- Email: [email protected]
OR28 Haploidentical donors for Hematopoietic Cell Transplantation (HCT): Changing demographics and the economics of typing this population
Abstracts / Human Immunology 79 (2018) 8–57
OR28
HAPLOIDENTICAL DONORS FOR HEMATOPOIETIC CELL TRANSPLANTATION (HCT): CHANGING DEMOGRAPHICS AND THE ECONOMICS OF TYPING THIS POPULATION Suraya A. Berger, Nancy L. Delaney Rossiter, Kevin Chesterton, Annette M. Jackson, Maria Bettinotti. Johns Hopkins University, Baltimore, MD, United States. Aim: HLA-mismatched allogeneic donors allow HCT of patients lacking an HLA identical sibling or matched unrelated donor. Most patients find a haploidentical or a partially-HLA mismatched donor among their firstand second-degree relatives or unrelated donors. We examined process improvements to reduce donor search time and cost in the new era of alternative donors and the less costly Next Generation Sequencing (NGS) technology for high resolution typing. Methods: HLA class I typing was performed using reverse sequence specific oligonucleotide probe (rSSO) hybridization (One Lambda, Inc) to identify potential haploidentical donors. Select donors were typed at high resolution using Sanger sequence base typing during 2015 and 2016 (local and commercial kits) or NGS in 2017 (lllumina). Specimen (blood) collection kits were sent to donors using a third party vendor (Path-Tec). Results: We performed a retrospective cost analysis of 2017 data. Currently, rSSO class I typing is performed on non-parent or child family members to rule out HLA disparate donors. Of 444 individuals, 188 appeared to be haploidentical and were reflexed to HRT. Only 3.9% of donors reflexed to NGS were disparate. If all 444 individuals had been initially typed by NGS, the cost for the program would have been 63.2% higher. As show in Table 1, the number of 2nd degree relatives has increased. As the donor pool expands beyond the patient’s nuclear family, the incidence of incorrectly reported donor relationships has increased, causing inappropriate testing and delays in reporting results. Furthermore, the donors’ geographical locations have expanded coast to coast, and even globally with increase of shipping costs. Of 413 kits sent in 2017, 20.1% were not returned.
Conclusions: With the steady increase in the use of alternative HCT donors, the staggered class I typing schema remains cost effective even with the advent of NGS. Areas for cost reduction include obtaining correct relationships prior to testing and improving the return rate of collection kits. A.M. Jackson: 3. Speaker’s Bureau; Company/Organization; One Lambda/Thermo Fisher Scientific. M. Bettinotti: 3. Speaker’s Bureau; Company/Organization; One Lambda/ Thermo Fisher Scientific.
33
OR28
HAPLOIDENTICAL DONORS FOR HEMATOPOIETIC CELL TRANSPLANTATION (HCT): CHANGING DEMOGRAPHICS AND THE ECONOMICS OF TYPING THIS POPULATION Suraya A. Berger, Nancy L. Delaney Rossiter, Kevin Chesterton, Annette M. Jackson, Maria Bettinotti. Johns Hopkins University, Baltimore, MD, United States. Aim: HLA-mismatched allogeneic donors allow HCT of patients lacking an HLA identical sibling or matched unrelated donor. Most patients find a haploidentical or a partially-HLA mismatched donor among their firstand second-degree relatives or unrelated donors. We examined process improvements to reduce donor search time and cost in the new era of alternative donors and the less costly Next Generation Sequencing (NGS) technology for high resolution typing. Methods: HLA class I typing was performed using reverse sequence specific oligonucleotide probe (rSSO) hybridization (One Lambda, Inc) to identify potential haploidentical donors. Select donors were typed at high resolution using Sanger sequence base typing during 2015 and 2016 (local and commercial kits) or NGS in 2017 (lllumina). Specimen (blood) collection kits were sent to donors using a third party vendor (Path-Tec). Results: We performed a retrospective cost analysis of 2017 data. Currently, rSSO class I typing is performed on non-parent or child family members to rule out HLA disparate donors. Of 444 individuals, 188 appeared to be haploidentical and were reflexed to HRT. Only 3.9% of donors reflexed to NGS were disparate. If all 444 individuals had been initially typed by NGS, the cost for the program would have been 63.2% higher. As show in Table 1, the number of 2nd degree relatives has increased. As the donor pool expands beyond the patient’s nuclear family, the incidence of incorrectly reported donor relationships has increased, causing inappropriate testing and delays in reporting results. Furthermore, the donors’ geographical locations have expanded coast to coast, and even globally with increase of shipping costs. Of 413 kits sent in 2017, 20.1% were not returned.
Conclusions: With the steady increase in the use of alternative HCT donors, the staggered class I typing schema remains cost effective even with the advent of NGS. Areas for cost reduction include obtaining correct relationships prior to testing and improving the return rate of collection kits. A.M. Jackson: 3. Speaker’s Bureau; Company/Organization; One Lambda/Thermo Fisher Scientific. M. Bettinotti: 3. Speaker’s Bureau; Company/Organization; One Lambda/ Thermo Fisher Scientific.
33