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Physicians' preferences and perceptions regarding donor selection in allogeneic stem cell transplantation in Korea when a matched domestic donor is not available

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ABSTRACT

Background: A number of alternative donor options exist for patients who fail to find domestic HLA-matched donors for allogeneic hematopoietic stem cell transplantation (allo-HSCT). We assessed physicians' perspectives on allo-HSCT donor selection when a matched domestic donor is not available.

Methods: We administered a questionnaire survey to 55 hematologists (response rate: 28%) who attended the annual spring conference of the Korean Society of Haematology in 2015. The questionnaire contained four clinical allo-HSCT scenarios and the respondents were asked to choose the most preferred donor among the given options.

Results: In all four scenarios, the hematologists preferred a matched international donor over partially mismatched unrelated domestic or haplo-matched family donors. The numbers of hematologists who chose a matched international donor (HLA 8/8) in cases of acute myeloid leukemia, chronic myeloid leukemia, acute lymphoblastic leukemia, and aplastic anemia were 37 (67.3%), 41 (74.6%), 33 (60.0%), and 36 (65.5%), respectively. The important factors that affected donor selection included “expecting better clinical outcomes (40.5%)” and “lower risk of side effects (23.4%).” The majority of participants (80%) responded that allo-HSCT guidelines for donor selection customized for the Korean setting are necessary.

Conclusion: Although hematologists still prefer perfectly matched foreign donors when a fully matched domestic allo-HSCT donor is not available, we confirmed that there was variation in their responses. For evidence-based clinical practice, it is necessary to provide further comparative clinical evidence on allo-HSCT from haplo-matched family donors and fully matched unrelated international donors.

No MeSH data available.


Related in: MedlinePlus

Results of donor selection by case scenario. (A) Acute myeloid leukemia (AML), (B) Chronic myeloid leukemia (CML), (C) Acute lymphoblastic leukemia (ALL), (D) Aplastic anemia (AA).
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Figure 1: Results of donor selection by case scenario. (A) Acute myeloid leukemia (AML), (B) Chronic myeloid leukemia (CML), (C) Acute lymphoblastic leukemia (ALL), (D) Aplastic anemia (AA).

Mentions: For the AML case, among the 55 respondents, 67% (N=37) chose a donor from Taiwan whose HLA type perfectly matched that of the recipient; 27% (N=15) chose a haplo-matched family donor, while only 5% (N=3) chose a domestic donor with a partial HLA type match (HLA 6/8; Fig. 1A). The main reason for the donor choice was “expecting better clinical outcomes” (69%, N=38), followed by “shorter waiting time for transplantation” (15%, N=8), “lower risk of rejection” (13%, N=7), and “lower cost for transplantation” (4%, N=2).


Physicians' preferences and perceptions regarding donor selection in allogeneic stem cell transplantation in Korea when a matched domestic donor is not available
Results of donor selection by case scenario. (A) Acute myeloid leukemia (AML), (B) Chronic myeloid leukemia (CML), (C) Acute lymphoblastic leukemia (ALL), (D) Aplastic anemia (AA).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5383585&req=5

Figure 1: Results of donor selection by case scenario. (A) Acute myeloid leukemia (AML), (B) Chronic myeloid leukemia (CML), (C) Acute lymphoblastic leukemia (ALL), (D) Aplastic anemia (AA).
Mentions: For the AML case, among the 55 respondents, 67% (N=37) chose a donor from Taiwan whose HLA type perfectly matched that of the recipient; 27% (N=15) chose a haplo-matched family donor, while only 5% (N=3) chose a domestic donor with a partial HLA type match (HLA 6/8; Fig. 1A). The main reason for the donor choice was “expecting better clinical outcomes” (69%, N=38), followed by “shorter waiting time for transplantation” (15%, N=8), “lower risk of rejection” (13%, N=7), and “lower cost for transplantation” (4%, N=2).

View Article: PubMed Central - PubMed

ABSTRACT

Background: A number of alternative donor options exist for patients who fail to find domestic HLA-matched donors for allogeneic hematopoietic stem cell transplantation (allo-HSCT). We assessed physicians' perspectives on allo-HSCT donor selection when a matched domestic donor is not available.

Methods: We administered a questionnaire survey to 55 hematologists (response rate: 28%) who attended the annual spring conference of the Korean Society of Haematology in 2015. The questionnaire contained four clinical allo-HSCT scenarios and the respondents were asked to choose the most preferred donor among the given options.

Results: In all four scenarios, the hematologists preferred a matched international donor over partially mismatched unrelated domestic or haplo-matched family donors. The numbers of hematologists who chose a matched international donor (HLA 8/8) in cases of acute myeloid leukemia, chronic myeloid leukemia, acute lymphoblastic leukemia, and aplastic anemia were 37 (67.3%), 41 (74.6%), 33 (60.0%), and 36 (65.5%), respectively. The important factors that affected donor selection included “expecting better clinical outcomes (40.5%)” and “lower risk of side effects (23.4%).” The majority of participants (80%) responded that allo-HSCT guidelines for donor selection customized for the Korean setting are necessary.

Conclusion: Although hematologists still prefer perfectly matched foreign donors when a fully matched domestic allo-HSCT donor is not available, we confirmed that there was variation in their responses. For evidence-based clinical practice, it is necessary to provide further comparative clinical evidence on allo-HSCT from haplo-matched family donors and fully matched unrelated international donors.

No MeSH data available.


Related in: MedlinePlus