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Haematologica. 2019 Apr;104(4):844-854. doi: 10.3324/haematol.2018.200121. Epub 2018 Oct 31.

Related peripheral blood stem cell donors experience more severe symptoms and less complete recovery at one year compared to unrelated donors.

Author information

1
Children's Hospital Los Angeles, CA mpulsipher@chla.usc.edu.
2
Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI.
3
Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN.
4
University of North Carolina Hospitals, Division of Hematology and Oncology Chapel Hill, NC.
5
Department of Stem Cell Transplantation and Cell Transplantation and Cellular Therapy, Division of Cancer Medicine, MD Anderson Cancer Center, Houston, TX.
6
Department of Transfusion Medicine, National Institutes of Health Clinical Center, Bethesda, MD.
7
National Marrow Donor Program/Be The Match, Minneapolis, MN.
8
Department of Pediatrics and Human Development, Helen DeVos Children's Hospital, Grand Rapids, MI.
9
Department of Hematology and Oncology, Children's Mercy Hospitals and Clinics, Kansas City, MO.
10
Indiana Blood and Marrow Transplantation, Indianapolis, IN.
11
University of Chicago Hospitals, IL.
12
University of California, San Diego Medical Center, La Jolla, CA.
13
North Shore University Hospital, Manhasset, NY.
14
University of Mississippi Medical Center, Jackson, MS.
15
Taussig Cancer Institute, Cleveland Clinic Foundation, OH.
16
Jewish Hospital, Cincinnati, OH.
17
Indiana University Hospital/Riley Hospital for Children, IN.
18
Wake Forest University Baptist Medical Center, Winston-Salem, NC.
19
Division of Pediatric Blood and Marrow Transplantation, University of California San Francisco Benioff Children's Hospital, CA.
20
Roswell Park Cancer Institute, Buffalo, NY.
21
Aflac Cancer and Blood Disorders Center, Division of Hematology/Oncology-Bone Marrow Pediatric Hematology & Medical Oncology, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA.
22
Department of Medicine, Medical College of Wisconsin, Milwaukee, WI.
23
Doernbecher Children's Hospital, Oregon Health & Science University, Portland, OR.
24
Children's National Medical Center, Washington DC.
25
Memorial Sloan Kettering Cancer Center - Adult, New York, NY.
26
Pediatric Hematology Oncology Program, Bone Marrow and Stem Cell Transplantation Program, University of North Carolina Healthcare, Chapel Hill, NC.
27
Seidman Cancer Center-University Hospitals Cleveland Medical Center, OH.
28
Strong Memorial Hospital - University of Rochester Medical Center, NY.
29
Division of Hematology, Fred Hutchinson Cancer Research Center, Seattle, WA.
30
Division of Hematology, Mayo Clinic Rochester, MN.
31
University of Wisconsin Hospital and Clinics, Madison, WI.
32
Blood and Marrow Transplant Program, University of Iowa Hospitals & Clinics, Iowa City, IA.
33
Virginia Commonwealth University Massey Cancer Center Bone Marrow Transplant Program, Richmond, VA.
34
University of Kansas, Westwood, KS.
35
Florida Hospital Cancer Institute, Florida Center for Cellular Therapy, Orlando, FL.
36
Avera McKennan Transplant Institute, Sioux Falls, SD.
37
Duke Cancer Institute, Duke University Medical Center, Durham, NC.
38
Hackensack University Medical Center, Washington DC.
39
Penn State Health Milton S. Hershey Medical Center, PA.
40
Cohen Children's Medical Center of New York, New Hyde Park, NY.
41
Cancer Transplant Institute Honor Health, Scottsdale, AZ.
42
HCA Health Services of Oklahoma, Inc., University of Oklahoma, Oklahoma City, OK.
43
Texas Transplant Institute, San Antonio, TX.
44
Division of Hematology/Oncology, St. Louis Children's Hospital, MO.
45
Massachusetts General Hospital, Boston, MA.
46
Ann & Robert H. Lurie Children's Hospital of Chicago, IL.
47
Karmanos Cancer Institute, Detroit, MI.
48
Division of Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas, TX.
49
Emory University Hospital, Atlanta, GA.
50
University of Minnesota Medical Center, Fairview, Minneapolis, MN.
51
The University of Michigan, Ann Arbor, MI.
52
Division of General Internal Medicine, University of Pittsburgh, PA, USA.

Abstract

Unlike unrelated donor registries, transplant centers lack uniform approaches to related donor assessment and deferral. To test whether related donors are at increased risk for donation-related toxicities, we conducted a prospective observational trial of 11,942 related and unrelated donors aged 18-60 years. Bone marrow (BM) was collected at 37 transplant and 78 National Marrow Donor Program centers, and peripheral blood stem cells (PBSC) were collected at 42 transplant and 87 unrelated donor centers in North America. Possible presence of medical comorbidities was verified prior to donation, and standardized pain and toxicity measures were assessed pre-donation, peri-donation, and one year following. Multivariate analyses showed similar experiences for BM collection in related and unrelated donors; however, related stem cell donors had increased risk of moderate [odds ratios (ORs) 1.42; P<0.001] and severe (OR 8.91; P<0.001) pain and toxicities (OR 1.84; P<0.001) with collection. Related stem cell donors were at increased risk of persistent toxicities (OR 1.56; P=0.021) and non-recovery from pain (OR 1.42; P=0.001) at one year. Related donors with more significant comorbidities were at especially high risk for grade 2-4 pain (OR 3.43; P<0.001) and non-recovery from toxicities (OR 3.71; P<0.001) at one year. Related donors with more significant comorbidities were at especially high risk for grade 2-4 pain (OR 3.43; P<0.001) and non-recovery from toxicities (OR 3.71; P<0.001) at one year. Related donors reporting grade ≥2 pain had significant decreases in Health-Related Quality of Life (HR-QoL) scores at one month and one year post donation (P=0.004). In conclusion, related PBSC donors with comorbidities are at increased risk for pain, toxicity, and non-recovery at one year after donation. Risk profiles described in this study should be used for donor education, planning studies to improve the related donor experience, and decisions regarding donor deferral. Registered at clinicaltrials.gov identifier:00948636.

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