The National Transplant Organisation presents its strategy to improve the National Bone Marrow Plan, which now has some 400,000 donors

Objective achieved, well in advance: The National Bone Marrow Plan (PNMO) now has around 400,000 donors, nearly 2 years before the planned date of December 2020.

The information was given by the Minister for Health, Consumption and Well-being, María Luisa Carcedo, at the conference "Transplants of Haematopoietic Parents in Spain: New Challenges, New Solutions", held at the ministry's headquarters. The event, organised by the National Transplant Organisation (Spanish acronym: ONT), aims to publicise and analyse the main aspects of the National Haematopoietic Transplant Strategy for 2020-2025. Participating in the design of the plan were government administrations, the International José Carreras Foundation, health professionals, scientific companies and patient associations. The new Strategy brings together the National Bone Marrow Plan, the National Cord Blood Plan and the National Advanced Therapy Plan, in aspects related to haematopoietic transplantation (generically known as bone marrow transplant).

The ONT also presented the third phase of the National Bone Marrow Plan, some of whose measures are already in place.

"The current challenge of the National Bone Marrow Plan is to increase not only the quantity but also the quality of bone marrow donations," explained Carcedo. "We not only want to have many donors; we also want registered donors to have an ideal profile so that they are effective donors, and thus to give more opportunities to the patients in need", she added. "We want donors so we can carry out more transplants."

The National Bone Marrow Plan was launched early in 2013. Since then, the Ministry of Health has allocated more than 6 million euros for its development and implementation. In addition to this, there is the contribution from the autonomous regions.

Young donors between 18 and 40 years old

Every year around 3,300 haematopoietic progenitor transplants (HTPs) are carried out in Spain, of which around 1,300 will need a donor, which may or may not be related. For patients who need an unrelated donor, the transplant teams at present demand above all young male donors aged between 18 and 40 years, because the scientific evidence demonstrates that they offer better results. According to ONT figures from the Spanish Bone Marrow Donor Register (Spanish acronym: REDMO), currently 2 out of every 3 registered donors are women. However, the possibility of a man being an effective donor is three times higher than for a woman.

The director of the ONT, Beatriz Domínguez-Gil, then highlighted the importance of integrating all the programmes currently underway into a single strategy, to improve haematopoietic progenitor transplantation, regardless of its source (bone marrow, umbilical cord blood or advanced therapies).

She also explained that the objectives of the third phase of the National Bone Marrow Plan were revised last year to adapt them to scientific advances and the current patient requirements. This readjustment aims to increase the number of male donors and those under 40 years of age registered in the REDMO and achieve a 35% rate of self-sufficiency over the next 4 years (donors from Spain for transplants carried out in Spain). The level of self-sufficiency has multiplied fivefold since the National Bone Marrow Plan was implemented, from 4% in 2012 to 22% in 2018.

A third objective of the National Bone Marrow Plan is optimisation of the HLA types, through the incorporation into the laboratories that are part of the plan of the new sequencing techniques. This will provide complete information on the characteristics of the donor from the start. It will avoid the need to repeat the process if a compatibility has been found between a donor and a possible recipient. The aim is to allow donors and their characteristics to be more "visible" to the centres that start a search for a donor.

The National Bone Marrow Plan, on which all the social actors involved have collaborated, has increased the number of effective donors for Spanish or foreign patients from 35 donations in 2012 to 201 donations in 2018.

Data on donations and haematopoietic progenitor transplantation (HPT) in 2018

Data managed jointly by ONT and REDMO on donation and HPT in 2018 were also released at the event, among them the following:

• Last year 54,011 new donors were incorporated, of whom 75% were under the age of 40.
• The year closed with 373,196 available donors, an increase of 16% on the previous year.
• There are already more than 34 million registered donors around the world. Europe, with almost 15 million, is the continent with the most advanced culture of haematopoietic progenitor donation.
• In absolute terms, Spain is above France in 6th place of the European bone marrow donation rankings.
• The average age of the donors available in REDMO is 39, and that of donors incorporated in 2018 is 34. 52% of available donors are under the age of 40.
• Last year 3,362 haematopoietic progenitor transplants were carried out, the highest figure ever. Of these, 2,068 were autologous, 1,294 allogenic (433 of an identical family donor, 463 of an unrelated donor, 362 of a haploidentical family donor and 33 of umbilical cord blood).
• In 2018 a total of 808 new searches for unrelated donors were activated for Spanish patients; 1,251 compatible unrelated donors were located for 677 patients, or nearly 2 donors per patient.
• Over the last 10 years, the average search time has been reduced by 36%; the figure now stands at 30 days.
• Spain also has 64,526 umbilical cord blood units, 9% of all those stored around the world (770,000). The National Cord Blood Plan has resulted in self-sufficiency levels in this area of over 65%.
• In 2018, 163 cord blood units were shipped for transplants, 23 for Spanish patients and 140 for foreign patients.

Current situation of cord blood

The National Cord Blood Plan, which was launched in 2008, has turned Spain into a world power in this field. Our country is in third place in the world in terms of number of CBUs stored, after the United States and Taiwan. Although the use of cord blood in haematopoietic progenitor transplantation has declined in recent years, currently cord blood is showing potential new uses in cellular therapy.

In this case, the ONT aims to optimise the CBU inventory, foster their exchange, assess their role in cellular therapy, explain the real clinical use of cord blood and the potential use to which it could be put, and strengthen the supervision of cord blood banks with audit/accreditation/inspection processes.

Non official translation