The Anthony Nolan and NHS Stem Cell Registry Annual Review of 2016 FROM STRENGTH TO STRENGTH Anthony Nolan DKMS UK NHS Blood and Transplant Welsh Blood Service 2 Heathgate Place 75-87 Agincourt Road London NW3 2NU Ashburnham House Horticultural Place London W4 4JQ Oak House, Reeds Crescent Watford, Hertfordshire WD24 4QN Ely Valley Road, Pontyclun, Mid Glamorgan CF72 9WB anthonynolan.org 0303 303 03 03 www.dkms.org.uk 020 8747 5620 nhsbt.nhs.uk 0300 123 23 23 welsh-blood.org.uk 01443 622000 Registered charity no 803716/SC038827 Registered charity no 1150056 1 1257CM
BACKGROUND CONTENTS The fourth State of the Registry report has been compiled by the Anthony Nolan and the NHS Stem Cell Registry. It showcases the work that has been undertaken in 2016 in relation to recruitment of stem cell donors to the aligned registries, umbilical cord blood donations, and provision of donated stem cells to patients in need of a lifesaving transplant. Anthony Nolan Founded in 1974, Anthony Nolan was the world s first bone marrow registry. Four decades later, the charity has expanded its reach, saving the lives of people with blood cancer and blood disorders across the UK and beyond. It does so with the help of groundbreaking research, dedicated patient support, and a register of almost 650,000 truly remarkable volunteer donors. INTRODUCTION: THE STATE OF THE REGISTRY IN 2016 3 KEY STATISTICS 3 THE REGISTRY TODAY 4 PROVIDING UK DONORS 5 OUR CORD SUCCESS 6 ALIGNED REGISTRY 2016 DEMOGRAPHICS 7 STEM CELL PROVISION 9 SCIENTIFIC PROGRESS IN STEM CELL TRANSPLANTION AND DONOR FACTORS 10 DKMS UK DKMS is an international charity supporting patients living with a blood cancer, helping them find a matching blood stem cell donor and giving them a second chance of life. DKMS UK was founded in 2013 as a registered UK Donor Centre and has recruited more than 300,000 potential lifesavers to the UK register. Those aged between 17-55 and in general good health can register online for a home swab kit at www.dkms.org.uk NHS Blood and Transplant NHS Blood and Transplant (NHSBT) is a Special Health Authority, responsible for providing a safe and reliable supply of blood, blood products and expertise to hospitals in England; for increasing the number of organs available for transplant in the UK; and for the provision of tissues and stem cells to the NHS. The British Bone Marrow Registry is a division of NHS Blood and Transplant. It holds details of stem cell donors and cord blood donations from England, Scotland and Northern Ireland. Welsh Bone Marrow Donor Registry Founded by the Welsh Blood Service in 1989 to provide high quality donor typing, the Welsh Bone Marrow Donor Registry has recruited almost 90,000 blood donors to its panel - incredible people who give hope and a second chance to patients throughout the world. The Registry is proud to be working with donors, patients, transplant physicians in Wales and centres across the globe. 2
INTRODUCTION: THE STATE OF THE REGISTRY IN 2016 KEY STATISTICS It is with pleasure and pride that we present the fourth annual review of the Anthony Nolan and NHS Stem Cell Registry. The act of altruistic stem cell donation for transplantation potentially saves the lives of over a thousand patients suffering from blood cancers or other haematological disorders every year in the UK. This report highlights the strong and steady progress the partners of the aligned Anthony Nolan and NHS Stem Cell Registry are making towards a future where we can provide the best possible matching donor cells for every patient in need of transplant. and BAME patients. And finally, we must continue to promote stem cell donation among young people, as new research continues to highlight that younger donors can provide better outcomes for patients and increase survivorship. So our work continues. We are grateful to the Department of Health for their continuing support, and to all donor recruitment and provision partners. 1.3 million 2016 There are almost 1.3 million potential stem cell donors on the UK s aligned registry. 185,000 new stem cell donors were added to the aligned registry in 2016. 