Hematopoietic stem cell donor disqualification during recipient conditioning for transplantation: a proposition of rescue procedures

Abstract

Background

A donor hematopoietic cells disqualification is an uncomfortable situation at each stage of the donor typing and qualification because of extended waiting time to transplant. The occurrence of such an event occurring after completed conditioning is a life-threatening situation for the patient. We present a case report where the donor was disqualified during conditioning of the patient.

Case report

A 17-year-old girl suffering from secondary AML was referred to HSCT unit for a transplant from matched unrelated donor. Conditioning consisted of busulfan, melfalan, fludarabine, and anti-thymocyte globulin (ATG Genzyme). After 4 days of chemotherapy, an information has been received about severe adverse event during mobilization of peripheral blood stem cells (PBSC) at the donor and the lack of her agreement to harvest bone marrow. Hence there was a necessity to cancel the procedure of PBSC mobilization and apheresis.

Rescue procedures

Following rescue procedures have been undertaken immediately: (1) cessation of conditioning; (2) an urgent new search for another unrelated donor; and (3) arrangement for a rescue haploidentical transplant from mother, who was qualified for the procedure of PBSC mobilization.

Results

As a consequence of undertaken steps a new mismatched unrelated (8/10) donor was found within 4 days. The patient continued chemotherapy and dosage of ATG has been increased by 50%. The PBSC apheresis process from haploidentical donor was cancelled. The transplantation was performed with a three-day delay in comparison to initially scheduled protocol.

Conclusion

We believe that the proposed algorithm of rescue procedures can facilitate the proceedings in the case of donor hematopoietic cells disqualification directly prior to transplantation. It seems reasonable to propose a discussion on the implementation of procedures to reduce the risk of similar events. To consider is typing for each patient two potential donors, collection of material for transplantation before proceeding to transplantation and collection from each patient's own material for transplantation to the rescue.