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A consideration for efficient unrelated hematopoietic stem cell source acquisition—from an experience of Japan

Bone Marrow Transplantation volume 55, pages 657–660 (2020)Cite this article

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HLA is the first limiting factor to find suitable unrelated graft sources for allogeneic hematopoietic cell transplantation (allo-HCT). According to the HLA frequencies in Japan, more than 60% of patients could find at least one HLA 8/8 allele-matched donor from 400,000 donor registrants [1] (in reality, a median of 36% of total unrelated bone marrow/peripheral blood stem cell transplantation (UBMT) was performed from HLA 8/8 allele-matched unrelated donors), and an HLA 4/6 matched unrelated cord blood (UCB) unit can be found when 1600 UCB units were stored [2]. Because HLA-based analyses did not fully reflect the availability of unrelated graft sources in Japan, there is a gap between the HLA-based estimation and actual availability of unrelated graft sources. According to the Japan Marrow Donor Program, 493,627 donors are available (as of the end of December 2018) and more than 30,000 new donors are registered every year. The relatively high canceling rate during coordination is one of the major problems in Japan, although the financial factors and the accessibility to hospitals have few impacts to receive HCT medical services at patients. An average of 11 donor candidates are required to obtain a donor who actually leads to donation; the two major reasons of cancelled coordination were work circumstances and family opposition.

We attempted to comprehensively verify unrelated graft source acquisition reflecting the actual situation. This study included all patients who underwent allo-HCT between 2004 and 2013 according to the registry database [3]. The characteristics of the patients are shown in Supplemental Table 1. In this study, we intend to verify the required number of unrelated donor registrants to find an HLA 8/8 allele-matched unrelated donor for all patients who underwent UBMT, and the required number of UCB units to find a unit that included at least total nucleated cell count (TNCC) 10 × 108 (CBU10) for all patients who underwent UCBT. To reflect the recent trends of allo-HCT, it was divided into two cohorts every 5 years (Cohort1: 2004–2008, Cohort2: 2009–2013). We also analyzed the effective reduction of the unrelated donor coordination period in acute leukemia. HLA-matching was performed using 4-digit high-resolution typing for HLA-A, -B, -C, and -DRB1 and allele level disparity was identified for all URD [4,5,6,7]. HLA-matching of UCB was performed using low-resolution typing for HLA-A, -B, and -C and high-resolution typing for HLA-DRB1.

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Fig. 1

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Acknowledgements

The authors appreciate the cooperation of all the transplant centers in Japan, the Japan Marrow Donor Program, and Japanese Red Cross Society for this study. This study was supported in part by the Japan Leukemia Research Fund, JSPS KAKENHI Grant Number JP17K16186 and the Practical Research Project for Allergic Diseases and Immunology from Japan Agency for Medical Research and Development, AMED (18ek0510014h0003).

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Authors and Affiliations

  1. Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan

    Satoshi Nishiwaki

  2. Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan

    Koichi Miyamura & Yukiyasu Ozawa

  3. Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan

    Yoshinobu Kanda

  4. Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan

    Yoshinobu Kanda

  5. Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan

    Minoko Takanashi

  6. Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations TORANOMON HOSPITAL, Tokyo, Japan

    Naoyuki Uchida

  7. Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan

    Takahiro Fukuda

  8. Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan

    Kazuhiro Ikegame

  9. Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan

    Kazuteru Ohashi

  10. Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan

    Tetsuya Eto

  11. Department of Hematology, Hokkaido University Hospital, Sapporo, Japan

    Souichi Shiratori

  12. Department of Hematology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan

    Koji Iwato

  13. Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan

    Ken-ichi Matsuoka

  14. Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan

    Michihiro Hidaka

  15. Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan

    Tatsuo Ichinohe

  16. Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan

    Yoshiko Atsuta

  17. Japan Marrow Donor Program, Tokyo, Japan

    Yoshihisa Kodera

  18. Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan

    Shinichiro Okamoto

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  1. Satoshi Nishiwaki
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Correspondence to Satoshi Nishiwaki.

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Nishiwaki, S., Miyamura, K., Kanda, Y. et al. A consideration for efficient unrelated hematopoietic stem cell source acquisition—from an experience of Japan. Bone Marrow Transplant 55, 657–660 (2020). https://doi.org/10.1038/s41409-019-0542-0

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