|Year : 2021 | Volume
| Issue : 2 | Page : 122-124
Matched unrelated donor hematopoietic stem cell transplantation: Roles and responsibilities of workup coordinator - An observational study
Vikash Chandra Mishra, Dinesh Chandra, Nikki Dey, Amit Kr Bhardwaj, Archana Anthwal, Vimarsh Raina
Gene Bandhu, New Delhi, India
|Date of Submission||22-Sep-2020|
|Date of Decision||11-Feb-2021|
|Date of Acceptance||24-Mar-2021|
|Date of Web Publication||30-Jun-2021|
Dr. Vikash Chandra Mishra
Gene Bandhu, South Extension Part-II, New Delhi
Source of Support: None, Conflict of Interest: None
Background: With only 25% chances of finding a human leukocyte antigen matched stem cell donor within the family, in case of minimal residual disease, the dependence on matched unrelated donor (MUD) is inevitable. With increasing awareness about the MUD stem cell registries, the numbers of registrations for voluntary stem cell donations are also increasing each day. A workup coordinator is a strong and the most crucial link in the MUD hematopoietic stem cell transplantation (HSCT) workup. The coordination between the stem cell registry and transplant center TC in need of a MUD HSCT workup is handled by a workup coordinator. Aims and Objectives: The aim here is to highlight key roles and responsibilities of workup coordinators, without whom it can be impossible to complete a MUD HSCT. Materials and Methods: We accessed the roles and responsibilities of workup coordinators via the MUSD HSCT workup assisted by Genebandhu from May 2012 to August 2020. The methodology mainly involved was electronic communication between stem cell registry/transplant center (TC)/donor center/collection center/patient/donor. All these activities of coordinators were closely observed to understand their roles, requirements, and responsibilities in detail. Results: The workup coordinator has been successfully involved in 33 MUD HSCT workups since its inception. Out of these, 18 were from international stem cell registries and 15 with TC s from India. Discussion: Workup coordinator acts like a catalyst during a MUD HSCT. Appropriate and timely exchange of information between the registry and the TC is managed by a coordinator. Conclusion: This study showed the crucial role, requirements, and responsibilities of the coordinators and their importance in MUD HSCT workups.
Keywords: Human leukocyte antigen, matched unrelated donors hematopoietic stem cell transplantation, matched unrelated donors workup coordinator
|How to cite this article:|
Mishra VC, Chandra D, Dey N, Bhardwaj AK, Anthwal A, Raina V. Matched unrelated donor hematopoietic stem cell transplantation: Roles and responsibilities of workup coordinator - An observational study. Indian J Transplant 2021;15:122-4
|How to cite this URL:|
Mishra VC, Chandra D, Dey N, Bhardwaj AK, Anthwal A, Raina V. Matched unrelated donor hematopoietic stem cell transplantation: Roles and responsibilities of workup coordinator - An observational study. Indian J Transplant [serial online] 2021 [cited 2021 Jul 24];15:122-4. Available from: https://www.ijtonline.in/text.asp?2021/15/2/122/319880
| Introduction|| |
Stem cell donor registries around the world collect and store the human leukocyte antigen (HLA) types of volunteers to identify matched unrelated donors (MUDs) for patients requiring hematopoietic matched unrelated stem cell transplant. Selection of a MUD for hematopoietic stem cell transplantation (HSCT) is based primarily on HLA matching., As the number of registered stem donors increases day by day, a skilled and trained MUD workup coordinator has a key role in the overall MUD HSCT workup. Professionals involved in unrelated adult donor/cord blood unit search and selection are essential in the process to find the best donor for a patient. To standardize the level of expertise of staff performing searches and providing recommendations on graft selection, the world marrow donor association has also developed a global certificate program. At present, more than 5000 MUD HSCT are performed in the United States of America (USA) and more than 10,000 across the globe every year. Approximately half of all allogeneic transplants in the USA are performed from unrelated donors. Here, we attempted to highlight the importance of MUD workup coordinator and their roles, requirement, and responsibilities in a stem cell registry through the MUD workup assisted by Gene Bandhu stem cell registry.
| Materials and Methods|| |
This was an observational study where the role, requirements, and responsibilities of MUD workup coordinator were assessed via the total MUSD HSCT workup assisted by Genebandhu from May 2012 to August 2020.
Coordination for preliminary matched unrelated donor search
On receipt of a MUD search from a transplant center (TC)/stem cell registry, a preliminary donor search was performed using proprietary software (Prometheus) and world marrow donor association search tool. The preliminary search was a computerized search designed to identify potential stem cell donors that have similar HLA.
Managing pre workup of identified matched unrelated donor
Once a potential HLA 10/10 (A, B, C, DRB1, and DQB1 loci) matched donor was found and a transplant physician decided to go with the donor, a preworkup of that matched donor was initiated. During this course of action, matched donor was contacted, asked to appear for a counseling session, physical examination and blood sample draw to re-confirm HLA-typing (known as confirmatory HLA typing). Furthermore, samples were also examined for infectious disease markers (IDMs) (anti-HIV 1 and 2, hepatitis B surface antigen, anti-HCV, anti-CMV (immunoglobulin M [IgM] and IgG)). Moreover, tests for malaria and syphilis and a nucleic-acid amplification test for HIV, HBV, and HCV were conducted. Sometimes on request of TC/stem cell registry additional tests were also performed such as toxoplasma IgG, varicella zoster IgG, herpes simplex virus IgG, and HTLV I and II antibodies.
