Higher Risks of Toxicity and Incomplete Recovery in 13- to 17-Year-Old Females after Marrow Donation: RDSafe Peds Results

Abstract

Although donation of bone marrow (BM) or peripheral blood stem cells (PBSCs) from children to family members undergoing allogeneic transplantation are well-established procedures, studies detailing levels of pain, symptoms, and long-term recovery are lacking. To address this lack, we prospectively enrolled 294 donors age <18 years at 25 pediatric transplantation centers in North America, assessing them predonation, peridonation, and at 1 month, 6 months, and 1 year postdonation. We noted that 71% of children reported pain and 59% reported other symptoms peridonation, with resolution to 14% and 12% at 1 month postdonation. Both older age (age 13 to 17 years versus younger) and female sex were associated with higher levels of pain peridonation, with the highest rates in older females (57% with grade 2-4 pain and 17% with grade 3-4 pain). Multivariate analyses showed a 4-fold increase in risk for older females compared with males age <13 years (P <.001). At 1 year, 11% of 13- to 17-year-old females reported grade 2-4 pain, compared with 3% of males age 13 to 17 years, 0% of females age <13 years, and 1% of males age <13 years (P = .01). Males and females age 13 to 17 years failed to return to predonation pain levels at 1 year 22% and 23% of the time, respectively, compared with 3% and 10% in males and females age <13 years (P = .002). Our data show that females age 13 to 17 years are at increased risk of grade 2-4 pain at 1 year and >20% of females and males age 13 to 17 years do not return to baseline pain levels by 1 year after BM donation. Studies aimed at decreasing symptoms and improving recovery in older children are warranted.

Keywords: BM collection toxicities; Donor safety; PBSC collection toxicities; Stem cell transplantation.

Figure 1.. Location and grade of pain and type and grade of collection related toxicities reported by children within 48 hours after bone marrow collection by age group.

A. Sites of pain among BM donors B. Collection related toxicities among BM donors

Figure 2.. Overall highest reported grade of pain and symptoms by age at pre-collection, within 48 hours of collection and at 1month, 6months, and 1 year after first BM collection procedure.

A. Skeletal Pain. Skeletal pain experienced by BM donors, by age, at pre-collection, during the peri-collection period, and post-donation. (Skeletal pain represents pain in at least one of the following sites: back, bone, headache, hip, limb, joint, and neck). The severity of skeletal pain is defined as the maximum grade among these pain sites. B. Max MTC. Symptoms experienced by BM donors, by age, at pre-collection, during the peri-collection period, and post-donation. (Max MTC represents: fatigue, insomnia, site reaction, dizziness, anorexia, nausea, vomiting, skin (rash), fever, syncope). The severity of max MTC is defined as the maximum grade among these symptoms.