This page answers questions physicians often ask about unrelated donor hematopoietic cell transplantation and working with the National Marrow Donor Program® (NMDP), which operates Be The Match®.
Q: Is my patient eligible for hematopoietic cell transplant?
A: Whether a hematopoietic cell transplant (bone marrow, PBSC, or cord blood transplant — BMT) is a suitable treatment option for a patient depends on factors such as the patient's disease and disease stage and overall health. A timely referral to a transplant center for consultation can increase a patient's likelihood of a favorable outcome if transplant is needed. A transplant physician can work in partnership with the patient's treating physician to:
- Determine whether an autologous or allogeneic transplant may be a treatment option
- Incorporate the potential for transplant into the patient's treatment plan
- Plan the appropriate time for a transplant based on the patient's diagnosis and prognostic factors
Diseases Treatable by Hematopoietic Cell Transplant, Referring a Patient for Transplant, Recommended Timing for Transplant Consultation, Evaluating Adult Patients Prior to Hematopoietic Cell Transplant
Q: Does the NMDP have guidelines for when a patient should be referred?
A: Yes. The NMDP and the American Society for Blood and Marrow Transplantation (ASBMT) have jointly developed guidelines for transplant consultation. The intent of these guidelines is to indicate prognostic factors for patients at risk of disease progression and, therefore, which patients should be evaluated for transplantation. For more information, see Recommended Timing for Transplant Consultation.
Q: Who will identify a donor or cord blood unit for my patient?
A: If your patient does not have a suitable donor in his or her family, an NMDP-affiliated transplant center will identify the most suitable unrelated donor or cord blood unit for the patient. After the patient has been referred to a transplant center, the transplant center conducts a search and selects a donor or cord blood unit.
If and when transplant becomes an appropriate treatment for the patient, the NMDP transplant center performs the transplant. If a cord blood unit has been selected, the cord blood is shipped to the transplant center. If a marrow or PBSC donor has been selected, the volunteer's cells are collected at a hospital or blood center convenient to the donor. Immediately after donation, a trained courier transports the collected marrow or blood cells to the patient's transplant location.
Key Roles in the Search Process (PDF), Referring a Patient for Transplant
Q: Can I begin a search for a donor or cord blood unit for my patient?
A: Any licensed physician can submit a preliminary search to find out about potential adult volunteer donors or cord blood units on the Be The Match Registry®. Required information includes the patient's HLA typing for HLA-A, B and DR, the patient's name, address and telephone number, diagnosis and the date of diagnosis. A preliminary search is free of charge. To begin a preliminary search, physicians can complete the online Preliminary Search Request Form.
Physicians are encouraged to consult a transplant center to discuss preliminary search results and to develop a strategy and timeline for the donor search based on the search results and a patient's individual disease and prognostic factors. For assistance initiating a preliminary search or interpreting the results, contact Be The Match Patient Services at (888) 999-6743 (toll-free in the United States) or (612) 362-3410 or by e-mail at OPAservices@nmdp.org.
Key Roles in the Search Process (PDF), Referring a Patient for Transplant
Q: What is HLA typing?
A: HLA refers to proteins found on almost all cells of the body. These proteins are called human leukocyte antigens (HLA) because they were originally identified on white blood cells. HLA typing is used to match patients and donors for marrow and blood cell transplants. HLA matching plays an important role in engraftment, incidence of graft-versus-host disease (GVHD) and overall survival.
The first step in developing an effective donor search strategy is tissue typing the patient using DNA-based testing to identify the patient's HLA antigens at a high resolution (at or as close as possible to the allele level). The patient should be tested for the HLA Class I antigens HLA-A, -B and -C and for the Class II antigen HLA-DR.
HLA Matching for Hematopoietic Cell Transplantation
Q: Should I HLA type the patient's family before submitting an unrelated donor search?
