Annals of Hematology

, Volume 98, Issue 2, pp 501–510 | Cite as

Utility of allogeneic hematopoietic stem cell transplantation using international donors in a homogenous ethnic population: question in the era of various alternative donors

  • Sang-A Kim
  • Jayoun Lee
  • Joon Ho Moon
  • Hyewon Lee
  • Junho Jang
  • June-Won Cheong
  • Jeonghwan Youk
  • Yeonjoo Choi
  • Minjoo Kang
  • Minkyung Shin
  • Youngil KohEmail author
  • Sangjin ShinEmail author
Original Article


The advent of various alternative donors in allogeneic hematopoietic stem cell transplantation (HSCT) raises the question of using international donors, especially in ethnically homogenous populations. We analyzed the clinical outcome and medical expense of human leukocyte antigen (HLA)-matched HSCT using domestic and international donors. We analyzed the patients who received allogeneic HSCT at five medical centers in Korea in the last 10 years. Using propensity-score matching, we compared overall survival (OS), relapse-free survival (RFS), and transplantation-related complications. Medical expense was analyzed based on National Health Insurance Service (NHIS) data. A total of 269 patients were analyzed after 3:1 (domestic/international) matching. There was no difference in OS (p = 0.395) and RFS (p = 0.604) between the domestic and international donor groups (5-year OS rate 42.9 and 37.8%, 5-year RFS rate 37.6 and 33.5% for domestic and international groups, respectively). No difference in chronic graft-versus-host disease (GVHD) incidence was observed (34.2% in domestic and 35.9% in international group, p = 0.804). Early infection was more frequent in the domestic group (55.0 vs. 35.8%, p = 0.007), whereas infection after 30 days was more frequent in the international group (28.7 vs. 49.3%, p = 0.001). Mean medical expense was far higher in the international group, by US $51,944 in the entire follow-up period (p < 0.001). We would expect similar outcomes for international and domestic donors in terms of survival and treatment-related complications with HLA-matched HSCT in other ethnically homogenous populations. These findings should be considered together with the high cost of using international donors in the era of various alternative donors.


Allogeneic stem cell transplantation HLA International donor Alternative donor 



This study was supported by the National Evidence-based Healthcare Collaborating Agency (NC15-005, NC16-001).

Compliance with ethical standards

Conflict of interest

Sang-A Kim declares that there is no conflict of interest regarding the work described in this article.

Jayoun Lee declares that there is no conflict of interest regarding the work described in this article.

Junho Moon declares that there is no conflict of interest regarding the work described in this article.

Hyewon Lee declares that there is no conflict of interest regarding the work described in this article.

Junho Jang declares that there is no conflict of interest regarding the work described in this article.

June-Won Cheong declares that there is no conflict of interest regarding the work described in this article.

Jeonghwan Youk declares that there is no conflict of interest regarding the work described in this article.

Yeonjoo Choi declares that there is no conflict of interest regarding the work described in this article.

Minkyung shin declares that there is no conflict of interest regarding the work described in this article.

Youngil Koh declares that there is no conflict of interest regarding the work described in this article.

Sangjin Shin declares that there is no conflict of interest regarding the work described in this article.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was waived due to the retrospective nature of this study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Sang-A Kim
    • 1
  • Jayoun Lee
    • 2
  • Joon Ho Moon
    • 3
  • Hyewon Lee
    • 4
  • Junho Jang
    • 5
  • June-Won Cheong
    • 6
  • Jeonghwan Youk
    • 7
  • Yeonjoo Choi
    • 1
  • Minjoo Kang
    • 2
  • Minkyung Shin
    • 2
  • Youngil Koh
    • 1
    • 2
    Email author
  • Sangjin Shin
    • 2
    Email author
  1. 1.Department of Internal MedicineSeoul National University HospitalSeoulSouth Korea
  2. 2.National Evidence-based healthcare Collaborating AgencySeoulSouth Korea
  3. 3.Department of Internal MedicineKyungpook National University HospitalDaeguSouth Korea
  4. 4.Department of Internal MedicineNational Cancer CenterGoyangSouth Korea
  5. 5.Department of Internal MedicineSungkyunkwan University School of MedicineSeoulSouth Korea
  6. 6.Department of Internal MedicineYonsei University College of MedicineSeoulSouth Korea
  7. 7.Korea Advanced Institute of Science and TechnologyDaejeonSouth Korea

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