Page 223 - 2019_04-Haematologica-web

Toxicity in related versus unrelated HSC donors
BMI had increased risk of peri-collection grade 2-4 and 3- 4 pain and grade 2-4 MTC symptoms, along with grade 2- 4 pain at one year.
Table 4 shows additional factors other than RD/URD status associated with higher levels of late pain/MTC symptoms and lack of recovery to pre-donation levels at one year. Older BM and PBSC donors, and Black and mul- tiple-race PBSC donors were less likely to recover to their pre-donation level of pain. Hispanic and multiple-race PBSC donors were less likely to recover to pre-donation level of MTC symptoms. As might be expected, donors with pre-donation levels of pain or symptoms at grade 1 or grades 2-4 were more likely to recover to that level at one year.
Discussion
Unrelated HSC registries have a responsibility to ensure the safety of volunteer donors performing an altruistic act.17 They routinely defer donors with minor health prob- lems, erring on the side of safety. Transplant centers, whose primary task is treatment of patients with cancer and other life-threatening illnesses, must also evaluate the medical fitness of donors and advise them about risk, in
some cases deferring them. Although recent changes in accreditation requirements for transplant centers empha- size donor education and autonomy, requiring an inde- pendent donor advocate,18-20 RD may or may not listen to advice to forgo donation, being highly motivated and will- ing to take medical risks for their family member.
Studies have shown that a matched sibling is generally the best HSC donor;21-23 and recent expansion of hap- loidentical approaches24 have put even more family mem- bers into a donor role. Over the past decade, however, improvements in URD procedures have led to comparable outcomes using RD and URD in patients with hematolog- ic malignancies,25-27 offering reasonable HCT alternatives if a RD is unable to donate. With this in mind, when should a transplant center counsel a RD against donation?
Our study shows that the choice to donate by a RD with comorbidities can have consequences. We show by multivariate analysis that RD have more intense early pain and toxicities than URD, and because these symptoms are temporally associated with PBSC collection, there is little doubt that the toxicities are related to the donation proce- dure. There is a question, however, about whether our observation that RD have more pain and non-recovery to pre-donation levels at one year is due to the procedure itself, or other aspects associated with being a RD.
A
B
Figure 2. Severity of skeletal pain and highest toxicity level across key body symptoms experienced by first time relat- ed versus unrelated peripheral blood stem cell (PBSC) donors at baseline, on the first day of collection prior to apheresis, and one year post donation. (A) Skeletal pain. (B) Highest toxicity level across key body symptoms.
haematologica | 2019; 104(4)
851