A: The patient's full biological siblings should be tissue typed to identify potential related donors. In addition, for some patients, tissue typing the patient's parents and/or children can provide additional information that can be useful in developing a successful donor search strategy. HLA expertise (available at many transplant centers and from the NMDP) is critical to ensure potential donors in the patient's family are not overlooked.
To save time, tissue typing the family and submitting a preliminary search to the NMDP for an unrelated donor or cord blood unit can be done at the same time. HLA-identical siblings are the preferred donors. However, approximately 70% of patients in need of a transplant do not have a suitable sibling donor. Initiating an unrelated donor search early in the course of investigating treatment options allows time for more challenging searches and improves the likelihood that a transplant can be performed at the time when it has the best chance to succeed.
HLA expertise is available at many transplant centers and from the NMDP. To request an HLA consultation from the NMDP, contact Be The Match Patient Services at (888) 999-6743 (toll-free in the United States) or (612) 627-8140 or by e-mail at OPAservices@nmdp.org.
HLA Matching for Hematopoietic Cell Transplantation
Q: What is my role as a physician during the search and transplant process?
A: After an initial transplant consultation, most patients return to the care of the physician who referred them. The treating physician continues to provide patient care during the donor search and until the patient proceeds to transplant. During this time, communication between the treating physician and the transplant center is crucial to successful treatment.
- The treating physician updates the transplant center on changes in the patient's clinical status.
- Physicians discuss any treatment changes to avoid therapies likely to increase a patient's transplant complications.
- The transplant center updates the treating physician on search progress and delays.
The transplant team cares for the patient during transplant and recovery, then works with the referring physician to coordinate the patient's long-term post-transplant care.
Key Roles in the Search Process (PDF), Referring a Patient for Transplant, Patient Care Post-Transplant
Q: What is MatchView® and what should I do when patients bring in their MatchView results?
A: MatchView is an online resource to help patients discuss unrelated donor or cord blood transplant as a treatment option with their oncologists or primary care physicians. Patients may enter their HLA typing into MatchView to see the number of potential donors or cord blood units they may have on the Be The Match Registry. MatchView also includes information to help patients understand their results, HLA matching and the search process.
MatchView encourages patients to talk with their doctors. If your patients bring in their MatchView results, you can use the opportunity to discuss factors that indicate whether an unrelated donor or cord blood transplant is a treatment option. Note: MatchView is not an alternative to a donor search conducted by a physician. For more information, see the MatchView Physician Information.
Effective Planning for Unrelated Donor Transplant
Q: What is a preliminary search?
A: A preliminary search is a single "snapshot" of potential marrow or PBSC donors and cord blood units on the Be The Match Registry at a given time. The preliminary search report summarizes the volunteer donors and cord blood units that are potentially HLA-identical with the patient, as well as those that are, at most, one antigen mismatched (adult volunteers) or two antigen mismatched (cord blood units). Preliminary search results are not conclusive, but can indicate how challenging the search for a donor or cord blood unit may be and help in shaping the patient's treatment plan.
- When the preliminary search yields limited results, physicians are encouraged to consult with a transplant physician or coordinator to discuss transplant options for the patient.
- If the preliminary search yields a list of potential donors or cord blood units, a transplant center still must conduct a formal search to select the best match as well as confirm availability of potential donors.
A preliminary search can be requested by any licensed physician as soon as the patient's tissue typing is complete and can be repeated at any time at no cost.
Searching for an Unrelated Donor or Cord Blood Unit, Preliminary Search Request Form
Q: What is the next step after a preliminary search?
A: To continue the search process, the patient must be referred to an NMDP transplant center. A formal relationship is developed between the patient and his or her treating physician, the transplant center and the NMDP. To identify the best adult volunteer donor or cord blood unit for the patient, an NMDP transplant center selects potential donors and/or cord blood units from the NMDP for testing on behalf of a patient. (This process is called the formal search.) Further testing is needed to:
- Determine whether potential donors or cord blood units are matched at the level of resolution and at all HLA loci required by the transplant center's protocol.
