An evaluation of the donor experience in the canadian multicenter randomized trial of bone marrow versus peripheral blood allografting
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abstract
We compared the donation of bone marrow (BM) versus recombinant human granulocyte colony-stimulating factor-mobilized peripheral blood progenitor cells (PBPC) in HLA-matched sibling donors. Donors randomized to donate BM or PBPC completed questionnaires (Profile of Mood States [POMS] and Short-Form 36 Health Survey) assessing peridonation health-related quality of life (QoL), donation experience, and acceptability of donation before and 1 week and 4 weeks after donation. Between January 1996 and March 1999, 184 patients and their donors were randomized. Predonation and postdonation data were available on 52 (56%) and 35 (38%) of the BM and PBPC donors, respectively. The median donor age was 45 years, and 44% were female. The median time (range) to return to full activity for the BM and PBPC donors was 4 days (1-21 days) and 2 days (0-21 days), respectively (P = .01). One week after donation, BM donors reported more fatigue and less energy than the PBPC donors. BM donors' POMS total mood disturbance scores were worse 1 week after versus before donation, whereas the PBPC donors' scores did not change. POMS subscores indicated more fatigue and less energy in the BM versus PBPC donors. Anxiety improved in both groups, but more in PBPC donors. Four weeks after donation, the Short-Form 36 Health Survey indicated persistent moderate negative effects on QoL with BM donation versus small effects with PBPC donation. BM donation was associated with more physical morbidity and negative effects on QoL up to 1 month after donation than was PBPC donation. Despite this, most donors would donate again. Further work is needed to decrease donor anxiety and symptoms. If both BM and PBPC donation are feasible, then the graft source should be dictated by the predicted patient outcome as determined from the results of randomized trials.
