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Donor Registries for Bone Marrow Transplantation

National Institutes of Health
OMAR Technology Assessment
May 13-15, 1985

Conference artwork, an abstract of interacting red and shite shapes on a bright lilac background.

This statement is more than five years old and is provided solely for historical purposes. Due to the cumulative nature of medical research, new knowledge has inevitably accumulated in this subject area in the time since the statement was initially prepared. Thus some of the material is likely to be out of date, and at worst simply wrong. For reliable, current information on this and other health topics, we recommend consulting the National Institutes of Health's MedlinePlus http://www.nlm.nih.gov/medlineplus/.

This statement was originally published as: Donor registeries for bone marrow transplantation. Workshop summary; 1985 May 13-15. Bethesda (MD): National Institutes of Health, Office of Medical Applications of Research; [1985].

For making bibliographic reference to the statement in the electronic form displayed here, it is recommended that the following format be used: Donor registries for bone marrow transplantation. NIH Technology Assess Statement Online 1985 May 13-15 [cited year month day]; (2):16.


Introduction

The bone marrow produces the normal blood elements: red cells, white cells, and platelets. If the bone marrow ceases to function, as in aplastic anemia, or is replaced by abnormal cells, as in leukemia, then a bone marrow transplant from another individual may be useful.

The first phase of a bone marrow transplant is preparation of the recipient for the graft. Therapy to suppress the immune system is generally given in this phase. This is done to permit the recipient to accept the foreign bone marrow graft. Second, healthy marrow is taken from a tissue-matched brother or sister who shares certain genes with the patient, i.e., an HLA-identical sibling. The procedure is identical for unrelated donors. The collection of bone marrow from the normal donor involves the administration of general anesthesia and the insertion of a needle into the hip bone to withdraw marrow, usually from numerous sites. The marrow is then given by vein to the patient. The transfused marrow starts to function in 2 to 4 weeks. During this time, the patient is particularly vulnerable to infection.

After the grafted cells have started to multiply, the patient may develop graft-versus-host disease. Graft-versus-host disease occurs when the donor lymphocytes respond to antigens present on host (recipient) cells. The donor cells are activated and attack the host tissues, particularly the skin, intestinal tract, liver, and the immune system. Symptoms of acute graft-versus-host disease occur in 1 to 2 months and may include skin rash, diarrhea, jaundice, and increased susceptibility to infection. Acute graft-versus-host disease develops in 30 to 70 percent of patients transplanted with HLA-identical marrow and contributes to death in 20 to 40 percent of patients receiving a bone marrow transplant. Between 15 and 50 percent of transplanted patients who survive 6 months may develop chronic graft-versus-host disease with symptoms such as skin changes, joint contractures, and liver failure. The better the tissue matching between donor and recipient, the less the severity of graft-versus-host disease.

In the 1960's, it became possible to identify brothers and sisters who were compatible by tissue typing. This advance made it possible to perform a bone marrow transplant safely. With the experience accumulated since then, HLA-identical marrow transplantation has moved from being experimental therapy to being a major alternative treatment for certain disorders.

The largest number of patients receiving transplants have been those with leukemia. The intensive pretransplant therapy in these patients is designed to destroy malignant cells as well as to immunosuppress the recipient. Fifty to 80 percent of patients with acute myelogenous leukemia transplanted during their first remission from the disease show a prolonged disease-free survival. Patients with recurrent acute leukemia and chronic leukemia have also shown favorable responses. In addition, long-term remissions are seen in 40 to 80 percent of patients with aplastic anemia, and long-term survival of 55 percent has been reported in patients with severe combined immunodeficiency disease treated with bone marrow transplantation. Patients with genetic disorders of the bone marrow such as thalassemia major can also be helped in some instances with bone marrow transplantation. New applications for bone marrow transplantation are likely to develop in the future, while some current indications may change.

The above results have been gathered predominantly in bone marrow transplantation between HLA-identical siblings; however, only about one-third of patients for whom a transplant may be indicated will have an HLA-identical sibling donor. For this reason, there is interest in identifying other donors. Improved knowledge of tissue typing and new methods to combat graft-versus-host disease that are under investigation have allowed physicians to consider both partially matched family members and matched unrelated individuals as possible marrow donors.

In late l984, Congress passed legislation directing the Secretary of Health and Human Services to convene a technology assessment conference to explore the feasibility and efficacy of setting up a national registry of individuals who could donate marrow to unrelated patients. Secondary charges were to evaluate whether a permanent registry was needed and appropriate and to study the issues involved in the establishment and implementation of the registry.

