Kollman C, Weis T, Switzer G E, Halet M, Kitajima D, Hegland J, Confer D L
National Marrow Donor Program, Minneapolis, MN 55413, USA.
Bone Marrow Transplant. 2001 Mar;27(6):581-7. doi: 10.1038/sj.bmt.1702845.
A prospective survey involving 544 searches of the US National Marrow Donor Program (NMDP) Registry was conducted to identify reasons why many patients who have apparent HLA-matched donors do not proceed to transplant. Coordinators at NMDP transplant centers, patients and referring physicians were surveyed shortly after the initial search, and follow-up surveys were sent to the coordinators as the search was ongoing. The death of the patient, worsening of the patient's medical condition and length of the search process were the most commonly cited barriers to transplantation. Other times a decision was made not to transplant through the NMDP due to the use of a donor from another source, a preference for chemotherapy or immunotherapy, hesitancy on the part of the transplant physician or patient, or because the patient did not require a transplant. Responses differed between U.S. and international cases. An unrelated donor outside the NMDP was the most common reason cited by international coordinators (46%), whereas the death of the patient was the most common reason among US coordinators (13%). The death of the patient was the second most common reason cited by international coordinators at 9%. Financial problems were listed by 41% of US coordinators as a potential barrier at the time of initial search, but only 5% indicated this as an actual barrier on a follow-up survey. Finances were cited as the most important reason 3% of the time overall, and 6% for African Americans and Asian/Pacific Islanders.
开展了一项前瞻性调查，涉及对美国国家骨髓捐献者计划（NMDP）登记处的544次检索，以确定许多有明显HLA匹配捐献者的患者未进行移植的原因。在首次检索后不久，对NMDP移植中心的协调员、患者及转诊医生进行了调查，并在检索进行期间向协调员发送了后续调查问卷。患者死亡、病情恶化以及检索过程的时长是最常被提及的移植障碍。其他时候，由于使用了来自其他来源的捐献者、倾向于化疗或免疫疗法、移植医生或患者犹豫不决，或者患者不需要移植，故而决定不通过NMDP进行移植。美国和国际案例的回答有所不同。NMDP之外的无关捐献者是国际协调员提及的最常见原因（46%），而患者死亡是美国协调员中最常见的原因（13%）。患者死亡是国际协调员提及的第二常见原因，为9%。41%的美国协调员在首次检索时将经济问题列为潜在障碍，但在后续调查中只有5%表示这是实际障碍。总体而言，3%的情况下经济因素被视为最重要的原因，非裔美国人和亚裔/太平洋岛民中这一比例为6%。
