Non-HLA barriers to unrelated donor stem cell transplantation

A prospective survey involving 544 searches of the US National Marrow Donor Program (NMDP) Registry was conducted to identify reasons why many patient s who have apparent HLA-matched donors do not proceed to transplant. Coordi nators at NMDP transplant centers, patients and referring physicians were s urveyed shortly after the initial search, and follow-up surveys were sent t o the coordinators as the search was ongoing. The death of the patient, wor sening of the patient's medical condition and length of the search process were the most commonly cited barriers to transplantation. Other times a dec ision was made not to transplant through the NMDP due to the use of a donor from another source, a preference for chemotherapy or immunotherapy, hesit ancy on the part of the transplant physician or patient, or because the pat ient did not require a transplant. Responses differed between U,S, and inte rnational cases. nn unrelated donor outside the NMDP was the most common re ason cited by international coordinators (46%), whereas the death of the pa tient was the most common reason among US coordinators (13%). The death of the patient was the second most common reason cited by international coordi nators at 9%. Financial problems were listed by 41% of US coordinators as a potential barrier at the time of initial search, but only 5% indicated thi s as an actual barrier on a follow-up survey. Finances were cited as the mo st important reason 3% of the time overall, and 6% for African Americans an d Asian/Pacific Islanders.