There are four questions that will be directly addressed in this report:

  1. What is the experience with the possible alternatives to HLA-identical siblings as bone marrow donors for transplantation? Are these alternatives comparable?
  2. Should a national bone marrow donor registry be established?
  3. To what extent could the existing registries/blood donor programs be utilized as a source of potential unrelated bone marrow donors? What would be the impact on these programs?
  4. What are the logistic, legal, and ethical issues involved in establishing registries of unrelated donors? To what risks are donors exposed?

What is the Experience With the Possible Alternatives To Hla-identical Siblings as Bone Marrow Donors for Transplantation? Are These Alternatives Comparable?

The largest experience in marrow transplantation is with HLA-identical sibling donors. However, since only one-third of patients have an HLA- identical sibling, alternative donor sources are being used with increasing frequency. The alternative sources of marrow currently available are autologous (i.e., one's own marrow), partially matched family member donors, and unrelated donors. The experience to date with these various methods is limited, and all of these alternative sources are under continuing development.

Autologous marrow transplantation is being evaluated in a number of centers for patients with leukemia, lymphoma, and solid tumors. The major advantage of autologous marrow transplantation is lack of graft- versus-host disease. Autologous marrow transplantation is not possible for patients with immune deficiency, genetic disorders, severe aplastic anemia, or for patients who have marrow replaced by tumor.

When an HLA-identical sibling is not available, partially matched family members have been used as donors. The patients who have the best matched donors have had the best outcome. Specifically, patients with leukemia mismatched with the donor for only one HLA antigen have outcomes similar to those receiving transplants from HLA-identical siblings. Less than 10 percent of patients have this type of match with a family member.

Most patients have a family member who is a potential donor and who is haploidentical, i.e., shares one of two HLA chromosomes. Although a number of patients have been treated successfully using such donors, experience indicates an increased risk of graft-versus-host disease and graft rejection when results are compared with transplants between HLA- identical siblings. One approach that is under development for the reduction of graft-versus-host disease is depletion of immune cells from donor marrow. This procedure has given encouraging results. However, the risk of graft rejection appears to be increased over that seen in patients who receive untreated marrow. The followup of these patients is relatively short.

Bone marrow transplantation using unrelated donors has now been performed for immune deficiency diseases, severe aplastic anemia, and leukemia. Most patients with leukemia have had advanced disease. Most of the compatible donors were found through searches of local donor registries of HLA-typed individuals. To date, fewer than 70 such patients have been transplanted.

Recipients of unrelated donor marrow have generally experienced more problems with acute and chronic graft-versus-host disease than have recipients of HLA-identical sibling marrow. About 20 percent of recipients of unrelated marrow are alive and free of their disease for at least 3 months since transplantation. The longest living survivor was transplanted 3-1/2 years ago. Thus, survival in these patients has been poor, but not unlike the early experience with the use of HLA- identical donors in marrow transplantation for patients with advanced disease. Continuing efforts with the use of unrelated donors are certainly warranted.

The donor of choice for a patient with leukemia who lacks an HLA- identical sibling donor is a family member mismatched for not more than one HLA antigen. For other diseases, or if no such donor is available, the current results demonstrate no significant differences in survival with the use of unrelated matched marrow or haploidentical marrow from a family member. Both of these alternatives deserve further comparative studies, as does the use of autologous marrow transplantation.

Should a National Bone Marrow Donor Registry Be Established?

Based on the developmental nature of bone marrow transplantation from unrelated donors and the limited information relating to the efficacy of this procedure, we have concluded that a centralized national registry for unrelated marrow transplant donors should not be established at this time. However, the modest success of the results obtained with matched unrelated donors does warrant continuation of this form of marrow transplantation and facilitation of the efforts of local donor registries. These local donor registries should be encouraged to continue and to expand their activities. A mechanism should be established to enable registries to communicate more effectively with each other and with transplant centers to assure that patients who are suitable candidates will have the best possible opportunity to receive bone marrow from an unrelated donor.

