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Outcomes of strategic alternative donor selection or suspending donor search based on Japan Marrow Donor Program

Naomi Kawashima1,2, Satoshi Nishiwaki3, Naoko Shimizu4

  • 1Department of Hematology, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, Aichi, 453-8511, Japan. nkawashima@med.nagoya-u.ac.jp.

International Journal of Hematology
|January 29, 2018
PubMed

Insights

Delays in unrelated donor searches for allogeneic hematopoietic stem cell transplantation (allo-HSCT) impact outcomes. Switching to alternative donors may benefit high-risk patients, showing similar survival rates to those receiving matched unrelated donors.

Area of Science:

  • Hematology
  • Transplantation Immunology
  • Clinical Oncology

Background:

  • Unrelated donor stem cell transplantation is crucial for patients lacking matched siblings.
  • Donor search delays in allogeneic hematopoietic stem cell transplantation (allo-HSCT) negatively affect patient survival.
  • Optimal timing for unrelated donor searches versus alternative donor selection in allo-HSCT is not well-defined.

Purpose of the Study:

  • To evaluate the impact of unrelated donor search duration on patient outcomes in allo-HSCT.
  • To compare survival rates between patients receiving allo-HSCT from matched unrelated donors, alternative donors, or those who suspended transplantation.
  • To determine if alternative donor sources offer a survival benefit for high-risk patients undergoing allo-HSCT.

Main Methods:

  • Retrospective analysis of 349 adult patients from the Japan Marrow Donor Program (JMDP) registry.
  • Categorization of patients into three groups: allo-HSCT from JMDP donors (Group A), allo-HSCT from alternative sources (Group B), and suspended allo-HSCT (Group C).
  • Comparison of 5-year overall survival (OS) rates across the three groups, considering disease risk index (DRI).

Main Results:

  • Group A (JMDP donors) had a significantly higher 5-year OS rate (48.6%) compared to Group C (suspended) (38.5%).
  • Group B (alternative donors) showed a similar 5-year OS rate (40.9%) to Group A (48.6%), despite including more patients with high or very high DRI.
  • The median time to donor identification was 140 days for Group A and 111.5 days for Group B.

Conclusions:

  • Waiting for a matched unrelated donor (JMDP) improves survival compared to suspending allo-HSCT.
  • Utilizing alternative donor sources can achieve comparable survival outcomes to matched unrelated donors, particularly for high-risk patients.
  • These findings support the consideration of alternative donors to mitigate risks associated with prolonged unrelated donor searches in allo-HSCT.

Keywords:
Allogeneic hematopoietic stem cell transplantationBone marrow transplantationJMDPUnrelated donor

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