pros and cons of different stem cell sources and their ......pros and cons of different stem cell...
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Pros and Cons of Different Stem Cell Sources and Their
Availability in EMRO Region
Feras A. Alfraih, MD Alternate Stem Cell Program,
King Faisal Hospital and Research Centre, Saudi Arabia
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• In EMRO, the prevalence of matched family donors is relatively high; 60 – 70% vs 40%. 1, 2
• This is due to relatively higher family size and consanguinity where a restricted pool of genes is being inherited.
1 Sheth Blood 1996; 88 (Supp. 1): S265b
2 Gratwohl JAMA 303(16):1617–1624
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Hematopoietic Stem Cell Transplantation Activity in EMRO
Aljurf et al Hem Onco Stem 2015
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• Median age of population in EMRO is young, around 20 years in most countries ------- younger donors.
• Genetically homogeneous communities, possibly less GVHD
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Stem Cell Source: PB vs BM
Aljurf et al Hem Onco Stem 2015
23%
70%
7%
EBMT
Bone Marrow PB Cord
Gratwohl A et al Bone marrow transplant 2011
37%
59%
4%
EMBMT
Bone Marrow PB Cord
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Alternate Stem Cell Donor
Demand Supply
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5% 1
30-55% 2, 3
1 Aljurf et al Hem Onco Stem 2015 2 Alfraih et al Blood 2015; 126: (Supp. 1): 4387 3 Jawdat D et al. biology bone marrow transplant 2009
Use
Demands
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www.wmda.info; accessed Jan 15, 2017
International Registries / Cord blood banks
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BMDW 2015 annual report Currently, the region lacks efficient large-scale stem cell donor registries.
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Probability of finding donor from international registries
0.00%
1000.00%
2000.00%
3000.00%
4000.00%
5000.00%
6000.00%
7000.00%
8000.00%
9000.00%
10000.00%
Potential donor No donor
Probability of finding matched donor (8/8) using International Registries (NMDP & ZKRD) for adolescent/ adults Saudi patients; from 2004- 2015
97.7%
Alfraih et al unpublished
2.3%
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EMRO Stem Cell Donor Registry
• Establishing large-scale regional registry is highly warranted especially
with high similarity in HLA profile.
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World Marrow Donor Association (WMDA) : Registry Map
BMDW 2015 annual report
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Umbilical Cord Banks
• Currently, Umbilical cord blood is the main source of stem cells when alternate donor is considered especially for pediatrics.
• Unlisted / non-accredited cord banks
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Haploidentical BMT
• Many ongoing programs in the region using haploidentical BMT.
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Non-Sibling Related Donor
• With up to 30% consanguinity in some EMRO countries, there is approx. 20% chance of finding non-sibling related donor. 1, 2
Elbjeirami et al. Biol Blood Marrow Transplant 19 (2013) 221e226
Hamidieh et al Bone Marrow Transplantation (2015) 545 – 552
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In EMRO region :
• Higher chance of finding a sibling or related donor • Larger family size increase chance of finding donor >60%
• Consanguinity : • Non-sibling match found in 20% of searches
• No large MUD registries
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EMRO Donor Search Algorithm?
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Proposed Donor Search Algorithm
Look for matched sibling
Is patient in consanguineous marriage ? (Married to 1st cousin)
HR Type children. ≥9/10 match ?
Parental Consanguinity? [Type grandparents] ± uncles and aunts . Select ≥9/10 match if found
yes
No
No
Proceed with donor
yes
No Matched Related Donor
Timely 10/10 MUD available
Proceed with Haploidentical transplantation*
No matched sibling donor
No
*UCBT option if suitable double cord esp in pediatrics
Courtesy S.Osman Ahmed
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Conclusion
• Although the chance of finding matched family member in EMRO is high but expanding the use of alternate stem cell programs is highly warranted.
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Thank you
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• 109 non sibling matches found in 523 (20%) searches in Iran
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Umbilical cord banking