Related Donor Screening: An Increasingly Complex Process

Related Donor Screening � An Increasingly Complex Process

Tara Wolff, Molly Maloy, Shannon Andersen, Abigail Cohen, Shani Irby,� Nicole Lestrange, �Megan Scott,����������������������������������������������� Sergio Giralt, Ann A. Jakubowski

Memorial Sloan-Kettering Cancer Center, and Weill Cornell Medical College, Cornell University New York, NY, USA

�Allogeneic hematopoietic stem cell transplantation is being employed as a life-saving procedure for greater numbers of patients each year.� Outpatient, reduced intensity transplants and haplo-matched transplants, recognition of limited efficacy for chemotherapy in high risk diseases, and extending the age limit for adults have all contributed to the growing numbers. �As a consequence, the demand for donor screening resources has also increased.� The National Marrow Donor Programs (NMDP) has published the Assessment Tool at Workup) that has been recommended for use in determining eligibility of unrelated donors.� In order to avoid the risk of bias in determining eligibility of related donors, the same criteria are being applied to them at many centers.� As a referral center for complex transplants and increasing numbers of donors, we reviewed the outcomes of related donor screening and need for �additional' testing.

All donors were evaluated through a nurse practitioner-based clinic with physician backup.� �All donors were evaluated for bone marrow as well as peripheral blood donation regardless of the requested product.� Sixty-two related potential donors were screened at MSKCC from February through September 2014.� The median age was 48yrs and they were equally divided between males and females. �Their demographics and outcomes are described in Table 1.� Based on initial routine screening studies and utilizing the NMDP guidelines 15 donors (24%) were deemed eligible and cleared for donation; 6 were ineligible according to the NMDP guidelines for the following diagnoses: sickle cell trait, systemic lupus, multiple sclerosis, history of cervical cancer, babesiosis, and brain arteriovenous malformation. Forty-seven (76%) donors did not clear initially and 45 required additional evaluation based on ≥ 1 abnormalities.(Table 2). �These may have included laboratory or imaging studies, informal or formal subspecialty consultation or �other studies' such as bone marrow procedure. ��Notably only 1/14 foreign born donors cleared following initial evaluation.� Forty-four (71%) donors actually donated, 4 of whom were deemed ineligible but were used.�� In all but 13 cases, the additional testing led to clearance.

Conclusions:� 1) The process of donor clearance has become more complex and resource demanding.� 2) Care should be taken in selecting donors for screening to avoid unnecessary added costs to the transplant. �