40% 40% of the total number of donors provided were from the UK. Over the past year, we have not only increased the number of people on the aligned registry by 185,000, but we have also recruited more male donors and more black, Asian and minority ethnic (BAME) donors than ever before. In addition, we continue to recruit our strongest numbers among younger people. We have also seen significant increase in our inventory of donated cord blood stem cells, which provide a vital alternative source of cells, particularly for patients for whom it is more difficult to find a match on the UK and international donor registries. Although in percentage terms, the number of UK donors we provide to UK patients in comparison to overseas donors remains the same, we are providing more in number. In addition, we are providing more UK cord blood units for UK patients. Henny Braund Chief Executive, Anthony Nolan Ian Trenholm Chief Executive, NHS Blood and Transplant Stephan Schumacher Chief Executive, DKMS UK Cath O Brien Director, Welsh Blood Service 55% 55% of new stem cell donors were under 30. 35% 35% of new stem cell donors were male. 3,500 23% 23% of new stem cell donors were from an ethnic minority background. But there is still much work to do. We still need to address the imbalance in the number of male and female donors that we recruit to the aligned registry. Our data on donor provision shows clearly that transplant clinicians favour using male donors and we must work harder to meet that demand. 20,000 We must also continue to target our recruitment in ethnically diverse areas, and raise awareness among different ethnic communities, in order to address the disparity in the chance of finding a matching donor between white Northern European 411 UK stem cell donors and 41 UK cord blood units were provided for UK patients in 2016. Over 3,500 new UK cord blood units were banked and made available for stem cell transplant. There are now over 20,000 UK clinical grade cord blood units in the NHSBT and Anthony Nolan cord banks. 3
THE REGISTRY TODAY Since the UK s stem cell registries aligned in 2013, growth in the number of potential stem cell donors has been strong and steady. In 2016, awareness raising and donor recruitment activity by Anthony Nolan, NHS Blood and Transplant, DKMS UK and the Welsh Bone Marrow Donor Registry saw 185,000 new potential stem cell donors made available for transplant patients in the UK and across the world. This is an increase of over 50,000 on the number of donors recruited in the previous year, and takes the total number of available donors to almost 1.3 million. Research published in May 2017* by the Anthony Nolan Research Institute has identified that younger donors provide better patient outcomes within stem cell transplantation. Each organisation s donor recruitment strategy has, for a number of years, recognised this, and in 2016, 55% of UK donors recruited were under the age of 30. Awareness raising and donor recruitment saw 185,000 new potential stem cell donors made available for transplant patients in the UK and across the world. For some time, UK transplant centres have preferred to use male donors. The Anthony Nolan and NHS Stem Cell Registry has continued to meet this need in 2016, recruiting over 64,000 male donors - more than ever before. However, we still have much work to do in order to increase the proportion of new male recruits, as men only represented 35% of new potential donors recruited in 2016. We will continue to invest in targeted marketing and recruitment activity, and ensure new young male donors are tissue-typed to the highest possible resolution in order to address this imbalance and provide transplant clinicians with the UK donors they need. Recruiting more BAME donors is also critical to our goal of meeting the need of every person requiring a stem cell transplant from an unrelated donor. It remains the case that white Northern European patients have a significantly higher chance of finding a match than those from a BAME background. In 2016, we continued our strategies to address this imbalance, and 23% of donors recruited were from BAME backgrounds up from 