Coordination for work up request for hematopoietic stem cell product
Once the identified MUD was found to be suitable for donation based on the physical examination, confirmatory typing (CT), and IDM test, a workup request was initiated by transplant physician/stem cell registry. As per the instructions provided from transplant physician/stem cell registry, schedules were finalized for granulocyte colony stimulating factor administration, collection of hematopoietic stem cell, and transportation of collected product. Furthermore, coordination with courier person and preparation of documents required for airport clearance was also arranged by the workup coordinator.
Maintain posttransplant follow-up
All the donors and patients were followed up at 1st and 3rd months and at 1st, 2nd, and 3rd years respectively.
Mode of communication
Electronic communication was one of the major tools used in all the workup requests from international stem cell registry/Indian TCs. In addition, TCs/patients from India were approached by telephonic calls as well. Donors communications were done by telephonically and also by direct meetings as per his/her availability.
No inferential statistical analysis was performed in this paper as in this observational study only the roles and responsibilities of MUD workup coordinators has been demonstrated in a descriptive manner.
The patient consent has been taken for participation in the study and for publication of clinical details and images. Patients understand that the names and initials would not be published, and all standard protocols will be followed to conceal their identity.
It was an observational study to understand the roles and responsibilities of MUD workup coordinators and hence, EC clearance was not needed. The study was carried out as per the declaration of Helsinki.
| Results|| |
Matched unrelated donor transplant donor workup assistance from Genebandhu
Genebandhu MUD workup coordinator has successfully been involved in 33 MUD transplant workups since its inception from May 2012 to August 2020. Among these, 30 were for peripheral blood stem cells, 1 for bone marrow and 2 for cord blood units. Out of these 18 workups were with global stem cell registry. Genebandhu has so far assisted 15 MUDHSCT from their own donor data pool. Among these 6 were for international patients (USA, UK, Germany and Canada) and 9 for the Indian TCs from North and South India. Among all the assisted MUD HSCT, 18 workups coordination were in between patient registry, donor registry and TC (workup number 1, 2, 3, 4, 6, 7, 8, 9, 11, 12, 14, 15, 16, 19, 20, 21, 22 and 31). Whereas in 9 cases workup coordination were in between donor registry and TC (workup number 5, 13, 17, 18, 23, 24, 25, 26 and 28) and remaining 6 were in between patient registry and donor registry (workup number 10, 27, 29, 30, 32 and 33). Summary of all these workups has been represented in [Table 1].
|Table 1: Summary of all the matched unrelated donor hematopoietic stem cell transplantation workup assisted since May' 2012-August 2020|
Click here to view
| Discussion|| |
A workup coordinator plays an active role starting from the MUD search till successful completion of the transplant between TC, collection center (CC), stem cell registry, patients and donors. In addition, the coordinator is involved in posttransplant follow-ups. These follow-ups are done in the 1st-and 3rd-month posttransplant followed by annual follow ups.
Required skills, knowledge, and abilities of a matched unrelated donor coordinator
The MUD transplant coordinator must be aware about HLA, HLA matching, cell count (in case of cord blood unit only). In addition, a coordinator must have the knowledge about the importance of age, gender, ABO type, CMV status. Furthermore, a MUD HSCT workup coordinator must be aware about the words like of apheresis center (AC), CC, confidentiality, confidentiality breach, CT, DC, donor-identifying information, hematopoietic stem cell product, search process, high resolution HLA typing, TC. In addition, they should be aware about the documents needed for airport clearance during the transportation from CC to TC.
Major responsibilities of matched unrelated donor workup coordinator
The major responsibilities of MUD workup coordinator are preliminary MUD search, prepare preliminary search report and send it to the TC, contact the donor who is found to be matched with a patient in need of a MUD HSCT to evaluate donor interest and availability, educating and consenting donors on the marrow and peripheral blood stem cell donation process by taking informed consent, communication with TC/donor center (DC)/CC for collection of hematopoietic stem cell product, coordination for the physical exams and additional medical appointments as needed for donor clearance during the preworkup stage, coordination with CC for collection with marrow and peripheral blood stem cell donations, coordinating the transportation of the stem cell from CC to the TC, patient and donor posttransplant follow-up.
Timely and proactive communication for each of the above-mentioned activities is of great importance for any MUD HSCT workup. In MUD HSCT all the activities from preliminary donor search, transportation till infusion of the harvested product is correlated with each other. All communications should reach the personnel responsible, in the shortest possible time.
| Conclusion|| |
The overall MUD HSCT activity is coordinated by the workup coordinator between stem cell registry/TC/DC/CC/patient/donor. So, for a successful MUD HSCT, a workup coordinator is an important medium in a stem cell registry for exchange of information between donor registry, TC and the entire stake holders in time. The person who is working as a MUD workup coordinator must have knowledge of basic concepts of HLA, HLA matching, medical basics of HSCT, basic concepts of genetics, search strategy, registries, and characteristics of stem cell donors and cord blood banks.
We have not demonstrated about limitation of study in lack of previous studies in this area and hence there is scope of further discussions.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Mishra VC, Dorwal P, Solanki H, Kohli T, Tiwari AK, Raina V, et al
. Human leukocyte antigen-matched unrelated donor search experience for hematological disorder patients requiring transplant: Scenario for Indian patients. Indian J Med Paediatric Oncol 2019;40:32-4.
Hurley CK, Setterholm M, Lau M, Pollack MS, Noreen H, Howard A, et al
. Hematopoietic stem cell donor registry strategies for assigning search determinants and matching relationships. Bone Marrow Transplant 2004;33:443-50.
Tiwari AK, Bhati-Kushwaha H, Kukreja P, Mishra VC, Tyagi N, Sharma A, et al
. Probability of Finding Marrow Unrelated Donor (MUD) for an Indian patient in a Multi-national Human Leukocyte Antigen (HLA) Registry. Indian J Hematol Blood Transfus 2015;31:186-95.