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The Effect of Aging and Pre-Donation Comorbidities on the Related PBSC Donor Experience: A Report from the Related Donor Safety Study (RDSafe). Biol Blood Marrow Transplant 2018 Nov 10 PMID: 30423480

Pubmed ID

30423480

Abstract

The development of reduced intensity approaches for allogeneic hematopoietic cell transplantation has resulted in growing numbers of older related donors (RD) of PBSC. The effects of age on donation efficacy, toxicity, and long-term recovery in RD are poorly understood. To address this we analyzed hematologic variables, pain, donation-related symptoms and recovery in 1211 related PBSC donors aged 18-79 enrolled in the Related Donor Safety Study (RDSafe). RD >60 had a lower median CD34+ level pre-apheresis compared to younger RD (age >60, 59 × 10/L; age 41-60, 81 × 10/L; age 18-40, 121 × 10/L; p<0.001). This resulted in older donors undergoing more apheresis procedures (49% vs. 30% ≥2 collections, p<0.001) and higher collection volumes (52% vs. 32% >24L, p<0.001), leading to high percentages of donors >60 with post-collection thrombocytopenia <50 × 10/L (26% and 57% after 2 and 3 days of collection, respectively). RD age 18-40 had a higher risk of grade 2-4 pain and symptoms peri-collection, but donors above age 40 had more persistent pain at 1, 6, and 12 months (OR1.7, p=0.02) and a higher rate of non-recovery to pre-donation levels (OR 1.7, p=0.01). Donors reporting comorbidities increased significantly with age, and those with comorbidities that would have led to deferral by NMDP unrelated donor standards had an increased risk for persistent grade 2-4 pain (OR=2.41, p<0.001) and failure to recover to pre-donation baseline for other symptoms (OR=2.34, p=0.004). This information should be used in counseling RD regarding risk and can assist in developing practice approaches aimed at improving the RD experience for high-risk individuals.

Author List

Pulsipher MA, Logan BR, Chitphakdithai P, Kiefer DM, Riches ML, Rizzo JD, Anderlini P, Leitman SF, Varni JW, Kobusingye H, Besser RM, Miller JP, Drexler RJ, Abdel-Mageed A, Ahmed IA, Akard LP, Artz AS, Ball ED, Bayer RL, Bigelow C, Bolwell BJ, Broun ER, Bunin NJ, Delgado DC, Duckworth K, Dvorak CC, Hahn TE, Haight AE, Hari PN, Hayes-Lattin BM, Jacobsohn DA, Jakubowski AA, Kasow KA, Lazarus HM, Liesveld JL, Linenberger M, Litzow MR, Longo W, Magalhaes-Silverman M, McCarty JM, McGuirk JP, Mori S, Prasad VK, Rowley SD, Rybka WB, Sahdev I, Schriber JR, Selby GB, Shaughnessy PJ, Shenoy S, Spitzer T, Tse WT, Uberti JP, Vusirikala M, Waller EK, Weisdorf DJ, Yanik GA, Navarro WH, Horowitz MM, Switzer GE, Shaw BE, Confer DL

Authors

Parameswaran Hari MD Chief, Professor in the Medicine department at Medical College of Wisconsin
Mary M. Horowitz MD, MS Center Director, Professor in the Medicine department at Medical College of Wisconsin
Brent R. Logan PhD Director, Professor in the Institute for Health and Equity department at Medical College of Wisconsin




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