Related PBSC Donors Age >60 Have High Rates of Baseline and Donation-Related Pain and Slow Recovery: First Report from the Related Donor Safety Study (RDSafe)

As the use of hematopoietic cell transplantation (HCT) in older patients has increased over the past decade, so too have donations from their older siblings.   Prospective data addressing the experiences of older donors are limited, though such donors are more likely than younger donors to have comorbidities, and are often motivated to give in spite of potential risks.  To address this lack of data, the NHLBI-funded Related Donor Safety Study (RDSafe) prospectively enrolled related donors of all ages between 2010-2013 at 54 transplant centers in the United States, assessed their pre-donation comorbidities and health status, and followed them for 1 year after donation, collecting detailed information on pain levels and 12 additional frequently noted symptoms, e.g., nausea, vomiting, insomnia.  This report describes early experiences of 256 donors age >60.

Results: At baseline there were high rates of pre-G-CSF pain and symptoms in older donors, with 28% experiencing grades 1-3 pain and 17% grades 1-3 symptoms (baseline rates from earlier NMDP data for 41-60 year olds were 9% and 5%, respectively, with no grade 3 or greater).  Peak rates of all grades of pain and symptoms at day 5 of G-CSF (day 1 of collection) were 69% and 49%, respectively (see figure).  Of note, 11% experienced grades 3-4 pain; in contrast, for 41-60 year old NMDP donors, 89% experienced any grade pain; 3%, grade 3-4 pain.  Assessment at 1 month showed that 68% and 78% of older donors had returned to baseline pain and other symptom levels while 16% and 6% still reported grade 2-3 pain and symptoms, respectively (NMDP recovery: 96% at 1 month for both).  Univariate analysis of the effect of gender, race, age, and baseline rates of pain and symptoms on G-CSF-related pain and symptoms, and return to baseline at one month was performed.  Donors with grade 2-3 pain at baseline (only 3 donors had grade 3) were more likely to experience grade 2-4 pain (62 vs. 28%; p=0.001) and grade 2-4 symptoms (35 vs. 14%; p=0.01) on day 5 of G-CSF. Female donors showed lower rates of return to baseline symptom levels at one month (72 vs. 85%, female vs. male; p=0.028). Race and ages 61-65, 66-70, and 71+ had no effect. 

Conclusions:  Related donors over age 60 have high baseline rates of pain and other symptoms.  Their rate of any grade pain is lower but grade 3-4 pain is higher on the day of collection and recovery at one month is slower than noted in past studies of younger unrelated donors. Donors with baseline pain are at risk of experiencing higher levels of pain and symptoms during the collection process, and women recover more slowly than men. Additional analyses including baseline organ-specific comorbidities and multivariable analysis of risk will be presented with these data.

Figure 1.  Pain and Symptoms Pre-, During, and Post-Collection in Older Related Donors