Abstract
BackgroundHealthy volunteer registry donors have become the backbone of stem cell transplantation programs. While most registrants will never become actual donors, a small minority are called upon twice, most commonly for the same patient because of poor graft function. Anecdotal evidence provides no hard reasons to disallow second-time mobilized apheresis, but few centers have treated enough two-time donors for definitive conclusions. Moreover, for reasons unknown, the efficiency of G-CSF varies greatly between donations.MethodsComparison of outcomes of first vs. second donations can formally confirm G-CSF responsiveness as intrinsically, likely genetically, determined. In our database, we identified 60 donors (1.3%) who received two cycles of G-CSF 24 days to 4 years apart and systematically compared mobilization outcomes.ResultsFirst and second mobilization and collection proceeded without severe or unusual adverse effects. First-time mobilization efficiency was highly predictive of second-time mobilization. Neither mobilization efficiency nor time lag between donations affected the similarity of first- and second-time mobilization outcomes.ConclusionsWith the caveat that only donors with an unremarkable first donation were cleared for a second, our data indicate that a second donation is feasible, equally tolerable as a first donation, and efficient. Moreover, the data strongly support the notion of donor-intrinsic variables dictating mobilization response and argue against relevant damage to the stem cell compartment during mobilization with rhG-CSF.
Highlights
Healthy volunteer registry donors have become the backbone of stem cell transplantation programs
Stem cells are extracted from bone marrow or after Granulocyte colony-stimulating factor (G-CSF)-mobilization from peripheral blood using apheresis
Stem cell mobilization in the allogeneic setting is induced with recombinant human G-CSF which is administered, with minor local variations in the exact dosing and dosing schedule, subcutaneously for five days prior to apheresis on the fifth day, at least two hours after the most recent G-CSF injection
Summary
Healthy volunteer registry donors have become the backbone of stem cell transplantation programs. Stem cells are extracted from bone marrow or after G-CSF-mobilization from peripheral blood using apheresis. Kim‐Wanner et al J Transl Med (2020) 18:487 available, a different donor will be selected for patients with post-transplant relapse; for a new patient with the same HLA type preferentially a different donor will be activated This leaves the not very frequent events of brittle primary engraftment or impending secondary (not infrequently iatrogenic) graft failure as main indications for requests for second donations from the same donor. Sex and girth have been identified in some studies as modestly associated with mobilization efficiency [9] These studies, the limited data from multiply mobilized donors, as well as data generated with different strains of mice, together are being seen as evidence of donor-intrinsic factors modifying G-CSF responsiveness. Second-time mobilization is safe and effective as the same donor’s first mobilization cycle
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