Enables rapid alternative donor utilization
Many patients in need of a blood or marrow transplant (BMT) can’t wait. They need to advance to BMT before their disease progresses. To meet that need, the National Marrow Donor Program (NMDP) developed a search prognosis calculator that uses HLA typing to characterize the likelihood of having an available 8/8 matched unrelated donor (MUD). A first-of-its-kind clinical trial conducted through the Blood and Marrow Transplant Clinical Trials Network (BMT CTN) evaluated the use of the calculator to prioritize patient search strategy.
More than 1,700 patients of all ages who did not have available matched sibling donors were included in the trial. The patient’s clinical team determined that BMT was required within six months of study enrollment. Their diagnoses included acute myeloid leukemia, acute lymphoblastic leukemia, myelodysplastic syndrome, non-Hodgkin lymphoma, Hodgkin lymphoma, severe anaplastic anemia and sickle cell disease. Patients came from 51 centers across the U.S.
The trial found that even patients in need of BMT who don’t have a strong likelihood of a MUD as determined by the search prognosis calculator can be quickly matched with a suitable alternative donor. This is due to expanded alternative donor options, including mismatched unrelated and haploidentical donors and umbilical cord blood units. In other words, patients who need curative cellular therapy no longer need to have barriers to BMT due to donor selection.
Using the search prognosis calculator, 55% of patients were classified as highly likely to find an 8/8 MUD, 30% less likely and 16% very unlikely. Participating transplant centers were asked to follow a defined donor selection algorithm protocol. Ninety-four percent of the very likely group transplanted had an 8/8 MUD; 84% of the very unlikely group transplanted had alternative donors, most commonly haploidentical (58%), mismatched unrelated donor (19%) or umbilical cord blood (7%).
There was no statistical difference in the rate of getting to BMT for patients in the very likely group compared to the very unlikely at six months. The two groups achieved BMT at the same rate.
This study demonstrated for the first time that a search prognosis-based algorithm can be implemented in a national multicenter trial. It enabled rapid alternative donor utilization and comparable rates of BMT in all patients, regardless of their likelihood of having a fully matched donor. The outcomes of the transplants will be compared and reported at a future date.
Learn more by reviewing a comprehensive analysis and description of the study.