21% in 2015. Partnerships between DKMS UK, Anthony Nolan, NHSBT and organisations working specifically with BAME communities, such as the Rik Basra Leukaemia Campaign, Team Margot, and ACLT (African Caribbean Leukaemia Trust), have improved our BAME recruitment. Lastly, we can report that 34% of our donors are typed to the highest possible resolution an increase of 11% since 2015. *Shaw et al., Recipient/donor HLA and CMV matching in recipients of T-cell-depleted unrelated donor haematopoietic cell transplants, Bone Marrow Transplantation 52, 717-725 (May 2017) doi:10.1038/bmt.2016.352 http://www.nature.com/bmt/journal/v52/n5/full/bmt2016352a.html 4
55% of all UK donors selected were young men aged 30 and under. PROVIDING UK DONORS Our goal is to provide more UK donors for UK patients by making the best possible donors available on our registry. We are therefore pleased to report that we have seen an increase in the number of UK donors provided. In 2016, we provided 411 UK donors for UK patients. We believe this increase is supported by our activity in recruiting the young male donors that transplant centres prefer, and tissue typing them to the highest level so that their suitability for transplant is clear. Indeed, in 2016, 80% of donors provided by the UK s aligned registry to UK patients were male and 55% were young men aged 30 and under. Research shows that younger donors provide better patient outcomes.* While the availability of potential donors to give blood samples has remained steady at 64% indicating availability and willingness to donate work to improve this continues. Ensuring our potential donors are contactable, committed and available is critical to achieving our goal of providing more UK donors for UK patients. *66% of all UK donors (11% female and 55% male) for UK patients were aged 30 and under. 5
OUR CORD SUCCESS This year, NHS Blood and Transplant and Anthony Nolan have continued to achieve success in our cord blood banking programmes. Donated umbilical cord blood is an important source of stem cells for donation to patients in need of a lifesaving transplant. As a higher degree of HLA mismatch can be tolerated when using cord blood stem cells, this source is vital to helping address the challenge of finding donors for patients from BAME backgrounds particularly. Over 3,500 new cord blood units have been banked and made available for transplant. This takes the total number of cord blood units available to just over 20,000*. Proof of the value of these programmes has been seen in the significant increase in provision of UK cord blood units to UK patients this year. In 2016, we provided 41 cord blood units for lifesaving transplant up from 32 in 2015. *NHSBT have removed non-clinical grade cords from their total, accounting for the decrease from last year's figures. 6
ALIGNED REGISTRY 2016 DEMOGRAPHICS NEW DONORS MADE ACTIVE AGE MALE 34.6% FEMALE 65.4% East Wales London Islands 336 9,221 11,984 34,173 NEW DONORS BY REGION 56 60 72 85 Scotland Northern Ireland North East 4,634 5,782 20,841 North West 16,131 51 55 46 50 4,036 2,533 4,718 7,819 South East South West East Midlands West Midlands Yorkshire and Humber Unknown/Other 8,460 7,721 13,062 13,323 12,357 27,709 41 45 4,665 10,640 African African Caribbean 1,786 3,025 NEW DONORS BY ETHNICITY East Asian 1,548 36 40 31 35 8,725 7,205 15,353 19,386 Hispanic Jewish Middle Eastern Northern European Other Other European South Asian 225 875 376 11,079 5,671 16,548 143,408 Unknown 1,193 26 30 12,298 21,265 21 25 13,438 22,844 16 20 11,263 19,389 25000 20000 15000 10000 5000 0 5000 10000 15000 20000 25000 African African-Caribbean East Asian Hispanic Jewish Middle Eastern Northern European Other / Mixed Other European South Asian Unknown 96 47 30 10 1 9 61 33 276 212 478 1,776 CORD BY ETHNICITY* ANTHONY NOLAN / NHSBT ONLY * Includes all searchable UK cords (including research grade) 7
