Blood stem cells are collected from a donor in two ways: either through a bone marrow harvest (direct retrieval of the stem cells from the donor's hip bones, under general anaesthetic) or a peripheral blood stem cell collection (retrieval of stem cells using a blood cell separator machine, following a course of granulocyte colony stimulating factor (G-CSF) injections). Both these methods of donation are common. Much research has explored which method of donation gives the best outcome to the patient, however there has not been a lot of research exploring these methods of donation from the donor's perspective. Such research is important if there is the possibility of long-term adverse events for the donor. For example, the long-term adverse events of G-CSF are not known, but there is the suggestion of a correlation between G-CSF and development of myelodysplastic syndrome (MDS). However, in many instances, donors are given a choice as to which method they would like to use to donate their stem cells. The aim of this review was to compare directly these two methods of blood stem cell donation from the donor's perspective, to understand the experiences of the donor. In this review, each donor was a sibling of the patient to whom they were donating blood stem cells.
Six trials (807 donors) were identified for this review. The review found that donors donating via a bone marrow harvest experienced more pain at the donation site (hip bone area) in the days following the donation, more days of restricted activity (e.g. sick days), more days in hospital and more side effects than donors donating through a peripheral blood stem cell harvest. In contrast, peripheral blood stem cell harvest donors experienced more pain prior to the donation of blood stem cells than bone marrow harvest donors. This pain was as a result of G-CSF administration. All donors had increased levels of tiredness and reduced levels of energy and anxiety following their donation.
There were three main limitations of this review. Firstly, in two trials more than 40% of the donors did not complete the trial. Secondly, there was no long-term follow up of the donors in any trial. Thirdly, the trials used different questionnaires to record the donors emotional experience of the donation procedure which made it difficult to compare the results of these measurements across the six trials. Further research, with larger numbers of included donors, would provide a greater understanding of the donation experience.
The different short-term morbidities associated with each type of haemopoietic stem cell donation were clear, with bone marrow donors experiencing more pain and more restriction post-donation than peripheral blood donors. However, the studies were limited by their methodological quality, failure to provide long-term follow up (for which larger numbers of donors would be required) and a failure to apply consistent measures of quality of life in a way which allows more meaningful evaluation across studies.
Haemopoietic stem cells can be collected from a donor either as a bone marrow harvest or by peripheral blood collection. Both techniques have risks for the donor.
The aim of this review was to identify the adverse effects of haemopoietic stem cell donation and to compare the tolerability and safety of the two methods.
We searched bibliographic databases including the Cochrane Central Register of Controlled trials (CENTRAL) (The Cochrane Library 2008, issue 2), MEDLINE and EMBASE up to May 2008. We also searched reference lists of articles and contacted experts in the field.
Randomised controlled trials enrolling haemopoietic stem cell donors and evaluating the different methods of donating haemopoietic stem cells were eligible.
Two authors independently screened studies for inclusion. We extracted data and evaluated methodological quality. Quantitative analysis was not possible for most outcomes, but where used we preferred random-effects models due to the variability between the included studies.
Six trials (807 donors) were eligible: all were substudies, or constituent parts of, larger randomised controlled trials of bone marrow and peripheral blood stem cell allogeneic transplantation. No included trial was designed solely to measure and assess the experience of stem cell donors. The donors in all studies were related to the stem cell recipient. Overall, both types of donors experienced pain subsequent to donation, and psychological morbidity. The trend was for bone marrow donors to experience more pain at the donation site, more overall adverse events, and more days of restricted activity. They were also more likely to require hospitalisation than peripheral blood stem cell donors. In contrast, peripheral blood stem cell donors experienced more pain prior to donation, which may be related to the pre-donation administration of granulocyte colony stimulating factor (G-CSF). The methodological quality of the studies was poor and indicated limitations due to the risk of selection and attrition bias. The proportion of donors from the parent trial not included in the donor substudies was also inadequately explained.