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Racial and Ethnic Differences in Attitudes, Perceptions, and Knowledge about Unrelated Hematopoietic Stem Cell Donation: A Study of Younger Newly Recruited Potential Donors
Hamed, A. B., Bruce, J. G., Kuniyil, V., Mattila, D., Williams, E. P., Dew, M. A., Myaskovsky, L., Confer, D. L., Switzer, G. E.
Transplantation and Cellular Therapy. 2022;28(6):340.e1-340.e16
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Abstract
Attrition of young adult registry members is a significant issue impacting hematopoietic stem cell (HSC) donation registries, including the Be The Match registry in the US. The resulting limited supply of allogeneic HSCs, used to treat serious health conditions, has a stronger impact on racial/ethnic minority groups in the US. Compared with young white adults, young adults identifying with these minority groups are more likely to drop out of the donor registry when called to donate. However, the underlying psychosocial factors that differ between white and nonwhite registrants have not been fully investigated. The central goal of this study was to examine demographic, registry-related, and donation-related characteristics in a young, newly registered group of potential donors and to determine whether these characteristics differed by, or were distributed differently among, racial/ethnic groups. We conducted a cross-sectional survey in a random sample of young (age 18 to 30 years) newly registered members, stratified by racial/ethnic group and sex. Demographic, registry-related (eg, context and motive for joining the registry), and donation-related (eg, ambivalence, religious objections to donation, knowledge about donation) characteristics were assessed. The chi-square test and analysis of variance were used to examine differences among racial/ethnic groups. Discriminant function analysis was used to assess whether patterns of the 3 classes of characteristics were associated with membership in particular racial/ethnic groups. A total of 524 participants were surveyed. Joining online was most common among white individuals, whereas joining at college was most common among black and Hispanic individuals. Ambivalence toward donation was higher among Asian/Pacific Islanders compared with white or multiracial/multiethnic individuals. Discriminant function analysis revealed 4 psychosocial/attitudinal functions predicting membership in certain racial/ethnic groups. The function accounting for the most variance in responses included mistrust of HSC allocation, religious objections to donation, low parental support, and low knowledge level. This function discriminated significantly between the white and nonwhite groups. Another function also identified ambivalence as a discriminating factor, which was most strongly associated with Asian/Pacific Islanders. Among young adult members of an HSC donor registry, such factors as ambivalence, family concerns about donation, mistrust of HSC allocation, religious objections, and less knowledge about donation were more strongly associated with membership in the nonwhite groups compared with the white group. These factors are known to be associated with a higher risk of opting out after having been preliminarily matched with a patient. The finding that these characteristics are associated with racial/ethnic minority group membership provides targets for recruitment strategies aimed at improving retention of young registry members.
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Systematic scoping review of studies reporting unexpected donor-derived abnormalities from recipients of allogeneic hematopoietic cell transplantation: a proposed framework for donor disclosure: donor-derived abnormalities in allogeneic HCT
J, C., Am, K., R, S., Morris, G., P, B., Md, S., Ds, A.
Transplantation and cellular therapy. 2022
Abstract
BACKGROUND Allogeneic hematopoietic cell transplantation (HCT) is used increasingly to treat blood and immune-based disorders. Post-transplant testing of HCT recipients can lead to unexpected molecular, cytogenetic and other information in donor-derived cells, evoking questions regarding the potential impact on donor health. OBJECTIVE To identify the breadth of donor-derived abnormalities identified by testing HCT recipients and the extent to which disclosure and donor follow up are described. METHODS A systematic search and scoping review were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews in OVID MEDLINE and EMBASE (1947 to May 24, 2021). RESULTS We identified 38 studies (63 donor-recipient pairs) addressing non-leukemic abnormalities, to complement existing literature describing donor cell leukemia and donor-derived myelodysplasia. Donors were unrelated adults (n=20), related family members (n=28), cord blood donors (n=6) or were not reported (n=9). Acquired cytogenetic, molecular, and morphologic abnormalities were reported. Donor origin was confirmed by cytogenetic analysis via karyotyping, FISH, STR-PCR, and other techniques. A disease in donor-derived cells was described in 35 recipients (56.5%). Despite the relevance for testing and disclosure to donors, only 22 cases (32%) mentioned donor follow-up, and 5 cases confirmed that the donor developed a disease associated with the identified abnormality. Unrelated donor disclosure was mentioned in 3 of 26 cases (12%), where the findings were reported back to the registry. CONCLUSION Incidental abnormalities identified in transplanted donor cells may contribute to post-transplant risk of illness in the recipient and may be relevant to donor health. A framework for donor disclosure is proposed that incorporates consideration of analytic validity of the testing, potential significance of the finding, and the extent to which the abnormality is actionable. Adoption of effective processes to safeguard both donor and recipient health outcomes related to this issue is needed. [295].