ALIGNED REGISTRY 2016 DEMOGRAPHICS ALIGNED REGISTRY DEMOGRAPHICS AGE MALE 39.6% FEMALE 60.4% 3000 2500 2,717 2,925 3,012 REGIONAL 10,000,000 8,000,000 56 60 37,149 44,602 2000 2,310 1,844 1,955 1,968 1,905 1,840 6,000,000 1500 51 55 70,715 91,548 1000 1,137 946 1,184 4,000,000 46 50 73,169 103,502 500 2,000,000 41 45 60,899 97,048 0 East: 66500 East Midlands: 123168 London: 188848 N Ireland: 17136 North East: 75970 North West: 130048 Scotland: 103540 South East: 169975 South West: 100732 Wales: 92265 West Midlands: 103095 Yorkshire & Humber: 62579 Unknown/ Other: 55202 Note: The Aligned Registry per 100,000 population shows the concentration of potential donors in each region s population Aligned Registry per 100,000 population UK Population 36 40 56,151 97,854 African 10,450 ETHNICITY African Caribbean 23,409 East Asian 5,559 31 35 65,472 113,446 Hispanic Jewish 572 11,135 Middle Eastern 2,213 Northern European 1,010,202 26 30 68,157 107,175 Other Other European 42,975 22,003 South Asian 69,860 Unknown 90,680 21 25 59,646 90,508 16 20 19,446 100000 80000 60000 40000 20000 0 20000 40000 60000 80000 100000 32,571 African African-Caribbean East Asian Hispanic Jewish Middle Eastern Northern European Other / Mixed Other European South Asian Unknown 675 281 307 93 16 45 396 505 2,338 2,600 13,148 AVAILABLE CORD BY ETHNICITY* ANTHONY NOLAN / NHSBT ONLY 8
STEM CELL PROVISION 2016 PROVISIONS FOR UK PATIENTS (MARKET SHARE) TOTAL 1,131 UK PATIENTS HELPED UK patient, UK unrelated donor UK patient, imported unrelated donor UK patient, UK CBU UK patient, imported CBU 41 75 411 604 UK patient, UK unrelated donor UK patient, imported unrelated donor UK patient, UK CBU UK patient, imported CBU 27 51 408 587 UK DONORS FOR UK PATIENTS TOTAL 411 AGE MALE 79.6% 56 60 1 0 FEMALE 20.4% UK DONORS FOR UK PATIENTS SEARCH REQUESTS V BLOOD SAMPLES REQUESTED 51 55 4 1 46 50 15 4 41 45 14 9 Searches Blood samples requested Blood samples shipped Searches Blood samples requested Blood samples shipped 1,789 2,145 2,814 36 40 25 13 31 35 44 26 30 94 11 22 SUMMARY OF DONORS SELECTED FOR STEM CELL DONATION 21 25 90 16 20 40 5 19 16-30 year old males 16-30 year old females 31-60 year olds 11% 34% 55% 100 80 60 40 20 0 20 40 60 80 100 UK DONORS FOR UK PATIENTS BY ETHNICITY TOTAL 411 ALIGNED REGISTRY BY TYPING LEVEL African Asian Jewish Middle Eastern Northern European Other Other European South Asian Unknown 2 5 4 1 5 2 0 12 380 A,B A,B,C A,B,C,DR A,B,C,DR,DQ A,B,C,DR,DQ,DP A,B,DR A,B,DR,DQ 0.1% 3.0% 4.0% 15.2% 18.4% 25.5% 33.8% 9
SCIENTIFIC PROGRESS IN STEM CELL TRANSPLANTATION AND DONOR FACTORS Over the last decade, the rise in the number of transplants taking place has been accompanied by a significant increase in the proportion of patients who are achieving long-term survival. Five-year survival rates for adults receiving a transplant from a donor have risen from 43% to 48%. For children, it has risen from 63% to 73%.* While more lives are being saved than ever before, there is clearly still more to do. Cutting edge research will be key to delivering the continued improvement in outcomes that patients need, but it is clear that this requires a step change in the number of patients being entered into clinical trials. To meet this challenge, Anthony Nolan and NHS Blood and Transplant, in partnership with Leuka, are investing in a new research platform called IMPACT. By making it easier and quicker to set up and deliver clinical trials in stem cell transplantation, IMPACT will transform the ability of transplant centres to work collaboratively to develop increasingly effective approaches to treatment. The platform is due to be launched in the autumn of 2017. In addition to the creation of IMPACT, we have also seen new research published by the Anthony Nolan Research Institute that will influence how donors are selected in order to improve transplant outcomes for patients. The findings confirm a trend showing that the age of the donor can affect patient outcomes, with younger donors leading to better survival rates. The study also demonstrates for the first time that matching donors on their cytomegalovirus status ( a common virus known as CMV) can compensate for a genetic mismatch. *BSBMT 7th Report to Specialist Commissioners April 2016 Anthony Nolan and NHS Blood and Transplant, in partnership with Leuka, are investing in a new research platform called IMPACT. 10