Bone marrow harvesting for allogeneic transplantation – evaluation of ten years’ experience focusing on donor auto-transfusion utilisation
Authors:
L. Hejretová 1; D. Lysák 1; M. Hrabětová 1; P. Jindra 1,2
Authors‘ workplace:
Hematologicko-onkologické oddělení, Fakultní nemocnice Plzeň
1; Český národní registr dárců dřeně
2
Published in:
Transfuze Hematol. dnes,25, 2019, No. 4, p. 350-360.
Category:
Original Papers
Overview
Bone marrow (BM) is one of the sources of hematopoietic stem cells used for allogeneic transplantation. In this retrospective study, we analysed bone marrow harvests in 216 healthy donors over a ten-year period (2007–2017). Larger volumes of bone marrow were obtained from male compared to female donors (1300 ml vs. 1100 ml) due to their higher body weight, resulting in a higher number of nucleated cells (156 vs. 124 x 106 TNC, ns). The total yield was dependent on the volume of marrow (p < 0.0001) and donor weight (p = 0.01). Suboptimal grafts containing ≤ 2.0 x 108 TNC/kg (recipient) were collected in 6 % of cases, always with significant differences of weight between donor and recipient (median 20 kg). All donors underwent preoperative autologous blood donation (PAD). The initial haemoglobin level of 153 g/L (male donors) and 135 g/L (female donors) decreased by about 8 g/L after preoperative blood donation and by 23 g/L after bone marrow harvest. Auto-transfusion was administered to 70 % of donors, 30 % of the units remained unused. Evaluation of the risk of reaching transfusion threshold (<115 g/L males, < 105 g/L females) revealed that donors with initial haemoglobin level above 145 g/L and those weighing more than 75 kg have a minimal risk of requiring blood substitution (about 10 %). The incidence of adverse events associated with bone marrow harvests was low (5 %) and none of these were classified as serious. The analysis proved that the amount of nucleated cells harvested and substitution requirements are determined by donor parameters (weight, haemoglobin level) and recipient parameters (weight). Given the changing policy to auto-transfusion during bone marrow collection, the issue of balancing the benefits and risks of administering preoperative autologous transfusion should be addressed.
Keywords:
CD34+ – bone marrow – harvest – allogeneic – preoperative autologous blood donation – donor
Sources
1. Passweg JR, Baldomero H, Basak GW, et al. The EBMT activity survey report 2017: a focus on allogeneic HCT for nonmalignant indications and on the use of non-HCT cell therapies. Bone Marrow Transplant 2019; doi:10.1038/s41409-019-0465-9.
2. Blaise D, Kuentz M, Fortanier C, et al. Randomized trial of bone marrow versus lenograstim-primed blood cell allogeneic transplantation in patients with early-stage leukemia: a report from the Societe Francaise de Greffe de Moelle. J Clin Oncol 2000;18:537–546.
3. Anasetti C, Logan BR, Lee SJ, et al. Peripheral-blood stem cells versus bone marrow from unrelated donors. N Engl J Med 2012;367:1487–1496.
4. Nagler A, Labopin M, Shimoni A, et al. Mobilized peripheral blood stem cells compared with bone marrow as the stem cell source for unrelated donor allogeneic transplantation with reduced-intensity conditioning in patients with acute myeloid leukemia in complete remission: an analysis from the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation. Biol Blood Marrow Transplant 2012;18:1422–1429.
5. Holtick U, Albrecht M, Chemnitz JM, et al. Comparison of bone marrow versus peripheral blood allogeneic hematopoietic stem cell transplantation for hematological malignancies in adults – a systematic review and meta-analysis. Crit Rev Oncol Hematol 2015;94:179–188.
6. Savani BN, Labopin M, Blaise D, et al. Peripheral blood stem cell graft compared to bone marrow after reduced intensity conditioning regimens for acute leukemia: a report from the ALWP of the EBMT. Haematologica 2016;101:256–262.
7. Lee SJ, Logan B, Westervelt P, et al. Comparison of patient-reported outcomes in 5-year survivors who received bone marrow vs peripheral blood unrelated donor transplantation: long-term follow-up of a randomized clinical trial. JAMA Oncol 2016;2:1583–1589.
8. Eapen M, Logan BR, Horowitz MM, et al. Bone marrow or peripheral blood for reduced-intensity conditioning unrelated donor transplantation. J Clin Oncol 2015;33:364–369.
9. Byrne M, Savani BN, Mohty M, Nagler A. Peripheral blood stem cell versus bone marrow transplantation: A perspective from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Exp Hematol 2016;44:567–573.
10. Miller JP, Perry EH, Price TH, et al. Recovery and safety profiles of marrow and PBSC donors: experience of the National Marrow Donor Program. Biol Blood Marrow Transplant 2008;14:29–36.
