Martin PJ, Hansen JA . Tissue typing in support of unrelated hematopoietic cell transplantation. Tissue Antigens 2003; 61: 1–11.

    Article  CAS  Google Scholar 

  21. Morishima Y, Sasazuki T, Inoko H et al. The clinical significance of human leukocyte antigen (HLA) allele compatibility in patients receiving a marrow transplant from serologically HLA-A, HLA-B, and HLA-DR matched unrelated donors. Blood 2002; 99: 4200–4206.

    Article  CAS  Google Scholar 

  22. Beatty PG, Mori M, Milford E . Impact of racial genetic polymorphism on the probability of finding an HLA-matched donor. Transplantation 1995; 60: 778–783.

    Article  CAS  Google Scholar 

  23. Armitage S, Warwick R, Fehily D et al. Cord blood banking in London: the first 1000 collections. Bone Marrow Transplant 1999; 24: 139–145.

    Article  CAS  Google Scholar 

  24. Barker JN, Davies SM, DeFor T et al. Survival after transplantation of unrelated donor umbilical cord blood is comparable to that of human leukocyte antigen-matched unrelated donor bone marrow: results of a matched-pair analysis. Blood 2001; 97: 2957–2961.

    Article  CAS  Google Scholar 

  25. Gluckman E . Hematopoietic stem-cell transplants using umbilical-cord blood. N Engl J Med 2001; 344: 1860–1861.

    Article  CAS  Google Scholar 

  26. Laughlin MJ, Barker J, Bambach B et al. Hematopoietic engraftment and survival in adult recipients of umbilical-cord blood from unrelated donors. N Engl J Med 2001; 344: 1815–1822.

    Article  CAS  Google Scholar 

  27. Rubinstein P, Stevens CE . The New York Blood Center's Placental/Umbilical Cord Blood Program. Experience with a ‘new’ source of hematopoietic stem cells for transplantation. Ernst Schering Res Found Workshop 2001; 33: 47–70.

    Google Scholar 

  28. Michel G, Rocha V, Chevret S et al. Unrelated cord blood transplantation for childhood acute myeloid leukemia: a Eurocord group analysis. Blood 2003; 102: 4290–4297.

    Article  CAS  Google Scholar 

  29. Souillet G, Rey S, Bertrand Y et al. Outcome of unrelated bone marrow donor searches in 174 children resulting in 45 patients transplanted in the HLA-matched and -mismatched situation. Bone Marrow Transplant 2000; 26: 31–43.

    Article  CAS  Google Scholar 

  30. Oudshoorn M, Falkenburg JH, Ebeling LJ et al. Unrelated bone marrow transplantation as a rescue procedure following inadvertent loss of an autologous bone marrow graft. Bone Marrow Transplant 1996; 18: 461–463.

    CAS  PubMed  Google Scholar 

  31. Lane TA . Cord blood banking and transplantation: state-of-the-art review and future directions. Cytotherapy 2003; 5: 572–576.

    Google Scholar 

  32. United States General Accounting Office. Bone marrow transplants, despite recruitment successes, national program may be underutilized. October 2002 (GAO-03-182).

  33. Martelli MF, Aversa F, Velardi A, Reisner Y . HLA-mismatched family member hematopoietic stem cell transplantation. In: Atkinson K, Champlin R, Ritz J, Fibbe WE, Ljungman P, Brenner MK (eds). Clinical Bone Marrow and Blood Stem Cell Transplantation, 3rd edn. Cambridge University Press: Cambridge, 2004, pp 1011–1026.

    Google Scholar 

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Acknowledgements

We thank Drs DL Roelen and GMTh Schreuder and Professor A Brand for their constructive comments on this manuscript, and EJMA van Hoof for his editorial corrections of the English language.

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Correspondence to M B A Heemskerk.

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Heemskerk, M., van Walraven, S., Cornelissen, J. et al. How to improve the search for an unrelated haematopoietic stem cell donor. Faster is better than more!. Bone Marrow Transplant 35, 645–652 (2005). https://doi.org/10.1038/sj.bmt.1704865

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