Professor Charlie Craddock, Consultant Haematologist, Chairman, UK Stem Cell Strategic Oversight Committee and Chair of Anthony Nolan’s Science and Medical Affairs Committee, explains why younger donors are better donors for those who need a stem cell transplant.
Anthony Nolan has always been a pioneering charity.
From creating the world’s first bone marrow register, to switching to saliva samples for tissue typing potential donors, we’ve always been ready to lead the way in scientific innovation, while putting patients first.
Nearly three years ago, in October 2012, that pioneering spirit showed afresh, as Anthony Nolan became the first bone marrow register in the world to make a significant change to the age range of people eligible to join its life-saving register.
This ground-breaking move was to change our joining policy to allow 16-year-olds to join the register.
At the same time, we lowered the upper age limit for people signing up, bringing it down from 40 to 30 years old.
A joining policy founded on science
Anthony Nolan has always used scientific evidence as the basis for its medical decisions. So, naturally, this bold step was thoroughly researched; Anthony Nolan’s Research Institute used the knowledge it had gained over many decades to determine the ideal shape and size of the register.
A number of studies have demonstrated that patients transplanted using stem cells from younger donors have improved outcomes and this research has been instrumental in starting to change clinical practice and a more conscious choosing of young donors by transplant centres which continues to this day. These include a US study by the National Marrow Donor Program on the effects of donor age and a German study which saw better survival rates for young unrelated donors in comparison to HLA-identical siblings.
Through extensive data analysis, it also became clear that younger people are more likely to be picked as donors and that given their youth and general good health, there are fewer potential complications associated with stem cell donation.
All this evidence made it crystal clear that the shape and make-up of the register was just as, if not more important than its overall size.
In the UK and Europe, transplant centres prefer people to donate via Peripheral Blood Stem Cells (PBSC) rather than bone marrow, which can fit with younger donors, who are more likely to donate via PBSC.
A joining policy founded in empathy
So that’s the hugely important science bit. But ultimately this move towards younger stem cell and bone marrow donors is all about human beings and their lives.
Over the 25 years I have been working in this field, much has changed for the better in terms of outcomes for patients who have blood cancer or a blood disorder. Probably the most important advance has been the development of unrelated donor stem cell transplantation. However I still see too many patients for whom the transplant fails to deliver a long term cure. Therefore the increased awareness of the importance of choosing a younger donor really does influence my clinical practice.
As always our patients come first. And that’s why, given an option, and all other factors being equal, I will not hesitate to choose a younger donor for one of my patients.
In their shoes, there’s no doubt that I would want my doctor to give me the best possible match and the donor who would give me the best outcome. Wouldn’t any of us want this for ourselves, or for our child?
And a joining policy founded on common sense
Like me, Anthony Nolan puts patients first, and has been doing so for more than forty years. However, as a charity, it has to think about how it spends its public donations.
It also makes perfect economic sense to recruit those people most likely to be selected by doctors. In any industry, listening to your customers and their needs – in this case, patients and their medical teams – is simply obvious. And Anthony Nolan is recruiting more of these younger donors every year as it invests in the most valuable people on its register.
Three years on from that milestone change of policy, the Anthony Nolan register has over half a million potential lifesavers. And the number of Anthony Nolan donors aged between 16 and 30 to be chosen by doctors has risen significantly from 48% to 72 % since 2011. This reflects the charity’s investment and focus on younger donors.
Anthony Nolan’s Research Institute is leading the global effort to improve the success of stem cell transplants, and changing the make-up of that register is an ongoing and important part of that work. Early indications from its own recent research are confirming that the use of donors under 30 is associated with a trend towards better survival rates (Prof Steven Marsh, patient/donor study currently submitted for publication).
Thanks to scientific and medical advances, we are moving towards a position where the great majority of patients who require a transplant will find not just a suitable donor, but the best possible donor. That’s truly a lifesaving legacy for Anthony Nolan to be proud of.
