Stem Cell Registry Research Articles

Demand and usage of unrelated donor products for allogeneic haematopoietic cell transplantation during the COVID‐19 pandemic: A Canadian Blood Services Stem Cell Registry analysis

Background and ObjectivesUnderstanding changes in the demand and usage of unrelated allogeneic haematopoietic cell transplantation (HCT) donors during the COVID‐19 pandemic is needed to optimize pandemic preparedness of registry and donor collection services. The aim of this study was to understand the extent to which the pandemic has impacted the demand and usage of unrelated donors and cord blood units (CBUs) at Canadian Blood Services (CBS).Materials and MethodsData regarding stem cell donor interest and product usage for unrelated allogeneic HCT were retrieved from the database at CBS using de‐identified anonymous information.ResultsUnrelated donor searches for Canadian patients remained unchanged by the pandemic, reflecting stable demand. The number of unrelated allogeneic transplants performed within Canada also remained stable, while the number of cord blood transplants increased, chiefly for paediatric patients. Requests for donor verification typing, a first signal of potential interest, increased from domestic centres during the first 6 months of the pandemic and decreased from international centres, before returning to baseline levels. The proportion of transplants for Canadian patients who used stem cell products procured from Canadian donors increased between 3 and 6 months after the start of the pandemic before returning to baseline and appears to be increasing again more than 1 year after the start of the pandemic. Use of CBUs for Canadian paediatric patients increased and remains elevated.ConclusionDemand for unrelated adult HCT donors has remained stable despite the evolving pandemic with a transient and recurring increased interest and usage of domestic adult donors. Use of CBUs for paediatric patients has increased and remains elevated. Registries and donor collection centres should maintain the capacity to expand services for domestic donor collection during pandemics to offset threats to international donor usage.

Human pluripotent stem cell registry: Operations, role and current directions.

The human plutiripotent stem cell registry (hPSCreg) is a global database for human embryonic and induced pluripotent stem cells (hESC, hiPSC). The publicly accessible Registry (https://hpscreg.eu) was set up to provide a transparent resource of quality‐assessed hPSC lines as well as to increase reproducibility of research and interoperability of data.ObjectivesIn this review, we describe the establishment of the Registry and its mission, its development into a knowledgebase for hPSC and the current status of hPSC‐focussed databases. The data categories available in hPSCreg are detailed. In addition, sharing and hurdles to data sharing on a global level are described.ConclusionsAn outlook is provided on the establishment of digital representatives of donors using hybrids of data and hPSC‐based biological models, and how this can also be used to reposition databases as mediators between donors and researchers.

Organoids as Miniature Twins—Challenges for Comparability and Need for Data Standardization and Access

Organoids derived from human stem cell lines represent genetically mostly identical models of their donors. Their use as personalized in vitro miniature twins of living individuals creates challenges of reproducibility, comparability and standardization. To fully exploit personalization, it is essential to assess individual variabilities in organoid function, morphology or maturity. There is a need to establish platforms to compare individual organoids and to link them to data elements related to the individual donor. Moreover, principal ethical issues arise because of their infinite repetition for an unlimited period of time and global dissemination. This infinite temporal and spatial space applies to the biological material but also to the data associated with it. It increases the possibility of uses that are unpredictable at the time of donation, and thus, beyond the donor’s consented choices. We propose an open data platform to address the issue of authenticity and persistent comparability of the biological organoid models, and of preserving the ethical provenance information. The platform would collect standardized donors, organoids and ethical information to create a system suitable for quality control of individual organoids. We discuss whether the human pluripotent stem cell registry (hPSCreg), a well-established resource for stem cell data, provides a suitable model platform.