We propose an interim measure to be evaluated for its effectiveness in not more than 3 years. Specifically, we conclude that a coordinating center should be established to carry out the following functions:

  1. Identify all existing registries and marrow transplant programs in the United States that are capable of participating in an unrelated donor marrow program.
  2. Encourage international cooperation among registries.
  3. Disseminate information about unrelated bone marrow transplantation to the general public, patients, physicians, transplant centers, and those maintaining or interested in maintaining local donor registries.
  4. Facilitate the establishment of a communication network among local centers with the following functions: a. Respond to requests from individual patients and potential donors for information about unrelated bone marrow transplantation. The role of public education is particularly important in the case of bone marrow transplantation from unrelated donors because it is in a developmental stage. Questions of a clinical nature will be referred to the patient's physician. b. Respond to requests from transplant centers that have patients for whom they would like to locate a matched unrelated donor. c. Refer these requests to local transplant registries that have indicated interest in matching donors for specific patients. These registries, themselves, should determine whether they have a potentially matched donor and, if so, should communicate this fact directly to the transplant center working with the patient. The registry and transplant center should work together to arrange a transplant for the patient where feasible.
  5. Gather data on the overall level of activity in unrelated bone marrow transplantation and the size and number of participating local registries.
  6. Deal with other issues relevant to unrelated bone marrow transplantation such as medical, life, and disability insurance for donors, and legal considerations.

 

Funds will be required to support the education, coordination, and evaluation functions of the coordinating center. Unrelated bone marrow transplantation in the United States and its effect in relation to degree of donor-recipient matching, disease state, and other relevant variables should be monitored and data analyzed. These analyses should be reviewed at regular intervals of not more than 3 years by an independent panel of appropriate experts appointed by the Secretary of Health and Human Services. Studies of the effect of the procedures on unrelated bone marrow donors should also be undertaken and similarly evaluated. These investigations should be independent of the coordinating center, and reports should be prepared on a timely basis to enable the transplantation community to make a judgment on the effectiveness of this treatment.

To What Extent Could the Existing Registries/blood Donor Programs Be Utilized as a Source of Potential Unrelated Bone Marrow Donors? What Would Be the Impact On These Programs?

At present, there are approximately 100,000 people in the United States who are HLA typed for the purpose of providing blood components for transfusion. Of these, several thousand have consented to consider providing bone marrow for transplantation, if needed. The remainder have not been asked if they would be willing, but experience suggests that some 70 percent would consent if they were asked. This represents a significant resource for the bone marrow transplant donor program and could become the foundation of a national donor pool. With a typed donor pool of only 10,000 individuals, HLA A,B,DR identical and MLC compatible donors can be found for about 10 percent of recipients; a six-antigen (HLA A,B,DR) match could be achieved for 30 percent and a good partial match (DR identical, AB 3/4 antigens) for 80 percent of recipients. These calculations are based on data for Caucasians. The collection of similar data for other racial and ethnic groups is being made and should be intensified. Further, the enlargement of donor pools of other ethnic groups is needed and should be encouraged.

At this time, we see no useful purpose to be served by merging the data bases of individual donor programs into a single national data base. In fact, such a merger could be counterproductive. The degree of cooperation to be anticipated from donor centers is heavily dependent on a sense of local responsibility and community involvement. Donation of bone marrow is highly dependent upon a spirit of voluntarism and altruism. Maintaining the registries on a local level leaves unaffected currently operating relationships between donor centers and transplant services.

The goal of making unrelated bone marrow donors available throughout the country can be achieved with local registries by establishing a coordinating center to interact with donor centers, transplant services, local physicians, and patients. We urge the registries to encourage their existing panel of HLA-typed people to volunteer to participate as bone marrow donors. In addition, current HLA A,B typings should be expanded to include DR, DQ, and, if feasible, DP. This will shorten the time required for complete identification of an appropriate unrelated marrow donor. For some centers, this elapsed time is now on the order of months, and a significant fraction of potential recipients die while awaiting transplant. We believe the impact of this proposal on existing programs will be positive.

What Are the Logistical, Legal, and Ethical Issues Involved in Establishing Regritries of Unrelated Donors? To What Risks Are Donors Exposed?

Local bone marrow donor registries already in place have instituted a system unique in the level of sacrifice asked of living individuals to benefit a stranger. Life-threatening complications for all marrow donors have been rare; there were 13 reported in 4,800 analyzed marrow donations; however, a fatal complication could occur. Short-term discomfort appears manageable, and almost all donors are back to their usual activities within a week. Neither the psychological risks or benefits to the donor nor the long-term physical effects of donation have been studied.

