Evaluation of the hematopoietic cell transplantation donor
- Joseph H Antin, MD
Joseph H Antin, MD
- Professor of Medicine, Harvard Medical School
- Chief, Stem Cell Transplantation Program, Dana-Farber/Brigham and Women’s Cancer Center
- Christine N Duncan, MD
Christine N Duncan, MD
- Assistant Professor of Pediatrics
- Harvard Medical School
Allogeneic hematopoietic cell transplantation is an important and potentially curative treatment option for a wide variety of malignant and nonmalignant disorders. The multipotent hematopoietic stem cells required for this procedure are usually obtained from the bone marrow, peripheral blood, or umbilical cord blood of a related or unrelated donor. The hematopoietic products used for transplantation have a mixture of very primitive stem cells and more mature committed progenitor cells; these two levels of maturation of hematopoietic cells cannot be distinguished morphologically. The term "hematopoietic cell transplantation" (HCT) will be used throughout this review as a general term to cover transplantation of hematopoietic progenitor/stem cells from any source (eg, bone marrow, peripheral blood, umbilical cord blood). Otherwise, the source of such cells will be specified (eg, autologous peripheral blood stem/progenitor cell transplantation). The peripheral blood hematopoietic product will be termed PBPC (peripheral blood progenitor cells) recognizing that stem cells must be present for long-term hematopoietic engraftment. (See "Sources of hematopoietic stem cells".)
In contrast to most organ transplantation, hematopoietic stem cells are a renewable resource that, with the exception of umbilical cord blood donation, requires the participation of a donor. It is critical that the donor evaluation determine both that the collection procedure is safe for the donor and the recipient. This is particularly important as advances in transplantation have resulted in an increase in allowable patient age into the seventh decade, which increases the likelihood that potential sibling donors will be older and have co-morbidities that could affect the health of either the donor or the recipient.
This topic will review the evaluation of a potential donor that has been identified as an appropriate match for a transplant recipient. The general issues involved in donor selection for allogeneic HCT and the use of umbilical cord blood for transplantation are discussed separately. (See "Donor selection for hematopoietic cell transplantation" and "Collection and storage of umbilical cord blood for hematopoietic cell transplantation" and "Selection of an umbilical cord blood graft for hematopoietic cell transplantation" and "HLA-haploidentical hematopoietic cell transplantation", section on 'Donor selection for haploidentical HCT'.)
CANDIDACY FOR DONATION
Donor guidelines — In the United States, unrelated donors are evaluated to comply with guidelines and regulations from the US Food and Drug Administration (FDA), the Joint Commission (TJC), the American Association of Blood Banks (AABB), the National Marrow Donor Program (NMDP), and the Foundation for the Accreditation of Cellular Therapy (FACT) guidelines and regulations. Guidelines for donor health are available on the BeTheMatch website. This set of guidelines is somewhat more restrictive than standard requirements for related donor transplantation. For instance, donors older than 60 years may be acceptable for related donor transplantation but are excluded by the NMDP. At times, if the risk is considered acceptable, related donors with autoimmune diseases, diabetes related complications, and other medical issues may be used within families but are excluded for unrelated donors.
Donors are assessed for medical suitability and donor eligibility. Medical suitability pertains specifically to the donor's physical health and the possibility of transmitting an inherited or acquired condition. Donor eligibility refers specifically to an FDA required assessment for the increased risk for transmission of relevant communicable diseases. The evaluation for medical suitability and donor eligibility includes a physical examination, directed medical history, a review of available medical records, infectious disease testing, and additional testing that may be warranted by virtue of any underlying pre-existent conditions. Risk of transmission of infectious or other diseases does not necessarily disqualify a donor; however, the recipient must be informed of the potential risk. Often, the stringent prohibition of donors at risk of transmitting communicable diseases is waived if use of the donor is determined to be in the best interest of the patient.
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- CANDIDACY FOR DONATION
- Donor guidelines
- Assessing for risks to the recipient
- Informed consent
- Assessing for risks to the donor
- - Psychological effects
- - Bone marrow donation
- Preoperative assessment
- Bone marrow collection
- - Peripheral blood progenitor cell (PBPC) collection
- Toxicity of PBPC donation
- Safety of filgrastim in normal healthy donors
- WHICH PRODUCT IS PREFERRED?
- CHILDREN AS DONORS
- Potential risks and benefit to minor donors
- Selection of a minor donor
- SECOND DONATIONS
- Graft failure
- Immune therapy
- INFORMATION FOR PATIENTS