Outcomes After Donor Lymphocyte Infusion in Patients With Hematological Malignancies: Donor Characteristics Matter

In the context of T-cell depletion, failing to achieve full donor chimerism (FDC) entails higher risk of graft loss and disease relapse. Donor lymphocyte infusion (DLI) is an adoptive immunotherapy for mixed chimerism (MC) or relapsed disease after reduced-intensity conditioning allogeneic hematopoietic stem cell transplantation (HSCT). Nevertheless, little is known of factors associated with attaining FDC or disease remission. We carried out a retrospective study with 100 adult patients to identify patient and donor factors that can predict achievement of FDC and disease remission and describe complications after DLI. Indications for DLI were T-cell MC in 61 patients and relapsed disease in 39 patients. Forty patients (65.6%) with MC attained T-full donor chimerism (T-FDC), with higher responses seen in patients whose donors were female (81.5% versus 52.9%, P = .004) and cytomegalovirus negative (76.5% versus 52%, P = .004). However, only patients with younger donors (<30 years old) compared to older donors (94.4% versus 53.5%, P = .013) and those attaining unfractionated whole blood (UWB) FDC after DLI (76.6% versus 28.6%, P < .001) had a survival benefit and subsequently a better graft-versus-host disease (GvHD)–free/relapse-free survival. Nineteen of 39 patients (48.7%) with relapsed disease achieved remission after DLI. In this cohort, attaining T-FDC impacted favorably in disease control (76.7% versus 12.5%, P = .012) and improved survival (45.5% versus 12.5%, P = .007). In the whole population, the cumulative incidence of acute GvHD (aGvHD) at day 100 after DLI was 23%, and chronic GvHD (cGvHD) at 1 year after DLI was 22%. In the whole population, donor age was also a determining factor for aGvHD, because patients with younger donors had a lower incidence of aGvHD (8% versus 36%, P = .021). The cGvHD was more likely to occur in patients who converted to T-FDC (34% versus 10.3%, P = .025). Donor characteristics are increasingly considered when deciding approaches for HSCT. Donor age should be considered when planning HSCT, as well as doses and scheduling of DLI. As per our experience, this should be done alongside T/UWB chimerism to achieve the maximal clinical benefit with less associated toxicity. Selection of younger male donors from stem cell registries can minimize the risk of GvHD and improve survival.

Turn around time in matched unrelated donor search workup national versus international registries: Retrospective study

Background: Timeline is a key factor for hematopoietic stem cell transplant (HSCT) recipient. HSCT by matched unrelated donor (MUD) is a standard definitive therapeutic approach for many hematological disorders which are not amenable to chemotherapy and other conventional treatment. Aims and Objectives: The aim of the present study was to compare the turnaround time (TAT) involved in completion of MUD HSCT workup from an Indian registry (Genebandhu) with international registries. Materials and Methods: On receipt of pre-transplant matching request through a transplant physician, patient's human leukocyte antigen (HLA) type was entered in both Genebandhu and World Marrow Donor Association search tool for initiating a “search.” The software gave the descending order of the best possible matches by performing computational analysis. The search result was considered a “match” when potential 10/10 HLA match was found. The average TAT was calculated in the middle of search request and HLA confirmatory typing (CT) and infectious disease marker (IDM). Further, TAT was also determined between the infusion of harvested stem cell product and CT and IDM. At last, the total time engaged in completion of each MUD HSCT workup was determined and compared in national versus international registries. Results: The average TAT involved in between search request and CT and IDM was 71 days in case of global registry and 67 days in case of Genebandhu. Similarly, the average TAT involved between infusion of harvested cell product and CT and IDM testing in case of donor identified in global stem cell registry was 65 days whereas 45 days in case of Genebandhu. At last, the average time associated with the finishing of a MUD workup was 136 days in case of global registry, whereas 112 days in the case of Genebandhu at P ≤ 0.05 with a 95% confidence interval. Conclusion: To conclude, the average TAT obtained through this study clearly demonstrates the advantages in terms of donor availability for MUD HSCT through the national registry.

English

BACKGROUND Stem cells are pluripotent cells that continuously divide, have the ability of selfrenewal, and can generate complex tissues and organs. Globally there are almost 20 lakh stem cell centres, whereas in India we don’t have such a good network of stem cell registries. The Indian Council of Medical Research (ICMR) study says that if you have 10 lakh stem registries with you, you will be able to serve at least 40 % of the demand, but when we have 20 lakh of the global registry we are not able to meet the demand because of genetic variation. We wanted to spread awareness on stem cells from various levels like NGO’s, government, health sectors and everybody should take the initiative. The objective of the study was to assess knowledge and awareness of stem cells among eligible beneficiaries (ANC mothers and eligible couples) METHODS A cross-sectional educational interventional study was done in the Gwalior region for 2 months. A total of 100 eligible beneficiaries (ANC mothers and eligible couples) were registered for the study. Collection of questionnaire sheets &amp; sorting out of data for analysis was done. RESULTS After awareness, 86 % of the subjects thought that the regenerated tissues from stem cells were good enough to replace the previous tissues and 91 % of the subjects were willing to donate stem cells after awareness. CONCLUSIONS Doctors and health workers can be a potential source of information for these subjects because of effective convincing strategies. KEY WORDS Stem Cells, Awareness, Umbilical Cord Blood (UCB).