Given the unprecedented and serious nature of this new social experiment, ethical, logistic, and social issues should be given careful thought and investigation. Every effort should be made to protect the donor and the recipient and to minimize logistical difficulty; careful scientific investigation and evaluation of the procedure should accompany the venture.

Recommendations Involving Donors

Eligibility for Registration

Only persons at least 18 years old who are capable of giving informed consent should be admitted into the registries for the purpose of serving as donors in unrelated transplants.

Eligibility for Donation

At the point that donation is a real possibility, physical, laboratory, and psychological screening of the donor should be part of the process, to exclude individuals at particular risk.

Informed Consent

The panel suggests a staged informed consent procedure that is active rather than passive. The donor should specifically agree to participate in a registry for bone marrow donors. Informed consent should be obtained in two or more stages: (1) a generalized consent to be listed as a potential donor of bone marrow and (2) a specific consent to be a donor for a particular recipient.

The donor consent process should be voluntary and uncoerced, and the donor should be provided with a full factual basis for decisionmaking, including complete available information on physical and other risks to himself or herself. The actual and possible financial consequences should be outlined as well as the scope of protection provided. The donor should be advised that the effectiveness of the procedure has not been fully evaluated. He or she should also be made aware of the procedure's possible contribution to medical knowledge.

The donor should be permitted a sufficient time period to reflect upon and consider the decision to donate marrow. During this time,counseling and the services of a donor advocate should be available.

The donor should be made aware that last minute withdrawal of consent to a transplant donation could be catastrophic to the patient. The donor ought not to withdraw from the transplant after the time at which the recipient's marrow has been destroyed in preparation for receipt of the donated marrow.

Evidence suggests that involvement of the donor's spouse in the decisionmaking at all points will decrease the risk of a late withdrawal by the donor.

Quality Control

The donor should be assured that the marrow is collected under proper conditions and that it will be viable and used for an appropriate recipient in a situation where further knowledge about bone marrow transplantation will be accrued. Centers that collect bone marrow and centers that perform bone marrow transplants should have to meet certain standards, including substantial experience with the techniques in humans.

Confidentiality

Registries must protect the confidentiality of donor information by utilizing a method such as coded identification. Only authorized registry personnel should have access to names and other identifying information. Statutory safeguards should be created at the Federal level to prevent unauthorized disclosure of data that will identify the individuals involved.

Other Issues

Donor Advocacy

To protect the donor's rights and interests, we recommend that a donor advocate be assigned by the relevant registry to the donor when a match is found. The role of the advocate will be to ensure that the consent is made without time pressure and with full information, to enhance the personal attention given to the donor during all procedures, to help prevent unnecessary inefficiencies and discomfort, to mobilize official expressions of gratitude after the donation, and to aid in the resolution of subsequent problems.

Separation of Roles

It is strongly recommended that the person soliciting consent, the person screening the donor, and/or the donor advocate be separate from the health care providers involved in the direct care of the potential bone marrow recipient.

Anonymity

Both positive and negative experiences have been reported as a result of contact between donor and recipient. To prevent undue pressure on the donor, we recommend that anonymity be preserved at least until after the donation. In any case, both recipient and donor should agree to any breach of anonymity.

Recommendations Involving Recipients

Informed Consent

Potential recipients of transplants should be presented with accurate data on the uncertainties at present in the use of unrelated donors, contrasted with the alternative therapies available. They should be advised that the search for a living unrelated donor is costly in terms of money and effort and should be initiated only for appropriate transplant candidates. Informed consent should be obtained before the search for a donor is initiated.

Equitable Access

There are great inconsistencies in current coverage of bone marrow transplantation, both in regard to private insurance carriers and Federal and state reimbursement programs. In such a system, financially less well-off people are frequently excluded from access to registry searches and to the procedure. These inequities should be addressed.

Research and Evaluation

The panel has already emphasized the importance of clinical trials and prospective medical studies of unrelated bone marrow donor transplants. In terms of evaluating the marrow transplant for the recipient, quality of life should be considered in addition to survival and disease status.

Because this is an experiment in social altruism, research about the donor should address social scientific and ethical questions. Donors' social-psychological states and attitudes both before and after donation should be investigated. Studies should be rigorously designed and should involve researchers who are independent of bone marrow registries and transplant programs.

Conclusion

The establishment of the field of bone marrow transplantation in man has led to important therapeutic results. In some cases, patients for whom no other effective type of treatment exists can be cured by bone marrow transplantation. These encouraging results have been achieved primarily using HLA-identical sibling donors. However, only one-third of patients will have an HLA-identical sibling donor.

