Predonation health-related quality of life scores predict time to recovery in hematopoietic stem cell donors.

The physical reactions to hematopoietic stem cell donation have been extensively studied, but less is known about factors that predict poorer donation experiences. The aim of this prospective study was to examine demographic and health-related quality of life (HRQOL) factors that might be associated with recovery and side effects. We also described the changes in HRQOL during the donation process. In total, 275 peripheral blood stem cell (PBSC) and 37 bone marrow (BM) consecutive donors completed the SF-36 questionnaire predonation and 4 weeks, and 3 months postdonation. Predonation HRQOL markers were the strongest predictors of time to recovery. Poorer predonation physical health was associated with longer recovery (P = .017) and certain side effects in PBSC donors. Poorer predonation mental health was associated with longer recovery in BM donors (P = .03) and pain after PBSC donation (P = .003). Physical HRQOL scores declined significantly from predonation to 4 weeks postdonation. This was shown both for PBSC and BM donors (P < .001 and P = .009, respectively), but the decline was much greater for BM donors. There was a return to predonation HRQOL values 3 months after donation in both groups with values well above the mean of the general population (P < .001).

Volunteer unrelated donor experience after administration of filgrastim and apheresis for the collection of haemopoietic stem cells: the Australian perspective.

BACKGROUND: Voluntary donations of peripheral blood stem cells after administration of filgrastim (granulocyte-colony stimulating factor, G-CSF) are undertaken throughout the world by healthy individuals, but the short-, medium- and long-term adverse events during and after donation are not fully understood. AIMS: We document the experience of donors of peripheral blood stem cells mobilised by G-CSF at Australian Bone Marrow Donor Registry collection centres. METHODS: When the Australian Bone Marrow Donor Registry commenced collecting mobilised peripheral blood stem cells, based on data used for registration of G-CSF, all adverse reactions in donors were documented prospectively to determine the rate and severity of events. A total of 512 consecutive first-time donors assessed between July 2001 and March 2010 were included in this study. RESULTS: The median age at work-up was 40 years and 71% of donors were male. A large proportion of donors (91%) experienced bone pain during administration of G-CSF, and in fewer numbers headache (61%) and fatigue (61%). Bone pain was associated with a body mass index of overweight/obese (P = 0.03). Headache (P = 0.03), muscle pain (P = 0.03) and fatigue (P = 0.001) were all significantly associated with female sex. More than a quarter (28%) of donations involved a range of complications at collection. CONCLUSION: The incidence of short- and medium-term symptoms and events observed provide support for the information provided to unrelated donors at counselling. Follow up of the consequences of unrelated voluntary donation remains important to provide accurate and relevant information to prospective donors.

Haploidentical hematopoietic stem cell transplantation with unmanipulated granulocyte colony stimulating factor mobilized marrow and blood grafts.

PURPOSE OF REVIEW: This article summarizes recent improvements and progress with unmanipulated haploidentical blood and marrow transplantation (HBMT) and discusses the difference in outcomes between patients receiving HBMT and those receiving unmanipulated granulocyte colony stimulating factor (G-CSF) mobilized haploidentical peripheral blood (G-PB) grafts as allografts. RECENT FINDINGS: Long-term follow-up confirmed that unmanipulated HBMT is a promising protocol that can be successfully extended to treat severe aplastic anemia. Recent observations regarding immune recovery, infections, and strategy for modified donor lymphocyte infusions have provided insight into the prevention of infections and the decrease in relapse after HBMT. Extensive chronic graft-versus-host disease (GVHD) strongly and negatively impacts patient health-related quality of life, suggesting that it should be successfully controlled. A prospective study suggested the inclusion of HBMT in treatment algorithms as a viable option for adults with acute myeloid leukemia with unfavorable cytogenetics who lack a matched donor. Randomized clinical trials are warranted to investigate whether mixture grafts of G-CSF-mobilized blood and marrow or G-PB alone should be chosen as allografts in haploidentical settings. SUMMARY: Unmanipulated HBMT is a reliable protocol. New strategies should be investigated to decrease the incidences of GVHD and relapse. Novel mobilization regimens such as AMD3100 alone or G-CSF+AMD3100 for allograft engineering may improve transplant outcomes following HBMT.

Impact of stem cell donation modality on normal donor quality of life: a prospective randomized study.

As part of a previously reported trial comparing granulocyte-colony stimulating factor (G-CSF) stimulated bone marrow and peripheral blood stem cells (PBSCs) in allogeneic stem cell transplantation, we included a questionnaire to compare donor morbidity and long-term complications between the two donation procedures. Bone marrow donation was associated with significantly more donors experiencing localized pain at the donation site compared to PBSC collection. However, this was not associated with any increased delay in returning to normal activity. Although a minority of bone marrow donors suffered chronic pain at the donation site, no serious long-term side effects relating to G-CSF stimulated stem cell donation were identified.

Donating stimulated peripheral blood stem cells vs bone marrow: do donors experience the procedures differently?

As the demand for undifferentiated stem cells for the treatment of leukemia and other cancers has increased, new methods for their collection have been developed. One of these new methods, allogeneic peripheral blood stem cell (PBSC) donation, involves the administration of a granulocyte colony-stimulating factor (G-CSF, filgrastim), and a 1-2 day apheresis collection procedure. Our goal in the current study was to examine donors' psychosocial and physical experiences of PBSC vs marrow donation. Potential participants included 80 donors from the National Marrow Donor Program (NMDP) who donated a second time between 1991 and 1997. All of these donors had previously donated marrow. A final cohort of 70 donors (25 PBSC and 45 marrow) participated in a retrospective questionnaire study of their donation experiences. In general, all second-time donors reported low levels of concern about the physical consequences of donation. However, PBSC donors were more likely to have postponed the decision to donate a second time. Despite their reservations, PBSC donors reported fewer donation-related side-effects than did marrow donors. Finally, PBSC donors reported that marrow donation was more physically difficult, time-consuming, and inconvenient, and that they preferred PBSC to marrow donation.