Correlation between peripheral blood automated hematopoietic progenitor cell counts and flow cytometric CD34+ cell counts differs according to diagnosis in patients undergoing autologous peripheral blood stem cell transplantation.

An automated hematopoietic progenitor cell count measurement in Sysmex XN analyzer (XN-HPC) has been developed to assist flow cytometry CD34+ cell count measurement, which requires technical expertise and a long turnaround time. Here, we evaluated the correlation between XN-HPC count and flow cytometric CD34+ cell count in pre-harvest peripheral blood (PB) samples from patients undergoing autologous peripheral blood stem cell (PBSC) transplantation according to diagnosis and investigated the possible cause of the decreased correlation in plasma cell neoplasm patients. We retrospectively included 399 patient data that had matched PB XN-HPC count and CD34+ cell count of PB and apheresis product from Samsung Medical Center (SMC) and the Hematopoietic Stem Cell (HSC) registry. We assessed the diagnostic accuracy and the potential cutoff values of XN-HPC count for predicting adequate PBSC collection. The PB XN-HPC count was 1.6 and 1.3-fold higher than the CD34+ cell count in SMC (25.0 vs 15.9/μl) and the HSC registry (20.0 vs 15.2/μl), respectively. Overall the correlation between the PB XN-HPC and CD34+ cell count was moderate (SMC, r=0.71; HSC registry, r=0.66). A significant proportional and systemic bias with overestimation of XN-HPC count were noted in the plasma cell neoplasm patients in both SMC and the HSC registry. However, no significant difference in correlation was observed according to myeloma-related laboratory parameters in plasma cell neoplasm patients. Our results suggest that XN-HPC count should be interpreted cautiously in cancer patients undergoing autologous PBSC transplantation, especially in those with plasma cell neoplasm.

Matched Unrelated Donor Attrition in a Stem Cell Registry

Background and Objective: Increment in voluntary stem cell donor registrations has led to an increase in the chances of a patient finding a perfect match for matched unrelated donor (MUD) hematopoietic stem cell (HSC) transplant. However, it has been seen multiple times that the donor's passion to donate HSCs is short lived. They register with a strong commitment, however, when they are approached to donate, they back out. This write-up is an attempt to quantify and analyze the rate and reasons of MUD deferral in a stem cell registry from North India. Methods: Registered volunteer stem cell donors who backed out after getting matched were interviewed to understand the reasons behind their deferral. Key steps taken for sustaining the passion of registered donors included amendments in the donor recruitment process and maintaining constant communication with the recruited donors. Results: The attrition rate of the registry for final donation during the studied period was 22.91%. A total of 22 cases of donor deferral were observed. Among these, 15 donors (68.19%) who backed out were female and 7 (31.81%) were male. There were three main reasons observed behind this attrition, namely personal reasons, medical reasons from the donor side, and medical reasons from the patient side. Conclusion: To minimize donor deferral, various new strategies could be implemented such as requesting the participation of experienced donors in counseling sessions, requesting guardian's involvement in case the donor is a teen or is in their early twenties (between 18 and 25 years), and requesting the name of the person they consulted before signing up for donation.

285 - Unrelated Donor Usage for Allogeneic HCT in Canada during the First 6 Months of the COVID-19 Pandemic: A Canadian Blood Services Stem Cell Registry Analysis

285 - Unrelated Donor Usage for Allogeneic HCT in Canada during the First 6 Months of the COVID-19 Pandemic: A Canadian Blood Services Stem Cell Registry Analysis

Pandemic-related trends and challenges in adult donor stem cell and cord blood collection, banking, and processing