The desire to use bone marrow transplantation for patients who do not have an HLA-identical sibling donor has led to the evaluation of the use of unrelated bone marrow donors who have been matched with the recipient for HLA. Since the probability of finding HLA matches in unrelated individuals is low, large volunteer donor panels have been established in several locations. These local registries have identified over 100 potential matched unrelated donors, and almost 70 patients have been transplanted. About 20 percent of patients have survived for 3 months after transplantation, and one is still alive 3-1/2 years after transplant. Thus, at the present time, bone marrow transplantation from matched unrelated donors requires further evaluation.

Based on the limited information available on the efficacy of using matched, unrelated donors, we do not recommend that a national registry for unrelated donors should be established. There is already a large pool of several thousand typed potential donors in several local registries. We conclude that the most efficacious and reasonable development of this proposed use of unrelated donors for bone marrow transplantation, at the present time, is to promote and expand the functioning of these local registries.

In reaching our conclusions, we have taken into consideration the legitimate and persuasive need of patients for information about, and ready access to, bone marrow transplantation; the existence of local donor registries throughout the United States that have proven capability and that have considered most carefully the rights of donors and the preservation of those rights; and the need for further information regarding the usefulness of bone marrow transplantation using unrelated, HLA-matched donors. To this end, we urge the establishment of a coordinating center, which should function as a clearinghouse, to facilitate and speed access of patients to potential unrelated donors in local registries. The feasibility of transplants with unrelated marrow donors and the effects on both donor and recipient should be evaluated in the next several years to determine if a different organizational approach should be taken in the future.

Technology Assessment Panel

Brigid G. Leventhal, M.D.
Panel Chairperson
Special Assistant to the Associate Director
Division of Cancer Treatment
National Cancer Institute
National Institutes of Health, Bethesda, Maryland
Richard H. Aster, M.D.
President,
The Blood Center of Southeastern Wisconsin
Clinical Professor of Medicine and Pathology
Medical College of Wisconsin
Milwaukee, Wisconsin
Fritz H. Bach, M.D.
Harry Kay Chair Professor of Immunobiology
University of Minnesota
Minneapolis, Minnesota
William R. Berry
Director
Office of Organ Transplantation
Health Resources and Services Administration
U.S. Public Health Service
Department of Health and Human Services
Rockville, Maryland
M. Julian Duttera, M.D.
Director
Enoch Calloway Cancer Clinic
LaGrange, Georgia
Seymour Grufferman, M.D., Dr.P.H.
Associate Professor and Chief
Division of Clinical Epidemiology
Department of Pediatrics
Director
Cancer Prevention and Control Program
Duke University Medical Center
Durham, North Carolina
Geoffrey P. Herzig, M.D.
Associate Professor of Medicine
Director of Bone Marrow Transplantation
Washington University
St. Louis, Missouri
Ernst R. Jaffe, M.D.
Distinguished University Professor of Medicine And Senior Associate Dean
Albert Einstein College of Medicine
Bronx, New York
John H. Kersey, M.D.
Professor of Pediatrics and Laboratory Medicine/Pathology
Director
Bone Marrow Transplantation Program
University of Minnesota
Minneapolis, Minnesota
Jeffrey P. Krischer, Ph.D.
Pediatric Oncology Group Statistical Office
Professor and Chief
Division of Epidemiology and Biostatistics
Department of Pediatrics
University of Florida College of Medicine
Gainesville, Florida
Grace Powers Monaco, J.D.
President
The Candlelighters Childhood Cancer Foundation
Partner
Law Firm of White, Fine, and Verville
Washington, D.C.
Herbert A. Perkins, M.D.
Scientific Director
Irwin Memorial Blood Bank of the San Francisco Medical Society
San Francisco, California
Stuart O. Schweitzer, Ph.D.
Professor
School of Public Health
University of California, Los Angeles
Los Angeles, California
Roberta G. Simmons, Ph.D.
Professor of Sociology and Psychiatry
University of Minnesota
Minneapolis, Minnesota
LeRoy Walters, Ph.D.
Director
Center for Bioethics
Kennedy Institute of Ethics
Georgetown University
Washington, D.C.
Jack E. White, M.D.
Director
Howard University Cancer Center
Washington, D.C.

