During the past two decades, there have been multiple investigations of unrelated hematopoietic stem cell (HSC) donor safety and health-related quality of life (HRQoL). During this same time period, there have been few investigations of related donor safety and HRQoL – particularly older related donors. Co-morbid conditions may be particularly likely to affect the risk of donation to related donors >60 years of age. As older related siblings are increasingly asked to donate, it is critical to understand HRQoL in this group. Findings presented here are the first from a 5-year investigation of related donor safety and HRQoL (RDSafe). The goal was to compare HRQoL among older adult related donors to that of younger related and unrelated adult donors.
Participants included older adult related HSC donors (ages >60 yrs; n=106) and adult related (n=55) and unrelated (n=46) HSC donors ages 18-60 who donated PBSCs at domestic U.S. centers between 3/2010 and 4/2013. Findings presented here are based on structured telephone interviews completed pre-donation and 4 weeks post-donation. Interviews focused on socio-demographics, physical and mental health status, and donation-related perceptions using well-validated instruments. Odds-ratios for dichotomous variables and t-tests for continuous variables were used to examine pre- and post-donation differences (older donors versus the two younger donor groups).
As expected, given known demographic differences between the groups, older related donors were less likely to be employed, and more likely be white, married, and to have children. Pre-donation psychosocial and donation-related: Pre-donation, older related donors reported higher importance of religion/spirituality (t=2.60; p<0.01) than did younger unrelated donors and better general emotional health (SF-12v2) than did both younger groups (unrelated t=2.26; p<0.03; related t=2.05; p=0.04). They did not differ from either of the two younger groups on other psychosocial variables (e.g., depression, anxiety). Older donors were less ambivalent about (t=-2.47; p<0.05) and more satisfied with the decision to donate (t=2.51; p<0.05) than were younger unrelated donors. They did not differ on these variables from younger related donors. Older donors were less likely to have consulted family/friends about the donation (OR=0.35; 0.13-0.98) than younger unrelated donors but more likely to have consulted professionals than either of the younger groups (younger unrelated OR=2.70; 1.30-5.56; younger related OR=1.96; 1.01-3.85). Older donors were less likely to have been discouraged by others from donating (OR=0.45; 0.21-0.95) and more likely to have been encouraged (OR=2.50; 1.12-5.56) than younger unrelated donors – they did not differ from younger related donors on these variables. Although older donors reported poorer general pre-donation physical status (SF-12v2) than did both younger groups (unrelated t=-3.67; p<0.001; related t=-3.25; p=0.001), they did not differ from either younger group on any of 14 donation-related medical/work/family concerns about donation. Donation experience/effects: Although older donors continued to report somewhat poorer post-donation general health status than did younger unrelated donors (t=-2.25; p=0.03), they were less likely to report that the donation was painful (unrelated t=-1.90; p=0.06; related t=-2.28; p=0.02) and less likely to have taken pain medication than younger unrelated donors during the donation process (OR=0.36; 0.17-0.76). They were also less likely to report that they would feel responsible if the donation was not successful than were either younger group (unrelated t=-2.12; p<0.05; related t=-2.44; p=0.02). There were no differences between older and younger donors in the proportion that felt back to normal by the post-donation interview or any of 12 other donation-related side effects.
These findings are very reassuring, as older donors are increasingly being asked to donate for their siblings. Despite having somewhat poorer overall general health that is likely age-related, the fact that older donors experience similar – and in some domains better – donation-related HRQoL compared to younger donors is a critical finding. Further data from this study detailing specific medical toxicities experienced by these older related donors will help better understand how to counsel these donors pre-collection.
No relevant conflicts of interest to declare.
Asterisk with author names denotes non-ASH members.