Comprehensive Donor Selection Guidelines

NMDP Establishes Roadmap for Physicians, Transplant Coordinators

The National Marrow Donor Program (NMDP) has published a comprehensive set of guidelines on unrelated donor marrow and blood stem cell transplants to provide transplant center physicians and coordinators guidance and strategy for donor selection.

The guidelines appear in the October 2003 edition of the journal Biology of Blood and Marrow Transplantation.

"With these practical guidelines, the NMDP conveys to transplant physicians a roadmap to help them make informed decisions about how to treat patients for whom a matched donor cannot be found," said Carolyn Hurley, Ph.D., professor of oncology at Georgetown University Medical Center's Lombardi Comprehensive Cancer Center and lead author of the National Marrow Donor Program HLA Matching Guidelines for Unrelated Marrow Transplants.

Every year, thousands of Americans with leukemia and other potentially fatal blood diseases need a marrow or blood stem cell transplant. Only 30% of these patients find a matched donor in their family. The other 70% must search for an unrelated donor.

Finding a suitable donor is a complex and frequently misunderstood component of unrelated donor stem cell transplantation. Because the quality and timing of the donor match are primary factors in transplant outcome, the donor search is a critical component of the transplant process.

The major criteria for marrow donor matching is a set of genetically determined markers that determine whether donated marrow is accepted or rejected by the recipient's immune system. Marrow and blood stem cell transplantation require a close match between a donor's HLA tissue type and the patient's. HLA proteins are found on the surface of virtually every cell in the body.

HLA alleles and haplotypes are distributed at different frequencies in different racial or ethnic groups. When searching for a donor, a match is more likely to be found among persons of the same ethnicity.

"These guidelines will improve transplant outcomes by detailing the best approach to match patient and donor tissue types," said Dr. Dennis L. Confer, NMDP chief medical officer.

The guidelines encourage consideration of transplants as a treatment option even without a perfect match.

"The new guidelines indicate to transplant physicians that they can get good results with some degree of HLA marker mismatching although the final word is not in on how mismatched the donor and recipient can be," Hurley said.

Co-authors of the guidelines are Hurley; Confer; Lee Ann Baxter-Lowe, Ph.D., of University of California-San Francisco; Brent Logan, Ph.D., Medical College of Wisconsin; Chatchada Karanes, M.D., NMDP medical director; Claudio Anasetti, M.D., Fred Hutchinson Cancer Research Center, Seattle, Wash.; and Daniel Weisdorf, M.D., NMDP scientific director and director of clinical research, University of Minnesota Department of Medicine.

The guidelines are published online at http://www.bbmt.org.