Published online 4 December 2008
Haematologica, Vol 94, Issue 1, 94-101 doi:10.3324/haematol.13668
Copyright © 2009 by Ferrata Storti Foundation

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Stem Cell Transplantation

Severe events in donors after allogeneic hematopoietic stem cell donation

Joerg Halter¹, Yoshihisa Kodera², Alvaro Urbano Ispizua³, Hildegard T. Greinix⁴, Norbert Schmitz⁵, Geneviève Favre¹, Helen Baldomero⁶, Dietger Niederwieser⁷, Jane F. Apperley⁸, Alois Gratwohl¹ for the European Group for Blood and Marrow Transplantation (EBMT) activity survey office

¹ Hematology, Department of Medicine, University Hospital Basel, Basel, Switzerland
² Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
³ Department of Hematology, Virgen del Rocio, Sevilla, Spain
⁴ Department of Internal Medicine I/BMT, Medical University of Vienna, Austria
⁵ Department of Hematology and Stem Cell Transplantation, Asklepios Klinik St. Georg, Hamburg, Germany
⁶ EBMT activity survey office, Hematology, University Hospital Basel, Switzerland
⁷ Department of Hematology and Oncology, University of Leipzig, Leipzig, Germany
⁸ Department of Haematology, Hammersmith Hospital, DuCane Road, London, UK

Correspondence: Joerg Halter, MD, Hematology, Department of Medicine, University Hospital Basel, CH-4031 Basel, Switzerland. E-mail:jhalter{at}uhbs.ch

Background: The risk for donors of allogeneic hematopoietic stem cells transplants is generally considered negligible. Scattered reports of severe complications and a recent controversy on hematopoietic malignancies after granulocyte colony-stimulating factor administration have challenged this opinion.

Design and Methods: Three hundred and thirty-eight allogeneic transplant teams from 35 primarily European countries were asked to report numbers of fatalities, severe adverse events and hematologic malignancies occurring among their hematopoietic stem cell donors.

Results: Two hundred and sixty-two of the 338 teams (77.5%) responded to a first survey (1993–2002) and 169 of the 262 responder teams (65%) to a second survey (2003–2005). They had performed a total of 51,024 first allogeneic hematopoietic stem cell transplantations, of which 27,770 were bone marrow and 23,254 peripheral blood. They observed five donor fatalities, one after a bone marrow donation and four after peripheral blood donation (incidence 0.98 per 10,000 donations; 95% CI 0.32–2.29), 37 severe adverse events (7.25/10,000; 95% CI 5.11–9.99), of which 12 in bone marrow donors (4.32/10,000; 95% CI 2.24–7.75) and 25 in peripheral blood donors (10.76/10,000; 95% CI 6.97–15.85; p<0.05) and 20 hematologic malignancies (3.92/10,000; 95% CI 2.39–6.05), of which 8 after donating bone marrow and 12 after donating peripheral blood stem cells. The observed incidence rate of hematologic malignancies did not exceed the expected incidence in an age- and sex-adjusted general population.

Conclusions: Hematopoietic stem cell donation is associated with a small but definite risk of fatalities and serious adverse events. True incidences might be higher, due to potential underreporting by study design. A continuous, standardized donor follow-up is needed to define donor risk groups and to monitor intermediate and long-term sequelae.

Key words: hematopoietic stem cell donation, adverse event, hematologic malignancies, donor fatality.

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