11. Switzer GE, Bruce JG, Harrington D, et al. Health–related quality of life of bone marrow versus peripheral blood stem cell donors: a prespecified subgroup analysis from a phase III RCT – BMTCTN Protocol 0201. Biol Blood Marrow Transplant 2013;20:118–127.
12. Spitzer TR, Areman EM, Cirenza E, et al. The impact of harvest center on quality of marrows collected from unrelated donors. J Hematother 1994;3:65–70.
13. Parkkali T, Juvonen E, Volin L, et al. Collection of autologous blood for bone marrow donation: how useful is it? Bone Marrow Transplant 2005;35:1035–1039.
14. Mijovic A, Britten C, Regan F, et al. Preoperative autologous blood donation for bone marrow harvests: Are we wasting donors time and blood? Transfusion Med 2006;16:57–62.
15. Arora K, Kelley J, Martinez F, et al. Preoperative autologous collec-tion before bone marrow harvests in haploidentical related donors: is it justified? Transfusion 2018;58:1618–1625.
16. Spitzer TR, Sugrue MW, Gonzalez C, et al. Transfusion practices for bone marrow harvests: a survey analysis from the AABB Bone Marrow Quality Improvement Initiative Working Group. Bone Marrow Transplant 2017;52:1199–1200.
17. Bashey A, Zhang MJ, McCurdy SR, et al. Mobilized peripheral blood stem cells versus unstimulated bone marrow as a graft source for T-cell-replete haploidentical donor transplantation using post-transplant cyclophosphamide. J Clin Oncol 2017;10;3002–3009.
18. Battiwalla M, Tichelli A, Majhail NS. Long-term survivorship after hematopoietic cell transplantation: roadmap for research and care. Biol Blood Marrow Transplant 2017;2:184–192.
19. Bacigalupo A, Tong J, Podesta M, et al. Bone marrow harvest for marrow transplantation: effect of multiple small (2 ml) or large (20 ml) aspirates. Bone Marrow Transplant 1992;9:467–470.
20. Remberger M, Ringden O, Mattsson J. Bone marrow aspiration technique has deteriorated in recent years. Bone Marrow Transplant 2015;50:1007–1009.
21. Pulsipher MA, Logan BR, Kiefer DM, et al. The effect of race, socioeconomic status, and collection center size on bone marrow (BM) and peripheral blood stem cell (PBSC) donor experiences at National Marrow Donor Program (NMDP) collection centers. Biol Blood Marrow Transplant 2015;21:40–41.
22. Vassallo R, Goldman M, Germain M, Lozano M, BEST Collaborative. Preoperative autologous blood donation: waning indications in an era of improved blood safety. Transfus Med Rev 2015;29:268–275.
23. Kiss JE, Brambilla D, Glynn SA, et al. National Heart, Lung, and Blood Institute (NHLBI) Recipient Epidemiology and Donor Evaluation Study–III (REDS-III). Oral iron supplementation after blood donation: a randomized clinical trial. JAMA 2015;10:575–583.
24. Pruszczyk K, Skwierawka K, Malgorzata K, et al. Bone marrow harvest from unrelated donors-up-to-date methodology. Eur J Haematol 2017;99:357–365.
25. Bartnik K, Pruszczyk K, Skwierawska K, et al. Bone marrow harvest in donors with anaemia. Vox Sang 2018;113:795–802.
26. Gouëzec H, Ferré N, Hervé F, et al. Suitability of autologous blood donation before bone marrow donation. Transfus Clin Biol 2015;22:71–75.
27. Carson JL, Grossman BJ, Kleinman S, et al. Red blood cell transfusion: a clinical practice guideline from the AABB*. Ann Intern Med 2012;157:49–58.
28. Lown RN, Philippe J, Navarro W, et al. Unrelated adult stem cell donor medical suitability: recommendations from the World Marrow Donor Association Clinical Working Group Committee. Bone Marrow Transplant 2014;49:880–888.
29. Lysák D, Hrabětová M, Jungová A, Svoboda T, Navrátilová J, Koza V. Nežádoucí reakce při odběru hemopoetických kmenových buněk u nepříbuzných dárců – desetiletá zkušenost Českého národního registru dárců dřeně (ČNRDD). Transfuze Hematol dnes 2011;3:130–137.
30. Miller JP, Perry EH, Price TH, et al. Recovery and safety profiles of marrow and PBSC donors: experience of the national marrow donor program. Biol Blood Marrow Transplant 2008;14:29–36.
31. Halter J, Kodera Y, Ispizua AU, et al. Severe events in donors after allogeneic hematopoietic stem cell donation. Haematologica 2009; 94:94–101.
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Transfusion and Haematology Today
2019 Issue 4
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