Speakers

Patrick G. Beatty, M.D., Ph.D.
"The Seattle Experience With Matched Unrelated Donors"
Assistant Professor
University of Washington
Associate Director
Histocompatibility Laboratory
Puget Sound Blood Center
Associate Member
Fred Hutchinson Cancer Research Center
Seattle, Washington
Mortimer M. Bortin, M.D.
"Low Risk of a Major Complication to Donors of Bone Marrow"
Professor of Medicine and Scientific Director
International Bone Marrow Transplant Registry
Medical College of Wisconsin
Milwaukee, Wisconsin
Hayden G. Braine, M.D.
"Other Implementation and Strategic Issues"
Associate Professor of Oncology and Medicine
Johns Hopkins Oncology Center
Johns Hopkins University School of Medicine
Baltimore, Maryland
Bruce M. Camitta, M.D.
"Bone Marrow Transplantation Using Fully Histocompatible Unrelated Donors"
Professor
Pediatric Hematology/Oncology
Director
Midwest Children's Cancer Center
Medical College of Wisconsin
Milwaukee Children's Hospital
Milwaukee, Wisconsin
Robert Peter Gale, M.D., Ph.D.
"Bone Marrow Transplantation: Current Results With HLA-Identical and
Sibling Transplants"
Associate Professor of Medicine
University of California, Los Angeles School of Medicine
Los Angeles, California
Roger D. Gingrich, M.D., Ph.D.
"Partial Mismatching of the Unrelated Bone Marrow Donor in Clinical
Transplantation: A Study of the Feasibility and Effectiveness"
Director
Bone Marrow Transplant Program
Department of Internal Medicine
University of Iowa College of Medicine
Iowa City, Iowa
Nancy E. Goeken, Ph.D.
"Establishment and Utilization of an Unrelated Bone Marrow Donor
Registry at the University of Iowa"
Director
Tissue Typing Laboratory
Assistant Professor
Department of Internal Medicine
Veterans Administration and University of Iowa Medical Center
Iowa City, Iowa
E.C. Gordon-Smith, F.R.C.P.
"T-Lymphocyte Depletion of Donor Bone Marrow in Human Bone Marrow
Transplantation"
Reader in Hematology
Royal Post Graduate Medical School
Consultant Hematologist
Department of Hematology
Hammersmith Hospital
London, England
John A. Hansen, M.D.
"The Seattle Experience With Partially Matched Related Donors"
Professor of Medicine
University of Washington
Director
Histocompatibility Laboratory
Puget Sound Blood Center
Member
Fred Hutchinson Cancer Research Center
Seattle, Washington
Jill M. Hows, M.D.
"Unrelated Donor Transplants for Aplastic Anemia"
Senior Lecturer in Hematology
Royal Post Graduate Medical School
Consultant Hematologist
Department of Hematology
Hammersmith Hospital
London, England
David C.O. James, M.D.
"Experience of the Anthony Nolan Registry"
Medical Director
Anthony Nolan Laboratories
St. Mary Abbots Hospital
London, England
Guido Lucarelli, M.D.
"Bone Marrow Transplantation in Thalassemia"
Chief of Hematology
Department of Hematology
Hospital of Pesaro
Pesaro, Italy
Jeffrey McCullough, M.D.
"Experience of the St. Paul Regional Red Cross Bone Marrow Donor Registry"
Professor
Department of Laboratory Medicine and Pathology
Director, Blood Bank
University of Minnesota Hospitals
Minneapolis, Minnesota
Margaret C. McElligott, S.B.B.
"Experience of the Blood Center of Southeastern Wisconsin in Recruiting
Unrelated Bone Marrow Donors"
Supervisor
Special Patient Services
Blood Center of Southeastern Wisconsin
Milwaukee, Wisconsin
Anthony J. Melaragno, C.D.R., M.C., U.S.N., M.D.
"Alternative Sources of Transplantable Stem Cells: Cryopreserved
Peripheral Blood Stem Cells and Human Cadaveric Bone Marrow"
Research Medical Officer
Transplantation Research Program Center
Naval Medical Research Institute
Bethesda, Maryland
M. Ray Mickey, Ph.D.
"Donor Pool Size for Bone Marrow Transplantation"
Department of Biomathematics
University of California, Los Angeles
Los Angeles, California
Richard J. O'Reilly, M.D.
"Summary of Matched Unrelated Donor Experiences (single cases)"
Chief
Bone Marrow Transplantation Service
Memorial Sloan-Kettering Cancer Center
New York, New York 10021
Glenn E. Rodey, M.D.
"Impact of a Bone Marrow Donor Registry on Existing Blood Donor Systems"
Professor of Medicine and Pathology
Chief, Immunogenetics Services
Washington University School of Medicine
American Red Cross Blood Services, Missouri-Illinois Region
St. Louis, Missouri 63110
George W. Santos, M.D.
"Discussion of Relative Merits of Alternatives to HLA-Identical Sibling
Transplants"
Professor of Oncology and Medicine
Johns Hopkins University School of Medicine
Baltimore, Maryland
Mark Siegler, M.D.
"Unique Ethical Issues Related to Bone Marrow Transplantation"
Associate Professor and Director
Center for Clinical Medical Ethics
Acting Chief
Section of General Internal Medicine
Department of Medicine
University of Chicago
Chicago, Illinois