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Suitability of haematopoietic cell donors: updated consensus recommendations from the WBMT standing committee on donor issues
Worel, N., Aljurf, M., Anthias, C., Buser, A. S., Cody, M., Fechter, M., Galeano, S., Greinix, H. T., Kisch, A. M., Koh, M. B. C., et al
The Lancet. Haematology. 2022;9(8):e605-e614
Abstract
The contribution of related donors to the globally rising number of allogeneic haematopoietic stem cell transplantations (HSCT) remains increasingly important, particularly because of the growing use of haploidentical HSCT. Compared with the strict recommendations on the suitability for unrelated donors, criteria for related donors allow for more discretion and vary between centres. In 2015, the donor outcome committee of the Worldwide Network for Blood and Marrow Transplantation (WBMT) proposed consensus recommendations of suitability criteria for paediatric and adult related donors. This Review provides updates and additions to these recommendations from a panel of experts with global representation, including the WBMT, the European Society for Blood and Marrow Transplantation donor outcome committee, the Center for International Blood and Marrow Transplant Research donor health and safety committee, the US National Marrow Donor Program, and the World Marrow Donor Association, after review of the current literature and guidelines. Sections on the suitability of related donors who would not qualify as unrelated donors have been updated. Sections on communicable diseases, clonal haematopoiesis of indeterminate potential, paediatric aspects including psychological issues, and reporting on serious adverse events have been added. The intention of this Review is to support decision making, with the goal of minimising the medical risk to the donor and protecting the recipient from transmissible diseases.
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Shorter Interdonation Interval Contributes to Lower Cell Counts in Subsequent Stem Cell Donations
Panch, S. R., Logan, B., Sees, J. A., Bo-Subait, S., Savani, B., Shah, N. N., Hsu, J. W., Switzer, G., Lazarus, H. M., Anderlini, P., et al
Transplantation and cellular therapy. 2021
Abstract
Approximately 7% of unrelated hematopoietic stem cell donors are asked to donate stem cells a subsequent time to the same or a different recipient. Recent studies have shown that donation-related symptoms for second donations are similar to those for the first donation. Little is known about differences in stem cell mobilization and yields for subsequent peripheral blood stem cell (PBSC) and bone marrow (BM) collections. We hypothesized that CD34(+) cell yields and total nucleated cell (TNC) concentrations for subsequent PBSC or BM donations are lower than those at the first donation. We also evaluated the factors influencing stem cell yields in healthy unrelated second-time donors. Data were gathered from the Center for International Blood and Marrow Transplant Research database on 513 PBSC and 43 BM donors who donated a second time between 2006 and 2017 through the National Marrow Donor Program. Among the second-time PBSC donors, we found significantly lower preapheresis peripheral blood CD34(+) cell counts (68.6?×?10(6)/L versus 73.9?×?10(6)/L; P?=?.03), and collection yields (556?×?10(6) versus 608?×?10(6); P?=?.02) at the second donation compared to the first. This decrease at the subsequent donation was associated with a shorter interdonation interval, lower body mass index (BMI), and a lower total G-CSF dose. In most instances, suboptimal mobilizers at their first donation donated suboptimal numbers of stem cells at their subsequent donations. Among repeat BM donors, the TNC concentration was lower at the second donation. The small size of this group precluded additional analysis. Overall, when considering repeat donations, increasing the interdonation intervals and evaluating for BMI changes should be considered to optimize stem cell yields. Some of these parameters may be improved by increasing G-CSF dose in PBSC donors within permissible limits.
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Factors associated with registrant availability for unrelated adult donor hematopoietic stem cell donation: Analysis of the stem cell registry at Canadian Blood Services
Monaghan, M., Yi, Q. L., Green, M., Campbell, T., Weiss, J. T., Dibdin, N., Mercer, D., Elmoazzen, H., Allan, D. S.
Transfusion. 2020
Abstract
BACKGROUND Greater use of unrelated donors to support hematopoietic cell transplantation can be hampered by unavailability of registrants when identified as potential candidates for donation. METHODS 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). RESULTS 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. CONCLUSION 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.
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The role of prospection in altruistic bone marrow donation decisions
Vekaria, K. M., Hammell, A. E., Vincent, L., Smith, M., Rogers, T., Switzer, G. E., Marsh, A. A.
Health psychology : official journal of the Division of Health Psychology, American Psychological Association. 2019
Abstract
OBJECTIVE The decision to become an unrelated allogeneic bone marrow or hematopoietic stem cell (HSC) donor is a consequential and complex one. Although new registry members pledge to donate if asked in the future, significant proportions ultimately reconsider when they are notified as a potential match for a patient and are asked to undergo confirmatory typing (CT), resulting in many patients failing to receive transplants. We consider the roles of prospection, or thinking about the future, and ambivalence, or having mixed emotions about an event, in this phenomenon. Prospection theory dictates that distant and improbable events are construed more abstractly than near-term and probable events. We hypothesized that construals about donation in new registry members versus those asked to undergo CT would differ in accordance with these patterns, and that variation in construals would be associated with decisions about whether to proceed toward donation. METHOD In collaboration with the National Marrow Donor Program, we measured donation intentions and CT decisions in 516 new registry members and 213 members asked to undergo CT, respectively. Participants were asked to describe what they imagined would happen in the donation process. RESULTS We found that the valence and heterogeneity with which registry members construed donation were significant predictors of donation-related decisions. Assuming the temporal ordering of cognitive processes, ambivalence about donation was a mediator of these relationships. CONCLUSIONS Findings suggest that encouraging a focus on positive central features of marrow and HSC donation may reduce ambivalence and decrease attrition from the registry. (PsycINFO Database Record (c) 2019 APA, all rights reserved).