Outcomes of strategic alternative donor selection or suspending donor search based on Japan Marrow Donor Program coordination status
In allogeneic hematopoietic stem cell transplantation (allo-HSCT) from unrelated donors, delays in donor search are adversely associated with patient outcome. However, the optimal duration for either waiting for an unrelated donor or selecting alternative sources remains undetermined. Using data from the Japan Marrow Donor Program (JMDP) registry, we retrospectively analyzed 349 adult patients who had searched for unrelated donors. Two hundred and three patients received allo-HSCT from JMDP donors (Group A) with a median of 140 days required to identify a donor, 60 received allo-HSCT from alternative sources (Group B) after a median of 111.5 days at which point either all donor candidates had failed or the patient achieved a second or subsequent complete remission, and 77 suspended allo-HSCT (Group C) after a median of 310 days. The 5-year overall survival (OS) rate in Group A was superior to that of Group C (48.6 vs 38.5%, P = 0.001). Although Group B included more patients with high or very high disease risk index (DRI) at the time of allo-HSCT compared with Group A, the 5-year OS was not significantly different between Groups A and B (48.6 vs 40.9%, P = 0.07), indicating that switching to alternative donors may benefit patients with high DRI.
KeywordsBone marrow transplantation Allogeneic hematopoietic stem cell transplantation Unrelated donor JMDP
We thank the members of the Japan Marrow Donor Program for generously providing donor search information. This work was supported in part by a Grant-in-Aid from the Ministry of Health, Labor, and Welfare, Japan (H26-Nanchi- (Immunology)-Ippan-101 and H28-Nanchi- (Immunology)-Ippan-101).
Compliance with ethical standards
Conflict of interest
The authors declare no competing financial interests.
- 3.Kurosawa S, Yakushijin K, Yamaguchi T, Atsuta Y, Nagamura-Inoue T, Akiyama H, et al. Changes in incidence and causes of non-relapse mortality after allogeneic hematopoietic cell transplantation in patients with acute leukemia/myelodysplastic syndrome: an analysis of the Japan Transplant Outcome Registry. Bone Marrow Transplant. 2013;48:529–36.CrossRefPubMedGoogle Scholar
- 4.McClune BL, Weisdorf DJ, Pedersen TL, Tunes da Silva G, Tallman MS, Sierra J, et al. Effect of age on outcome of reduced-intensity hematopoietic cell transplantation for older patients with acute myeloid leukemia in first complete remission or with myelodysplastic syndrome. J Clin Oncol. 2010;28:1878–87.CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Miyamoto T, Takashima S, Kato K, Takase K, Yoshimoto G, Yoshida S, et al. Comparison of cyclosporine and tacrolimus combined with mycophenolate mofetil in prophylaxis for graft-versus-host disease after reduced-intensity umbilical cord blood transplantation. Int J Hematol. 2017;105:92–9.CrossRefPubMedGoogle Scholar
- 7.Chevallier P, Labopin M, Milpied N, Bilger K, Socie G, Yakoub-Agha I, et al. Outcomes of adults with active or progressive hematological malignancies at the time of allo-SCT: a survey from the Societe Francaise de Greffe de Moelle et de Therapie Cellulaire (SFGM-TC). Bone Marrow Transplant. 2014;49:361–5.CrossRefPubMedGoogle Scholar
- 10.Terakura S, Atsuta Y, Tsukada N, Kobayashi T, Tanaka M, Kanda J, et al. Comparison of Outcomes of 8/8 and 7/8 Allele-Matched Unrelated Bone Marrow Transplantation and Single-Unit Cord Blood Transplantation in Adults with Acute Leukemia. Biol Blood Marrow Transplant. 2016;22:330–8.CrossRefPubMedGoogle Scholar
- 12.Koreth J, Pidala J, Perez WS, Deeg HJ, Garcia-Manero G, Malcovati L, et al. Role of reduced-intensity conditioning allogeneic hematopoietic stem-cell transplantation in older patients with de novo myelodysplastic syndromes: an international collaborative decision analysis. J Clin Oncol. 2013;31:2662–70.CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Frassoni F, Labopin M, Powles R, Mary JY, Arcese W, Bacigalupo A, et al. Effect of centre on outcome of bone-marrow transplantation for acute myeloid leukaemia. Acute Leukaemia Working Party of the European Group for Blood and Marrow Transplantation. Lancet. 2000;355:1393–8.CrossRefPubMedGoogle Scholar