Meeting the Demand for Unrelated Donors in the Midst of the COVID-19 Pandemic: Rapid Adaptations by the National Marrow Donor Program and Its Network Partners Ensured a Safe Supply of Donor Products

Abstract

The impact of the coronavirus disease 2019 (COVID-19) pandemic on hematopoietic cell transplant (HCT) donor registries and transplant center (TC) practices is underreported. This article reports on the National Marrow Donor Program (NMDP) Be The Match Registry and its coordinating the provision of unrelated donor (URD) products to domestic and international TCs during the initial 3 months of the COVID-19 pandemic (March through May 2020). Specifically, NMDP data are presented for disease indications for transplant, URD search volumes and availability, graft requests and processing, courier utilization and performance, and conversion rates from formal donor search and workup to graft collection and shipment. Data following the onset of COVID-19 are compared to the immediate 3 months prior to the COVID-19 pandemic (December 2019 through February 2020) and the same quarter 1 year prior to COVID-19 (March through May 2019). During the initial onset of COVID-19 and compared to 1 year prior, TCs requested and the NMDP performed less donor searches. More multiple URD and direct to workup requests were processed by the NMDP, which likely reflected reductions in donor availability. Yet TCs continued to perform allogeneic transplants for acute disease indications like acute leukemia and myelodysplasia, using more cryopreserved grafts than before COVID-19. In comparison to prepandemic patient cycle conversion rates and durations, the NMDP was able to convert patient cycles at nearly the same or higher rates and in similar or shorter periods of time. Last, despite significant challenges caused by the pandemic, including interruptions in domestic courier services and travel restrictions, graft products were delivered to and received by TCs in similar periods of time than before COVID-19. Taken together, these data show that NMDP service line operations continued to function effectively during the early phases of the COVID-19 pandemic, ensuring requests for and delivery of URD products to domestic and international allogeneic HCT recipients.

Keywords: Bone marrow transplant; COVID-19; Coronavirus; Donor registry; Donor search; Graft; HLA matching; National Marrow Donor Program; Peripheral blood transplant; Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); Umbilical cord blood; Unrelated donor.

Figure 1

Conversion rates in domestic (A) and international patient (B) cycle times during the COVID-19 pandemic. A complete patient cycle for each transplant recipient is defined from initiation of preliminary search until graft infusion. Individual cycles (in days) comprising a complete cycle include time from preliminary to formal search, time from formal search to donor WU/graft order, time from WU/graft order until graft collection/shipment, and time from graft shipment until graft infusion. Conversion rates from formal donor search and WU to graft collection and shipment are also recorded for each patient cycle. The median days between each patient cycle is shown. The number of patients at each stage varies depending on TC location, numbers of patients who make it to the next stage of the patient cycle, and the time range of interest (Supplementary Table S4).

Figure 2

Domestic courier utilization by the NMDP during the COVID-19 pandemic. Types of commercial (On Time Courier Service and Time Matters), staff, and volunteer couriers utilized by the NMDP for shipment of graft products from February through May 2020. Total assigned, completed, and cancelled courier trips are listed for each month. Volunteers comprised the majority of couriers utilized during the initial onset of the COVID-19 pandemic with commercial vendors increasing in April and May, as these businesses started to reopen.

Figure 3

Summary of NMDP logistics during the early onset of the COVID-19 pandemic. (A) COVID-19-driven changes affecting NMDP operations (left) and response from the NMDP to address these changes (right). (B) Summary of NMDP operation logistics early after the onset of COVID-19.