Allogeneic Stem Cell Transplantation From Donors Other Than HLA-Matched Siblings in Pediatric Patients: Family Bank

Allogeneic haematopoietic stem cell transplantation (HSCT) has been used to treat a variety of diseases including malignant and nonmalignant diseases. Best choice of a donor is a sibling matched donor. However, more than 70% of patients who need a transplant will have not such donors. For the patients, donors can be found in the extended family of the patient or in registries of unrelated donors or cord blood banks. The purpose of this study is to investigate HSCT from other related donors. During January 2008 to September 2010, we searched in specified members of a family to detected related donor for 210 patients who lack a sibling donor and their parents' marriage was consanguineous marriage. High resolution typing for class I and II alleles was completed for recipient/donor pairs. The result of search in the extended family was successful in 43 out of 210 of patients (20.4%) who didn't have HLA matched sibling donors. Median age was 5 (range: 1-15 year) that 62.8% was male. 43 patients with major thalassemia (n = 11), acute leukemia (n = 10), fanconi anemia (n = 8), severe aplastic anemia (n = 4), primary immunodeficiency (n = 4), histocytic disorder (n = 2), hurler syndrome (n = 2) and osteopetrosis (n = 2) were selected. The stem cell source was bone marrow in 30 and peripheral blood in 13 patients. The donors were parents (n = 29), grandfather or grandmother (n = 5) and uncle or aunt (n = 9). All the 43 patients engrafted with neutrophils (> 500/micro L) at a median of 14 days. 15 out of 43 patients who engrafted (37.2%) were complicated by Acute GVHD. Transplantation related mortality occurred in 2 patients (4.6%). We have a potentially available donor registry (family bank) in some countries that consanguineous marriage is not forbidden, such as Iran and eastern Mediterranean. While many countries have very limited numbers of donor registries and cord blood banks, this type of “Family Bank” can be very helpful and important donor source. Therefore, all of transplant unit especially in these countries have to evaluate each single patient before searching in unrelated donor registry and cord blood banks in case of patient who are without matched sibling donor.