- Confirm the original typing. For a potential marrow or PBSC donor, this requires a fresh blood sample.
Potential marrow or PBSC donors are also educated about the donation process, screened for any health problems and asked to confirm their availability and commitment to donating. The NMDP process of identifying an unrelated donor or cord blood unit is designed to provide a high quality of donated hematopoietic cells for transplant with minimal risk to the patient or donor.
Searching for an Unrelated Donor or Cord Blood Unit
Q: How long does it take to identify a donor or cord blood unit?
A: The time needed to identify a suitable unrelated donor or cord blood unit for a patient varies greatly, depending on both patient and donor factors. For details on factors that can affect search times, see step 5 of the Unrelated Donor Search Process, Step by Step.
- For a marrow or PBSC donor, the median time from initiation of the formal search to the request of a donor is 51 days.
- For a cord blood unit, the average time from initiation of the formal search to the request for a cord blood unit is two weeks.
To allow time for more challenging searches and to enable transplant to proceed when the therapy has the best chance to succeed, the NMDP recommends starting the search process early in the course of investigating treatment options.
Effective Planning for Unrelated Donor Transplant, Recommended Timing for Transplant Consultation
Q: What if a search of the Be The Match Registry shows very few potential donors?
A: When the preliminary search yields limited results, physicians are encouraged to consult with a transplant physician or coordinator to discuss transplant options for the patient. An HLA expert at a transplant center or the NMDP can employ search strategies that may yield a suitably matched volunteer donor or cord blood unit. These strategies include:
- Repeating the patient's tissue typing to ensure that the initial typing used was the most specific available
- Identifying and retyping donors who may have HLA types that were possibly mis-assigned
- Identifying and retyping donors whose HLA type was determined at a broad level of specificity
- Consulting antigen tables to identify low-frequency antigens, then re-testing donors
- Running the search with alternate HLA phenotypes, which may identify suitable donors that may have been missed in the preliminary search
To request an HLA consultation from the NMDP, contact Be The Match Patient Services at (888) 999-6743 (toll-free in the United States) or (612) 362-3410 or by e-mail at OPAservices@nmdp.org.
Likelihood of Finding an Unrelated Donor or Cord Blood Unit
Q: What are the costs of a transplant?
A: The cost of a transplant depends on the country and hospital where the transplant is performed. There are costs related to the transplant procedure as well as additional costs, which could include:
- Travel to and from the transplant center
- Housing during the transplant
All costs are the patient's responsibility. However, concerns about inadequate resources should not prevent referral for transplantation evaluation. The best place for a patient to find help with funding is in his or her own country. For resources to share with your patient on how to manage search and transplant costs, see Planning for Transplant Costs.
Q: Where are NMDP transplant centers located?
A: The NMDP works with transplant centers throughout the world:
For links to other online transplant center directories as well as factors to consider when selecting a transplant center for patient referral, see Identifying a Transplant Center.
Q: Can my hospital perform a transplant using a donor or cord blood unit identified through the NMDP?
A: When a matching donor or cord blood unit is identified through the NMDP, the transplant must be done at a hospital that has established a formal relationship with the NMDP. An NMDP transplant center is a hospital that has a transplant team with many years of experience in allogeneic hematopoietic cell transplantation and that meets and maintains specific quality criteria described in Transplant Center Participation Criteria (PDF) and NMDP Standards. For more information about becoming an NMDP transplant center, contact the NMDP at firstname.lastname@example.org.
Q: What does my patient need for post-transplant care?
A: In the immediate post-transplant period, an immunosuppressed patient requires specialized care at a transplant center with a heath care team experienced in treating post-transplant complications.
Transplant patients may still have special health care needs after returning home, and the NMDP has several online and printed educational materials that can assist physicians in this process, including a two-part toolkit combining a guide to general post-transplant care with a guide to help physicians screen for chronic GVHD. For more information, see Clinical Guidelines for Transplant Consultation and Post-Transplant Care.