Implementation of allogeneic hematopoietic stem cell transplantation from unrelated donors from Russian and foreign registries

Abstract

Introduction. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a standard treatment for many patients with hematological malignancies. Over the past 20 years, an increase in transplantation activity has been noted throughout the world. About 50 % of all allo-HSCT are transplanted from unrelated donors. Aim: to present the dynamics and stages of the development of unrelated donation using the example of one transplant center. Materials and methods. This study analyzed Allo-HSCT performed from 2009 to March 2019 at the National Research Center for Hematology (NRCH). The work of the unrelated donor recruiting group and the tissue typing laboratory was analyzed for this period. 107 patient requests for unrelated donor search were dissected to identify search failures. The parameters of 206 unrelated donors were estimated depending on the register (Russian Federation/foreign). Results. The number of allo-HSCTs did not exceed more than 20 per year, in 2009-2011. Since 2012, the number of allo-HSCT significantly increased when the possibility for searching for unrelated donors abroad as well as in the Russian Federation (RF) databases appeared. During this time an increase by more than 50 % was noted in the number of allo-HSCTs. Allo-HSCs from unrelated donors of the Russian Federation make up 30-40 % of all unrelated allo-HSCs. 16 % of potential donors of hematopoietic stem cells included in the NRCH registry are donors of the human blood components. Despite the increasing number of unrelated donors in international and RF databases, 12 % of patients did not find a compatible donor in any of the registers, due to a rare combination of HLA genes. It was revealed that among donors from the RF from whom allo-HSCT was performed, there was not a significant prevalence of men, compared to the foreign registry, 50.7 % and 66.7 %, respectively, despite the preference of donor-male by doctors. The 5-year overall survival in patients with acute leukemia in the first complete remission, depending on the performance of allo-HSCT from a donor from the RF or foreign registers, are comparable, 40 % and 39.5 %, respectively. Conclusion. The number of allo-HSCT has increased 5 times over the past 10 years largely due to the development of unrelated donation: 30-40 % of allo-HSC transplants received from unrelated donors were performed from donors from the United database of the Russian Federation. The 5-year overall survival of these patients is comparable with the results of the overall survival patients who received transplants from donors from foreign registers.