Experience in Facilitating Stem Cell Product for Matched Unrelated Donor Transplant in a Developing Country

Abstract

Background Allogeneic stem cell transplant is the only curative treatment for a majority of blood disorders (both malignant and benign). Full match related donor (MRD) option is available for 25 to 30% of patients; thus alternative donor transplant is the only option available, which includes matched unrelated donor (MUD) or haploidentical donor. The best long term outcome of alternative donor transplant in published literature is by MUD transplant. Herein we are highlighting, our experience during the last one year in facilitating MUD transplant product. Method This is a prospective, observational study done at BLK centre for BMT from September 2018 to September 2019. All the patients that did not have MRD for transplant had undergone high resolution HLA typing on 10 antigens. A donor search was initiated with detail of patient including ethnicity, blood group, disease, disease status and CMV status primarily through DATRI and DKMS . We requested for a PBSC product as a graft source with a CD34 dose of >5 × 106cells/kg in all cases. Results In the last one year we initiated 114 searches. Out of these, 67 searches were urgent. On preliminary search we found prospective donors for 32 patients (DATRI-18 and DKMS-14). Twelve donors backed out of stem cell donation (DATRI-9 and DKMS- 3). Two donors were deferred due to medical reasons and two patients backed out from the MUD transplant in the waiting period. Five patients underwent haploidentical SCT and 1 patient expired during the waiting period. Successful stem cell product was collected in 10 searches that were initiated. Of these collections, 4 were cryopreserved (DATRI-3 and DKMS- 1) with prior consent of donor and were used for transplant later. Median time from initiation of donor search to stem cell collection was 68.5 days. Thus in the last one year 10 (9%) matched unrelated transplants were done successfully. Conclusion MUD transplant is a curative option for SCT but in developing countries the donor back out rate and delay median time from initiation of donor search to stem cell collection is high. These issues need to be addressed for converting the initiated searches to successful stem cell collection for MUD transplant.