<div class="authors authors-lg"><div class="author"><div class="author-img"><img src="https://bioinsights.blob.core.windows.net/uploads/Heidi_2_Director_StemCells copy 2.jpg" data-image="1"></div><div class="author-det"> <b>Heidi Elmoazzen</b> is currently the director of Canadian Blood Services’ Stem Cell Program which includes Canadian Blood Services’ Cord Blood Bank, Stem Cell Registry, Stem Cell Manufacturing programs and Cord Blood for Research Program. She has been with Canadian Blood Services for 10 years. Dr Elmoazzen obtained her PhD in Medical Sciences from the University of Alberta with a concentration in cryobiology. She then went on to do a post-doctoral fellowship at Harvard Medical School and Massachusetts General Hospital in Boston, USA. Following her fellowship, she became an instructor at Harvard Medical School and an Assistant in Bio-engineering in the Department of Surgery and Obstetrics and Gynaecology. Her area of research was focused on fertility preservation and developing novel biopreservation techniques for stem cells and reproductive cells. Her main areas of expertise and experience include bio-preservation, stem cell banking and translational medicine. She has published two book chapters on stem cell preservation as well as over 50 journal papers. She has hundreds of contributed and invited presentations at various national and international meetings. </div></div></div>

Navigating regulations to provide ethically sourced cellular material for research and development: UK perspective

Anthony Nolan is a UK based charity first set up by Shirley Nolan to find a matched hematopoietic stem cell donor for her son, Anthony. To this day our mission remains the same, to save and improve the lives of everyone who needs a hematopoietic cell transplant (HCT). Anthony Nolan has over 45 years’ experience of working with donors via the stem cell registry to provide hematopoietic cells for patients in need of a transplant across the globe. Along our journey in supporting HCT patients, we have evolved to ensure that we continue to do our best for the patient community. Our most recent evolution has resulted in the establishment of our Cell and Gene therapy services. Anthony Nolan is not unique in this transition, the National Marrow Donor Programme a Registry based in the United States of America, launched its Be the Match Biotherapies in 2016 to provide cell sourcing and supply chain management services for allogenic cell therapy development and Gift of Life Marrow Registry also in the United States of America has developed Gift of Life Biologics, an all-in-one solution for cell and gene therapy developers. An important aspect of the Anthony Nolan service is that the biological materials we provide to our clients will always be high quality and ethically sourced from well informed donors, allowing our clients to scale up from early proof of concept research on to the clinical trial stage. In the context of this article the term starting material will cover, mobilized peripheral blood stem cell collection, bone marrow collection, donor lymphocyte collection and whole blood collection as well as umbilical cord blood and tissue. In the field of cell and gene therapy where it is essential to ensure the end-product is safe and clinically effective the quality of all starting materials, including human cells is paramount. Human starting material by nature is complex; we have variability in the quality and content between different people, the global regulatory framework is ambiguous and emerging, it is considered a high-risk material requiring screening and evaluation of donors and their collected material. Most importantly it requires an individual, in our case a donor to consent to undergo a medical procedure to donate the precious cells for use in research, this does not apply to the umbilical cord material. In the UK it is illegal to pay for human body parts, this also applies to Europe, therefore our donors donate purely for altruistic reasons. This last point can sometimes be overlooked and therefore the ethical implications of obtaining this material are not considered as part of the cell therapy development plan.

Matched unrelated donor hematopoietic stem cell transplantation: Roles and responsibilities of workup coordinator - An observational study

Background: With only 25% chances of finding a human leukocyte antigen matched stem cell donor within the family, in case of minimal residual disease, the dependence on matched unrelated donor (MUD) is inevitable. With increasing awareness about the MUD stem cell registries, the numbers of registrations for voluntary stem cell donations are also increasing each day. A workup coordinator is a strong and the most crucial link in the MUD hematopoietic stem cell transplantation (HSCT) workup. The coordination between the stem cell registry and transplant center TC in need of a MUD HSCT workup is handled by a workup coordinator. Aims and Objectives: The aim here is to highlight key roles and responsibilities of workup coordinators, without whom it can be impossible to complete a MUD HSCT. Materials and Methods: We accessed the roles and responsibilities of workup coordinators via the MUSD HSCT workup assisted by Genebandhu from May 2012 to August 2020. The methodology mainly involved was electronic communication between stem cell registry/transplant center (TC)/donor center/collection center/patient/donor. All these activities of coordinators were closely observed to understand their roles, requirements, and responsibilities in detail. Results: The workup coordinator has been successfully involved in 33 MUD HSCT workups since its inception. Out of these, 18 were from international stem cell registries and 15 with TC s from India. Discussion: Workup coordinator acts like a catalyst during a MUD HSCT. Appropriate and timely exchange of information between the registry and the TC is managed by a coordinator. Conclusion: This study showed the crucial role, requirements, and responsibilities of the coordinators and their importance in MUD HSCT workups.

