Urgent Time to Allogeneic Hematopoietic Cell Transplantation: A National Survey of Transplant Physicians and Unrelated Donor Search Coordinators Facilitated by the Histocompatibility Advisory Group to the National Marrow Donor Program

PURPOSE: To characterize donor search and selection practices, the National Marrow Donor Program (NMDP) Histocompatibility Advisory Group developed a survey of allogeneic hematopoietic cell transplant (HCT) physicians and search coordinators. Objectives were to describe search practices, understand practices surrounding urgent time to HCT, and characterize strategies used when identifying a matched unrelated donor (MUD) is unlikely. METHODS: Participants included United States physician members of the American Society for Transplantation and Cellular Therapy (ASTCT) and donor search coordinators within the NMDP network. The web-based survey was conducted February to May 2018. RESULTS: A total of 317/858 physicians (37%) and 225/327 coordinators (69%) responded, of which 263 and 194 respectively were eligible and were included in the analysis. Most centers, 142 (95%) were represented; 108 (72%) had at least one physician and 128 (85%) had at least one coordinator respondent. Most (68% physicians, 61% coordinators) indicated donor selection decisions were made by individual physicians. Urgent time to HCT was most commonly (90 and 87%, of physicians and coordinators, respectively) defined as HCT within 4–6 weeks of search nitiation. Higher HCT urgency was associated with a higher disease risk index. For urgent cases with low probability of an 8/8 MUD, 75 and 80% of physicians and coordinators endorsed short (1–2 weeks) unrelated donor search before proceeding to an alternative donor source. NMDP-provided solutions to expedite donor identification were strongly endorsed. CONCLUSIONS: This survey clarified current donor selection practices in the United States and defined urgent time to HCT. These data provide insight to NMDP on potential solutions to support the path to transplant, such as highlighting futile searches and providing alternative donor options at the time of search initiation.