Planning Committee

Itzhak Jacoby, Ph.D. (Chairman)
Acting Director
Office of Medical Applications of Research
National Institutes of Health
Bethesda, Maryland
Anne P. Ball, Ph.D.
Chief
Blood Diseases Branch
Division of Blood Diseases and Resources
National Heart, Lung, and Blood Institute
National Institutes of Health
Bethesda, Maryland
Bruce D. Cheson, M.D.
Cancer Expert for the Clinical Investigations Branch
National Cancer Institute
National Institutes of Health
Bethesda, Maryland
Gregory Curt, M.D.
Deputy Director
Division of Cancer Treatment
National Cancer Institute
National Institutes of Health
Bethesda, Maryland
Donald Denny
Director of Organ Procurement
Pittsburgh Transplant Foundation
Pittsburgh, Pennsylvania
Jerry Elliott
Program Analyst
Office of Medical Applications of Research
National Institutes of Health
Bethesda, Maryland
Robert Peter Gale, M.D., Ph.D.
Associate Professor of Medicine
University of California, Los Angeles School of Medicine
Los Angeles, California
John A. Hansen, M.D.
Professor of Medicine
University of Washington
Director
Histocompatibility Laboratory
Puget Sound Blood Center
Member
Fred Hutchinson Cancer Research Center
Seattle, Washington
Brigid G. Leventhal, M.D.
Special Assistant to the Associate Director
Division of Cancer Treatment
National Cancer Institute
National Institutes of Health
Bethesda, Maryland
Jeffrey McCullough, M.D.
Professor
Department of Laboratory Medicine and Pathology
Director, Blood Bank
University of Minnesota Hospitals
Minneapolis, Minnesota
Jane S. Schultz, Ph.D.
Chief
Genetics and Transplantation Biology Branch
National Institute of Allergy and Infectious Diseases
National Institutes of Health
Bethesda, Maryland
Michael J. Bernstein
Director of Communications
Office of Medical Applications of Research
National Institutes of Health
Bethesda, Maryland

Conference Sponsors

National Institute of Allergy and Infectious Diseases
Anthony S. Fauci, M.D.
Director
National Heart, Lung, and Blood Institute
Claude Lenfant, M.D.
Director
National Cancer Institute
Vincent T. DeVita, Jr., M.D.
Director
Office of Medical Applications of Research, NIH
Itzhak Jacoby, Ph.D.
Acting Director

About the NIH Technology Assessment Program

NIH Technology Assessment Conferences and Workshops are convened to evaluate available scientific information related to a biomedical technology when topic selection criteria for a Consensus Development Conference are not met. The resultant NIH Technology Assessment Statements are intended to advance understanding of the technology or issue in question and to be useful to health professionals and the public.

Some Technology Assessment Conferences and Workshops adhere to the Consensus Development Conference format because the process is altogether appropriate for evaluating highly controversial, publicized, or politicized issues. Other Conferences and Workshops are organized around unique formats. In this format, NIH Technology Assessment Statements are prepared by a nonadvocate, nonfederal panel of experts, based on: (1) presentations by investigators working in areas relevant to the consensus questions typically during a 1-1/2-day public session; (2) questions and statements from conference attendees during open discussion periods that are part of the public session; and (3) closed deliberations by the panel during the remainder of the second day and morning of the third. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government.

Preparation and distribution of these reports are the responsibility of the Office of Medical Applications of Research, National Institutes of Health, Bldg 31, Room 1B03, Bethesda, MD 20892.

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