Peripheral Blood Stem Cell (PBSC) Donors Experience Higher Levels of Pain and Toxicities Early On, While Bone Marrow (BM) Donors Experience Slower Recovery and More Late Pain: A Prospective Study of the National Marrow Donor Program (NMDP).

Although PBSC has replaced BM as the most common unrelated donor stem cell product collected, a direct comparison of the PBSC vs. BM donation experiences has not been performed. We report a prospective study of 2726 BM and 6768 PBSC donors who underwent BM harvest at 83 centers or PBSC collection at 98 centers between January 2004 and July 2009. 340 donors who were randomized between PBSC and BM donation in a prospective clinical trial were excluded from this analysis. The proportions of donors of BM or PBSC were similar in regards to gender, race/ethnicity, age, body mass index (BMI), and year of donation. PBSC donors were collected using a median dose of 10 micrograms/kg/day of filgrastim for 5–6 days with 1–2 days of collection. Pain and toxicities were assessed using the common toxicity criteria (CTC) at baseline, daily during G-CSF administration and PBSC collection and within 48 hours of the bone marrow harvest. Peak levels of pain and toxicities of PBSC and BM donors were compared through the early collection period and at one week and one month after the procedure. Donors were followed weekly until they reported complete recovery. While the incidence of pain (80-90%) and common toxicities such as fatigue, insomnia, anorexia, nausea, dizziness, and site reactions (10-80%), was similar for both procedures, there were notable differences between donor experiences by type of donation. PBSC donors were at significantly increased risk of moderate, severe, and intolerable pain as well as ≥ grade 2 CTC toxicities during the peri-collection period (see table). In contrast, BM donors were more likely to experience ≥ grade 2 toxicities at 1 week after the procedure and moderate to severe pain at 1 week and one month, although these complaints were rare in both groups. BM donors reported a slower time to complete recovery compared to PBSC donors, with 3% of BM donors still not fully recovered at 24 weeks, while 100% of PBSC donors had recovered (see Figure). Unique aspects of BM donation included an overnight stay in 37% of donors (almost always routine) and a low risk (<1%) of requiring an allogeneic blood transfusion. PBSC donors experienced symptoms of hypocalcemia 45% of the time, and 11% required central line placement. In addition to risks associated with stem cell source donated, multivariate analysis showed that female gender, obesity, and increased age were associated with significantly increased risk of toxicity or pain. In summary, while the large majority of donors of BM and PBSC experience only mild to moderate symptoms and recover within a few weeks, PBSC donors experience more pain and toxicities in the early peri-donation period, while BM donors are more likely to experience discomfort for several weeks after the harvest, with a small fraction having persistent symptoms at 6 months. Women, obese, and older donors experience more pain and toxicity with the donation process independent of stem cell source donated. Prospective unrelated donors should be informed of the different risk profiles associated with BM vs. PBSC donation in order to assist them in making an informed decision.

OR indicates odds ratio

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No relevant conflicts of interest to declare.