Optimizing Donor Searches in HCT

This two-part "Explore Cell Therapy" podcast episode dives into recent research on the benefits and challenges of optimizing donor searches for allogeneic hematopoietic cell transplant (HCT). Joseph Pidala, MD, PhD, Moffitt Cancer Center, and Jason Dehn, MPH, NMDPSM, review crucial findings from the Blood and Marrow Transplant Clinical Trials Network (BMT CTN) 1702 trial to shed light on the pivotal role of search prognosis in helping more eligible patients receive HCT.

Learn why it's important to understand a patient's HLA typing and racial/ethnic background early to initiate an alternative donor search if a patient is less likely to find a fully matched donor. The experts discuss strategies to prioritize alternative donor sources to ensure that more patients receive HCT at optimal timepoints, and review implications for the future of donor search optimization, transplant access and health equity in an increasingly diverse patient population.

Listen to Part 1: Strategies and Considerations

Listen to Part 2: Overcoming Barriers

1. Use of alternative donor sources is growing: Advances in graft-versus-host disease (GVHD) prophylaxis, including use of post-transplant cyclophosphamide, have made HCT a viable treatment option for more patients unlikely to have a matched donor. However, more guidance on donor search strategy and selection is needed to help these patients achieve HCT in a timely manner to improve outcomes.
2. Similar time to transplant for those unlikely to have a full 8/8 match: Results from the BMT CTN 1702 study show that with an early alternative-donor-centered search strategy, patients with poor likelihood of finding a matched unrelated donor (MUD) still achieve transplant at comparable rates and without added resource utilization or delays in care.
3. Identifying and prioritizing donor sources early can impact outcomes: Since patients who get HCT earlier in their disease course have better survival, it’s critical to understand early on if a donor search should focus on finding alternative donor sources. This strategy can be particularly beneficial for patients who are racially and ethnically diverse who are less likely to have full matches on global donor registries, helping to reduce outcome disparities for these groups.
4. Time to transplant largely depends on patient factors: Achieving target HCT timing was more often delayed due to a patient’s disease course and not due to donor availability when a strategic donor search was conducted. Having multiple donor options can help stick to desired timelines in case of complications with a patient’s clinical pathway.
5. Physician perceptions about donor availability impact access: While this trial adds to the mounting evidence that there is a donor for all, there is still work to be done to level the playing field for all patients. Experts urge that the perception that some patients do not have a suitable donor should not deter hematologists/oncologists from referring for an early consult.

• Listen to Part 1: Strategies and Considerations
• Listen to Part 2: Overcoming Barriers

Access all "Explore Cell Therapy" episodes

Listen to "Explore Cell Therapy" on Spotify

1. Donor Search and Selection Strategy to Facilitate Comparable Transplant Rates Across Donor Search Prognosis Groups: A Report from the BMT CTN 1702 Trial (Transplantation and Cellular Therapy, February 2024)
2. Clinical Transplant-Related Long-term Outcomes of Alternative Donor Allogeneic Transplantation (BMT CTN 1702) (ClinicalTrials.gov, updated December 2023)
3. Likelihood of Proceeding to Allogeneic Hematopoietic Cell Transplantation in the United States after Search Activation in the National Registry: Impact of Patient Age, Disease, and Search Prognosis (Transplantation and Cellular Therapy, February 2021)
4. Post-Transplant Cyclophosphamide–Based Graft-Versus-Host Disease Prophylaxis Attenuates Disparity in Outcomes Between Use of Matched or Mismatched Unrelated Donors (Journal of Clinical Oncology, July 2024)
5. Transplantation Referral Patterns for Patients with Newly Diagnosed Higher-Risk Myelodysplastic Syndromes and Acute Myeloid Leukemia at Academic and Community Sites in the Connect® Myeloid Disease Registry: Potential Barriers to Care (Transplantation and Cellular Therapy, 2023)

This free program allows a community hematology/oncology practice to initiate early unrelated and related donor searches before a patient reaches a transplant center. This allows time for a more in-depth search and provides insights that can inform alternate treatment options to ensure the best possible outcomes.

Discover NMDP HLA Today

The new and improved HCT Guidelines app features our latest HCT Consultation Timing Guidelines, Post-Transplant Care Guidelines, tips to help identify GVHD, CME opportunities and more.

Download the app for Apple

Download the app for Android

This searchable database provides details on the transplant centers, such as center contact information, number of transplants by cell source, patient survival information and more.

Access the Transplant Center Directory

Get information about ACCESS, our clinical trial of mismatched unrelated donor (MMUD) HCT in patients with hematologic malignancies.

ACCESS clinical trial information

In this podcast episode, learn more about the latest research and ongoing trials that have led to the ability to find a suitable donor for nearly every patient who can benefit from HCT.

Listen to Ensuring a Donor for All

Patients, caregivers and families receive free support, information and resources before and after transplant from our NMDP Patient Support Center team.

Get Patient Support Center details

The CTSS program helps patients find and join clinical trials through one-on-one support and an easy-to-navigate website. Patients can receive financial assistance to help pay for travel costs to participate in a clinical trial.

Access CTSS details