Haemopoietic Stem Cell Services
Searching for Unrelated Stem Cell Donors - Using the BBMR
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Searching via the British Bone Marrow Registry (BBMR)
Eligibility to Use the Register
Requesting the Reservation of a Stem Cell Donor
Patient Follow-Up
BBMR Policies
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Searching via the British Bone Marrow Registry (BBMR)
Currently 285,000 donors are enrolled on the Registry, of these 90% are HLA-A,
-B and -DR typed. This facilitates approximately 140 transplants annually.
Approximately 7800 cord blood units are also listed.The service is provided for patients requiring a stem cell transplant and for whom no HLA compatible family member is identified. A search for an unrelated donor initiated through the British Bone Marrow Registry will also include the Anthony Nolan Bone Marrow Trust and the Welsh Bone Marrow Donor Registry. For patients under 16 years of age, the search will include UK cord blood banks whose units are registered . All BBMR donors meet strict donor selection criteria. All searches must be initiated by a Transplant Centre or Consultant Haematologist.
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Eligibility to Use the Register
The Transplant Centre
The Transplant Centre must be eligible or registered for accreditation with an appropriate body such as FAHCT or JACIE.
It must also be registered with an appropriate national or international transplant outcome organisation for allogeneic transplantation, such as the European Group for Blood and Marrow Transplantation (EBMT) or the National Marrow Donor Program (NMDP).
The Patient
Patient acceptance criteria are as follows:
- Adult or paediatric
- General Haematology Task Force of the British Committee for Standards in Haematology: Guideline for the flow cytometric enumeration of CD34+ haematopoietic stem cells (1999)
- First and second transplant recipients
- All current indications generally accepted for stem cell transplantation from unrelated donors as indicated by the EBMT (contact the BBMR for details)
- Reduced intensity and myeloblative transplants
- Manipulated and unmanipulated stem cell products
- All patient follow-up data must be reported to the BBMR as requested
Requests to access donors for ´experimental´ procedures and second donations for the same patient must be approved by the Medical Director.
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Requesting the Reservation of a Stem Cell Donor
Complete a search request form
The transplant centre must first complete a "search request" form and send it to the BBMR. Two forms are available for this purpose; a "BBMR Unrelated Marrow and Cord Blood Search Request Form" and a "BBMR Cord Blood Unit Request Form". The former is used to request a search for either a bone marrow donor or cord blood unit; the latter is used to request a search for a cord blood unit only. Forms may be obtained from the BBMR.
Identify preferred donors for confirmatory testing
Following the search, the BBMR will supply a report listing possible donors. At the same time, the BBMR will provide a form (Request for Confirmatory Typing Samples from BBMR Donors) which should be used by the transplant centre to identify those preferred donors or cord blood units which require further or confirmatory testing. The completed form should be returned to the BBMR who will then arrange for samples from the selected donors to be collected and sent to the transplant centre. It is the responsibility of the transplant centre to arrange for the required testing. When banked cord blood units have been selected, the BBMR will forward the form to the appropriate cord blood bank who will arrange for confirmatory and additional testing.
Recruit the stem cell donor
Following the completion of confirmatory testing, a request to recruit the preferred donor should be sent to the BBMR using a "Formal Recruitment of a Stem Cell Donor" form. The form should be used to state the preferred source of stem cells; peripheral blood or bone marrow.
Selected donors will be asked whether they prefer bone marrow collection or peripheral blood stem cell collection by apheresis. Their decision will be communicated to the requesting centre by the Designated Registered Medical Practitioner or the BBMR. The donor will have the final choice. The preference of the transplant centre will be indicated to the donor only if they request this information.
Donors who opt to have peripheral blood stem cells collected by apheresis will have the conventional bone marrow procedure explained to them should they fail to mobilise and a back-up bone marrow collection becomes necessary.
Donors who have a pre-existing back problem, latex allergy or contra-indications for general anaesthetic for example, may only be suitable for peripheral blood stem cell collection by apheresis. Where this is the case the transplant centre will be advised by the BBMR because a bone marrow collection will not be available in the event of a failure to mobilise under G-CSF. Any change in the source of stem cells will be agreed following consultation with the transplant centre.
Provide a prescription for stem cell collection or request a unit of cord blood
In addition to requesting the recruitment of the donor, the transplant centre must provide a prescription for the required stem cells using one of two forms, either a "Prescription for Marrow Collection" form or a "Prescription for Stimulated Blood Stem Cell Collection" form . Requests where there is a significant disparity between the donor and recipient weight will be referred to the Medical Director for review. The central office will normally advise the donor centre or participating Blood Transfusion Service of the prescription requirements within 1 working day of receipt.
Where a conventional bone marrow donation is offered the maximum volume that can be aspirated based upon the nucleated cell count and recipient weight will be 20ml/kg donor weight, or up to 1500mL. The target dose is 4 x 108 TNCs/Kg. When a peripheral blood stem cell collection is performed, apheresis will only be undertaken on subsequent days if a dose of less than 4 x 106 CD34+cells/kg recipient weight is obtained on day 1. Exceptions to this policy will require the approval of the Medical Director.
Details on requesting a cord blood donation.
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Patient Follow-Up
For recipients of bone marrow or peripheral blood stem cells, the BBMR central office will issue forms to the transplant centre for completion at the following intervals:
- 3 months post transplant
- 6 months post transplant
- 12 months post transplant and annually thereafter
The forms will be copied to the donor centre or participating Blood Transfusion Service Medical Officer for information.
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BBMR Policies
Policies covering the following issues are available from the BBMR on request:
- Counselling and medical assessment of stem cell donors
- Transfusion requirements for bone marrow donors
- The administration of G-CSF
- The collection of stem cells by apheresis
- Storage of stem cell products
- Product labelling and transport
- Stem cell donor follow-up
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