Factors associated with registrant availability for unrelated adult donor hematopoietic stem cell donation: Analysis of the stem cell registry at Canadian Blood Services.

Greater use of unrelated donors to support hematopoietic cell transplantation can be hampered by unavailability of registrants when identified as potential candidates for donation. Multivariate analysis was performed to identify donor factors associated with availability for verification of human leukocyte antigen typing (VT) needed before donor activation. All VT requests for registrants on the Canadian Blood Services Stem Cell Registry between 1 January and 31 December 2018 were reviewed (n = 1358). Potential donors identified by transplant centers were categorized as available at the time of VT but ineligible for medical or other reasons (n = 130 and excluded from further analysis), available (n = 622) or unavailable (n = 566) due to scheduling, loss of interest, and/or inability to contact. With multivariate analysis, registrants who previously donated blood, those recruited online or from blood donation clinics, and a shorter interval between registration and VT request were significantly correlated with increased donor availability. Donor sex and geographic location, however, displayed no correlation. Online registration and recruitment at whole blood donation centers should be enhanced to increase the availability of registrants at VT. More insight is needed to maintain registrant availability following community in-person recruitment events, especially if the interval between registration and activation is prolonged. Recruitment of male registrants who are well informed should not negatively impact availability.

A Manually Curated Database on Clinical Studies Involving Cell Products Derived from Human Pluripotent Stem Cells.

SummaryThe last 5 years have witnessed a significant increase in the number of clinical studies based on human pluripotent stem cells (hPSCs). In parallel, concern is increasing about the proliferation of unregulated stem cell treatments worldwide. Regulated clinical testing is a de facto standard to establish the safety and efficacy of new cell therapies, yet reliable information on clinical studies involving hPSCs is scattered. Our analysis of a multitude of resources found 54 clinical studies involving several types of hPSCs, which are performed in ten countries. While the majority of those studies is based on human embryonic stem cells (hESCs), clinical studies involving human induced pluripotent stem cells increased more strongly in the past 2 years than the number of hESC-based studies. A publicly accessible database was created using the human pluripotent stem cell registry (https://hpscreg.eu) platform, providing a steadily updated comprehensive overview on hPSC-based clinical studies performed worldwide.

Access to stem cell data and registration of pluripotent cell lines: The Human Pluripotent Stem Cell Registry (hPSCreg).

The value of human pluripotent stem cells (hPSC) in regenerative medicine has yet to reach its full potential. The road from basic research tool to clinically validated PSC-derived cell therapy products is a long and winding one, leading researchers, clinicians, industry and regulators alike into undiscovered territory. All stakeholders must work together to ensure the development of safe and effective cell therapies. Similarly, utilization of hPSC in meaningful and controlled disease modeling and drug screening applications requires information on the quality and suitability of the applied cell lines. Central to these common goals is the complete documentation of hPSC data, including the ethical provenance of the source material, the hPSC line derivation, culture conditions and genetic constitution of the lines. Data surrounding hPSC is scattered amongst diverse sources, including publications, supplemental data, researcher lab books, accredited lab reports, certificates of analyses and public data repositories. Not all of these data sources are publicly accessible nor associated with metadata nor stored in a standard manner, such that data can be easily found and retrieved. The Human Pluripotent Stem Cell Registry (hPSCreg; https://hpscreg.eu/) was started in 2007 to impart provenance and transparency towards hPSC research by registering and collecting standard properties of hPSC lines. In this chapter, we present a short primer on the history of stem cell-based products, summarize the ethical and regulatory issues introduced in the course of working with hPSC-derived products and their associated data, and finally present the Human Pluripotent Stem Cell Registry as a valuable resource for all stakeholders in therapies and disease modeling based on hPSC-derived cells.

