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.