Differences between graft product and donor side effects following bone marrow or stem cell donation

Area of Science:

• Hematology
• Transplantation Immunology
• Cellular Therapy

Background:

• Allogeneic stem cell transplantation is a critical treatment for hematologic malignancies and other diseases.
• Peripheral blood stem cell (PBSC) and bone marrow (BM) are primary sources for hematopoietic stem cell transplantation.
• Optimizing donor collection procedures is essential for both graft quality and donor safety.

Purpose of the Study:

• To compare graft product stem cell yields and donor safety between filgrastim-mobilized PBSC and BM donation.
• To evaluate the clinical outcomes and donor experience in a randomized multicenter study.

Main Methods:

• A randomized multicenter study involving 329 matched HLA-identical sibling donors.
• Donors were randomized to either filgrastim-mobilized PBSC or BM donation.
• Quantification of CD34(+) cells, T cells, and NK cells, along with assessment of donor hospital stay, restricted activity, and adverse events (AEs).

Main Results:

• PBSC donation yielded approximately two-fold higher CD34(+) cells, eight-fold higher T cells, and over eight-fold higher NK cells compared to BM donation (P<0.001).
• PBSC donors had a shorter median hospital stay (0 vs 2 days) and fewer days of restricted activity (2 vs 6 days) than BM donors.
• While 65% of PBSC donors and 57% of BM donors reported AEs, most were transient and mild-moderate, with PBSC AEs predominantly filgrastim-related and BM AEs harvest-related.

Conclusions:

• Filgrastim-mobilized PBSC donation is superior to BM donation in terms of stem cell yields (CD34(+), T cells, NK cells).
• PBSC donation offers significant advantages in donor comfort, with reduced hospital time and activity restrictions.
• Both donation methods are associated with manageable AEs, supporting PBSC as an effective and well-tolerated alternative to BM donation.