Willingness of volunteers from Canadian Blood Service's Stem Cell Registry to donate blood, marrow, and other tissues for regenerative therapy.

As research surrounding cell-based regenerative therapy advances toward human trials, greater demand for cell products sourced from healthy donors will arise. The extent to which volunteers in Canadian Blood Services Stem Cell Registry would be willing to donate cells to support regenerative therapy is not known and warrants exploration. We conducted a Web-based survey to assess factors that would influence donor willingness to donate various tissues (blood, skin, fat, and bone marrow) for regenerative therapy. The survey was provided to 15,000 randomly selected donors who registered between 2013 and 2018. Data from the 1118 respondents were analyzed. Despite a mixed degree of familiarity with regenerative medicine, potential donors were very supportive of donating for direct patient care and for research, and increasing their familiarity by reading a brief paragraph of information on regenerative medicine increased willingness to donate. Canadian Blood Services' stem cell registrants greatly preferred supporting nonprofit groups in research and development in comparison to entities that represent profit-seeking industry involvement. The most important factors influencing donor willingness to donate were having an impact on patients, safety of donation, advancing knowledge in regenerative medicine, a manageable time commitment, and tolerable pain that could be managed. Donors were most willing to donate blood and had mixed responses to donating other tissue types. Adult volunteers from a national stem cell registry are willing to support donation of biospecimens for regenerative therapy.

Extended HLA Haplotypes and Their Impact on DPB1 Matching of Unrelated Hematologic Stem Cell Transplant Donors.

Although HLA-DPB1 has long been considered of lesser importance in the selection of an unrelated donor (URD) hematologic stem cell transplantation, currently in many instances the DPB1 type of the donor is relevant or even critical. At present, however, only a minority of registry donors are DPB1 typed. It is also unclear to what extent the DPB1 alleles are linked to the 5-locus HLA-A-, B-, C-, DRB1, -DQB1 haplotypes. We sought to study whether there is such a linkage by using donors in the Finnish Stem Cell Registry as the study population. The 6-locus HLA-A, -B, -C, -DRB1, -DQB1, -DPB1 haplotype frequencies were estimated from a group of 43,365 Finnish registry donors using the German National Bone Marrow Registry algorithm. Five-locus haplotype (HLA-A, -B, -C, -DRB1, -DQB1) and HLA-DPB1 allele frequencies were calculated as marginal frequencies of the estimated 6-locus haplotype frequencies. The Finnish average frequency of individual DPB1 alleles was compared with their respective frequencies in association with individual 5-locus HLA haplotypes (haplotype-specific frequencies). Finally, the probability of DPB1 matching in 10/10 matched URD transplants was assessed. Haplotype-specific DPB1 frequencies differed significantly from the average DPB1 frequencies in 81 of 100 most frequent Finnish 5-locus HLA haplotypes, including some infrequent DPB1 alleles that were associated almost exclusively with certain individual 5-locus haplotypes. Five-locus haplotypes that are enriched in Finland but rare among other Europeans carried stronger DPB1 associations than haplotypes that are frequent European-wide. Finally, 10/10 matched transplants from domestic registry donors were significantly more likely to also be DPB1 matched than those from foreign donors. The results indicate an extension of linkage disequilibrium in the MHC complex in the Finnish population. With continuing upfront DPB1 typing of registry donors, it will be possible to perform similar extended 6-locus haplotype frequency estimations also in other registries. The associations are likely to be population specific but may be weaker in more heterogeneous populations. In the future the results might be used to predict the probability of DPB1 match or permissive/nonpermissive DPB1 mismatch for non-DPB1 typed donors in registry donor searches.

Comparison of Long-Term Effects of Cell Therapy in Patients with Ischemic and. Nonischemic Heart Failure

