Effect of Aging and Predonation Comorbidities on the Related Peripheral Blood Stem Cell Donor Experience: Report from the Related Donor Safety Study

• Authors: Michael A. Pulsipher, Childrens Hospital Los Angeles; Brent R. Logan, Medical College of Wisconsin; Pintip Chitphakdithai, Center for International Blood and Marrow Transplant Research; Deidre M. Kiefer, Center for International Blood and Marrow Transplant Research; Marcie L. Riches, University of North Carolina; J. Douglas Rizzo, Medical College of Wisconsin; Paola Anderlini, MD Anderson Cancer Center; Susan F. Leitman, Department of Transfusion Medicine, National Institutes of Health Clinical Center; Ann Haight, Emory University; Edmund Waller, Emory University
• Journal Title: Biology of Blood and Marrow Transplantation
• Volume: Volume 25, Number 4
• Publisher: Elsevier Science Inc. | 2019-04-01, Pages 699-711
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.bbmt.2018.11.004
• Subjects: Biology, Cell; Health Sciences, Immunology; Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Hematology; Immunology; Transplantation; Stem cell transplantation; BM collection toxicities; Donor safety; PBSC collection toxicities; Quality of life; Bone marrow; Retrospective analysis; Prospective trial; Adverse events; Healthy donors; Family donors; Mobilization; Collection; PBSC

Abstract

The development of reduced-intensity approaches for allogeneic hematopoietic cell transplantation has resulted in growing numbers of older related donors (RDs) of peripheral blood stem cells (PBSCs). The effects of age on donation efficacy, toxicity, and long-term recovery in RDs are poorly understood. To address this we analyzed hematologic variables, pain, donation-related symptoms, and recovery in 1211 PBSC RDs aged 18 to 79 enrolled in the Related Donor Safety Study. RDs aged > 60 had a lower median CD34 + level before apheresis compared with younger RDs (age > 60, 59 × 10 6 /L; age 41 to 60, 81 × 10 6 /L; age 18 to 40, 121 × 10 6 /L; P <.001). This resulted in older donors undergoing more apheresis procedures (49% versus 30% ≥ 2 collections, P <.001) and higher collection volumes (52% versus 32% > 24 L, P <.001), leading to high percentages of donors aged > 60 with postcollection thrombocytopenia <50 × 10 9 /L (26% and 57% after 2 and 3days of collection, respectively). RDs aged 18 to 40 had a higher risk of grades 2 to 4 pain and symptoms pericollection, but donors over age 40 had more persistent pain at 1, 6, and 12 months (odds ratio [OR], 1.7; P = 0.02) and a higher rate of nonrecovery to predonation levels (OR, 1.7; P =.01). Donors reporting comorbidities increased significantly with age, and those with comorbidities that would have led to deferral by National Marrow Donor Program unrelated donor standards had an increased risk for persistent grades 2 to 4 pain (OR, 2.41; P <.001) and failure to recover to predonation baseline for other symptoms (OR, 2.34; P =.004). This information should be used in counseling RDs regarding risk and can assist in developing practice approaches aimed at improving the RD experience for high-risk individuals.