Both Optimal Matching and Procedure Duration Influence Survival of Patients after Unrelated Donor Hematopoietic Stem Cell Transplantation

Eighty-six patients suffering from hematological malignancies, immunodeficiencies, and aplastic anemias received alloHSCT from unrelated donors. Donors were selected from the BMDW files and further matching was performed according to the confirmatory typing procedure with the use of PCR SSP and that based on sequencing. The time from the clinical request of the donor search to the final decision of clinicians accepting the donor was from 0.3 to 17.8 months (median 1.6). Matching was analyzed at the allele level, and 50, 27, and 9 donor-recipient pairs were 10/10 matched, mismatched in one or more alleles, respectively. In an univariate analysis we found better survival if patients were transplanted: (i) from donors matched 10/10 , (ii) not from female donor to male recipient , (iii) in female donation from those with ≤1 pregnancy than multiparous . Notably, it became apparent that duration of the confirmatory typing process affected the survival (HR = 1.138, ). In multivariate analysis only the level of matching and the duration of the matching procedure significantly affected the survival. In conclusion, the duration of the matching procedure in addition to the level of matching should be considered as an independent risk factor of survival. 1. Introduction The number of allogeneic hematopoietic stem cell transplantations (alloHSCTs) from unrelated donors has increased over the years and in Europe reached 7098 in 2010 (EBMT Survey on Transplant Activity 2010). This was possible due to the improvement in international cooperation in donor-recipient matching procedures facilitated by the Bone Marrow Donors Worldwide (BMDW) files [1] and implementation of the European Marrow Donor Information System (EMDIS) in a number of countries. The priority of the search procedure is to identify the optimally matched donor for patients badly needing hematopoietic stem cell transplantation (HSCT). Quite recently the pace of the matching procedure has improved due to the use of computer-assisted communication systems including the EMDIS. However, still some time is needed, especially when the process of searching for a fully matched donor is prolonged. Previously published studies showed that the time needed to identify an acceptable donor is associated with a profile of HLA alleles being prolonged in cases with rare haplotypes [2–4]. Prolonged search may result in postponing transplantation in some cases that become medically unfit in the meantime. This may be due to various medical reasons including relapse and consequently, unless successfully treated, advancing in