Purpose Short-term data suggest a beneficial effect of cell therapy in chronic heart failure (CHF) patients. However, long-term effects of cell therapy in this patient cohort remain largely unexplored. We sought to investigate the long-term effects of transendocardial cell therapy in patients with CHF. Methods We reviewed five-year stem cell registry data from 108 patients. Clinical, laboratory and echocardiographic parameters were analysed. At baseline all patients were NYHA class III with LVEF 8.3 mV and linear local shortening Results Of 108 included patients 68 (63%) had non-ischemic HF (Group A) and 40 (37%) patients had ischemic HF (Group B). At baseline the two groups did not differ regarding age (51±11 years in Group A vs. 55±10 years in Group B;p=0.1), gender (male; 80% vs. 87%;p=0.4), creatinine (88±20 µmol/L vs. 92±25 µmol/L;p=0.49), bilirubine (18±10 µmol/L vs. 19±11 µmol/L;p=0.62), LVEF (28±7% vs. 27±8%;p=0.15), and LVEDD (6.6±0.8 cm vs. 6.7±0.6 cm;p=0.62). At 5 years, the overall and transplant-free survival of the groups were comparable (overall: 87% in Group A vs. 86% in Group B;p=0.85; transplant-free: 58% vs. 57%;p=0.87). Overall 5-year survival was 86% and transplant-free 5-year survival was 58%. Of 15 patients that died 4 (29%) suffered sudden cardiac death (SCD) and 11 (71%) died of pump failure. SCD occurred in 67% of all deaths in Group B vs. 0% of Group A patients (p Conclusion In chronic heart failure of either ischemic or nonischemic etiology transendocardial CD34+ cell therapy appears to be associated with favorable long-term effects. Prospective validation of our registry-based results is warranted.

Human leukocyte antigen-matched unrelated donor search experience for hematological disorder patients requiring transplant: scenario for Indian patients

Abstract Introduction: Human leukocyte antigen (HLA)-matched unrelated donor (MUD) is the source of MUD transplantation (MUDT) for about 70% of patients who do not have matched related donor. To facilitate MUD search globally, there are 75 stem cell registries with more than 28 million donors registered (as of January 2017). Out of these donors, India has an insignificant representation of approximately 0.23 million. Further, Indians express high genetic variations, making it difficult to find MUD for an Indian patient. Aims and Objectives: The aim of this study is to analyze the MUD search for hematological disorder patients requiring transplant. An attempt was made to observe the MUD scenario for Indian patients requiring MUDT from accessible stem cell registries. Methods: A total of 558 patients approached Genebandhu registry and Chimera Transplant Research Foundation for MUD search over a period of 4 years requiring MUDT were included in this study. High resolution of HLA-A, -B, -C, -DRB1, and -DQB1 was used to perform MUD search through proprietary software called Prometheus and Bone Marrow Donors Worldwide (BMDW) search tool. Results: Out of 558 patients, MUD was located only for 135 (24.19%) patients. Out of these 135 patients, 91 (16.30%) patients found an MUD in global database and only 44 (7.88%) patients within India. Conclusion: This study demonstrates that building a large Indian database will not only help in increasing the chances of finding an MUD for maximum number of patients within India but also provide cost-effective treatment, in a society where cost is a vital factor.

A guide to organize voluntary stem cell donors recruitment drive for hematopoietic progenitor stem cell transplant.

BACKGROUND:Hematopoietic progenitor cell transplantation (HPCT) is used as a definitive treatment in hematological malignancies. For a successful HPCT, the donor and recipient should have matching human leukocyte antigens (HLAs). About 25% of patients have a chance of finding matching HLA within family, while rests 75% are dependent on voluntary stem cell donor. Globally, there are 75 stem cell registries with more than 30 million donors registered among which India represents 0.36 million. Therefore, finding a stem cell donor for Indian patient is quite difficult. The aim of the present study is to discuss the significance of voluntary stem cell donor recruitment drive and also to guide the drive organizers and their team for effectively organizing the drive to increase the database of such donors.MATERIALS AND METHODS:Voluntary stem cell donor recruitment drives are conducted to spread awareness among the people and motivate them to register as a donor. Once the donors have given their consent, the sample is taken and sent to laboratory for HLA typing and the result is uploaded in World Marrow Donor Association, an international association of member to find the best possible matches for patients with hematological disorders.RESULTS:Genebandhu has organized over 127 recruitment camps since 2012 and recruited 13,000 voluntary stem cell donors. HLA typing of 7446 donors has been completed. Out of this small number of typed donors, 11 lifesaving HPCTs have been successfully facilitated.CONCLUSIONS:Here, we have demonstrated guidelines along with steps to organize voluntary stem cell donors recruitment drive that is needed to increase number of donors, thus increasing significantly the chances of saving many vital lives.