Assessment of optimal size and composition of the US National Registry of Hematopoietic Stem Cell Donors
Assessment of optimal size and composition of the US National Registry of Hematopoietic Stem Cell Donors
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DOI：
10.1097/01.tp.0000132327.40702.97
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发表时间：
2004-07-15
期刊：
影响因子：
6.2
通讯作者：
Setterholm, M
中科院分区：
文献类型：
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作者：
Kollman, C;Abella, E;Setterholm, M
背景资料。国家骨髓捐赠者计划(NMDP)接受联邦资金，为需要造血干细胞移植的患者运营一个超过400万志愿者捐赠者的登记。由于少数族裔患者比白人更不可能找到合适的捐赠者，因此特别努力招募少数族裔。招募和组织类型的额外志愿捐赠者需要大量的财政资源。已经构建了群体遗传学模型，以预测为不同种族/民族的患者找到人类白细胞抗原(HL A)匹配的捐赠者的可能性。这些预测是在扩大全国民防方案登记册的各种战略下作出的。成本-效果计算纳入了供体不可获得性和其他移植障碍。按照目前的招募速度，预计到2007年，黑人、亚洲人/太平洋岛民、白人和西班牙裔的可用的人类白细胞抗原-A、B、DRB1匹配捐献者的概率将分别从27%增加到34%；45%增加到54%；75%增加到79%；48%增加到55%。少数族裔招募人数的大幅增加只会对这些预测产生轻微影响。这些预测受到捐赠者可获得率的严重影响，少数族裔志愿者的捐赠率不到50%。继续招募更多的志愿者可以提高找到匹配的捐献者的可能性，但仍然会使所有种族/民族的大量患者得不到匹配。努力改善捐赠者的可获得性(特别是在少数群体中)，并增加进入NMDP登记处的患者人数，可能被证明是增加移植的更具成本效益的手段。
Background. The National Marrow Donor Program (NMDP) receives federal funding to operate a registry of over 4 million volunteer donors for patients in need of a hematopoietic stem cell transplant. Because minority patients are less likely to find a suitably matched donor than whites, special efforts have been aimed toward recruitment of minorities. Significant financial resources are required to recruit and tissue type additional volunteer donors.Methods. Population genetics models have been constructed to project likelihoods of finding a human leukocyte antigen (HLA)-matched donor for patients of various racial/ethnic groups. These projections have been made under a variety of strategies for expansion of the NMDP Registry. Cost-effectiveness calculations incorporated donor unavailability and other barriers to transplantation.Results. At current recruitment rates, the probability of an available HLA-A,B,DRB1 matched donor is projected to increase from 27% to 34%; 45% to 54%; 75% to 79%; and 48% to 55%, for blacks, Asians/Pacific Islanders, whites and Hispanics, respectively, by the year 2007. Substantial increases in minority recruitment would have only modest impacts on these projections. These projections are heavily affected by donor availability rates, which are less than 50% for minority volunteers.Conclusions. Continued recruitment of additional volunteers can improve the likelihood of finding an HLA-matched donor, but will still leave significant numbers of patients of all racial/ethnic groups without a match. Efforts to improve donor availability (especially among minorities) and to increase the number of patients with access to the NMDP Registry may prove to be more cost-effective means of increasing transplants.