Donor search and selection strategy to facilitate comparable transplant rates across donor search prognosis groups: A report from the BMT CTN 1702 trial

Authors

Joseph Pidala, Department of Blood and Marrow Transplantation and Cellular Immunotherapy. Moffitt Cancer Center, Tampa, FL. Electronic address: Joseph.pidala@moffitt.org.
Brent Logan, Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, USA; Division of Biostatistics, Medical College of Wisconsin, Milwaukee, USA.
Stephanie J. Lee, Fred Hutchinson Cancer Center, Seattle, USA.
Bronwen E. Shaw, Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, USA.
Steven Devine, Department of Blood and Marrow Transplantation and Cellular Immunotherapy. Moffitt Cancer Center, Tampa, FL; Center for International Blood and Marrow Transplant Research, NMDP, Minneapolis, USA.
Stefan O. Ciurea, University of California-Irvine, Irvine, USA.
Mary Horowitz, Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, USA.
Naya He, Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, USA.
Peter Westervelt, MaineHealth

Document Type

Article

Publication Date

1-15-2026

Institution/Department

Oncology

Journal Title

Transplantation and cellular therapy

Abstract

BACKGROUND/OBJECTIVE: In a secondary analysis from the BMT CTN 1702 trial, we report on donor search and selection strategies per baseline recipient search prognosis (SP). STUDY DESIGN: A total of 1751 patients were analyzed (SP groups: very likely 958, less likely 517, very unlikely 276). RESULTS: Target time to HCT was most often 6-12 weeks (SP p=NS) and was associated with AML remission status (p< 0.01). Baseline preferred alternative donor (Alt-D) across all SP was most commonly haploidentical (haplo) donor (62.2% overall), whereas mismatched unrelated (MMUD) increased over time during the study period. Those in less/very unlikely groups prioritized more Alt-D types at baseline and had more priority ranking changes (SP p< 0.01). While comparable number of donors were typed (all SP, median 3 donors, median time 1.1 months), less/very unlikely SP had greater use of Alt-D, (SP p< 0.01). Reasons for non-selection of typed donors varied by SP: For less/very unlikely, degree of HLA mismatching and donor specific antibodies were more common, while for very likely SP, other preferred donors were more common. Of 1751, 65% reached HCT: 94% of the very likely used 8/8 matched unrelated donor (MUD) and 91% of very unlikely used Alt-D (haplo 61%, MMUD 22%, UCB 8%). HCT occurred within initial desired timeline for 38% of all subjects. HCT delays occurred in 29% mostly for disease or patient health overall, and of these 52% reached HCT after delay. CONCLUSION: In this prospective, multicenter evaluation of donor search and selection practices, we demonstrate that patients with poor likelihood of 8/8 MUD matching can reach HCT at comparable rates and with similar effort (time spent typing, number of donors typed) using an early Alt-D-centered strategy. Uniformly across SP, target time to HCT is not commonly reached and is disrupted mostly by disease/patient health delays, not commonly donor availability.

Recommended Citation

Pidala, Joseph; Logan, Brent; Lee, Stephanie J.; Shaw, Bronwen E.; Devine, Steven; Ciurea, Stefan O.; Horowitz, Mary; He, Naya; and Westervelt, Peter, "Donor search and selection strategy to facilitate comparable transplant rates across donor search prognosis groups: A report from the BMT CTN 1702 trial" (2026). MaineHealth Maine Medical Center. 4296.
https://knowledgeconnection.mainehealth.org/mmc/4296