How To Find Out How Many People Donate To Bone Marrow Transplant

Transcription

1 Bone Marrow Donors Worldwide Annual Report 2009

2 Bone Marrow Donors Worldwide Annual Report 2009 Contact address Bone Marrow Donors Worldwide Europdonor Foundation Plesmanlaan 1B 2333 BZ Leiden The Netherlands Tel: Fax: Acknowledgements Photographs by courtesy of the DKMS, Europdonor and the EBMT. Graphic Design: Five Spices b.v., The Hague. Printed by: RS Drukkerij b.v., The Hague Leiden, 2010

3 page I Preface The year 2009 was one of change, challenge and hope. It has been years since we last saw such a steep increase of new stem cell donors (Figure 4) and cord blood units (Figure 6), almost doubling the increase compared to the years 2000 to This in itself is a fantastic achievement, which was for the stem cell donors mainly due to the efforts of the ZKRD in Germany with the DKMS as main contributor, the NMDP in the USA and the Ezer-Mizion Bone Marrow Donor Registry from Israel. The increase of cord blood units was the result of an overall effort of the cord blood banks. The crucial question is how much did this impressive increase of stem cell donors help the patients with a rare HLA group or so-called unique HLA phenotype? The answer is a sobering: less and less! As can be seen in Chapter V, Figure 11 about half of the HLA groups or phenotypes is unique, which means that it occurs only once in all donors and cord blood units in BMDW, and in Figure 13 we see that the addition of new unique phenotypes shows a tendency to flatten out. That is not surprising because the number of possible HLA -A, -B, -DR split phenotypes is 52 million or in other words in the first 20 years of unrelated stem cell transplantation we have made a nice start with collecting donors with in total nearly one million different phenotypes largely from Caucasoid donors, but we are nowhere near solving the problem. On top of that the above is an underestimate of the problem as the HLA typing was only performed for 3 loci (HLA-A, -B, -DR) and at a median or split antigen level of resolution. If we would take the HLA-C and -DQ loci into account as well and do high resolution HLA typing the percentage of unique phenotypes would be substantially higher and the number of possible HLA phenotypes way above the number of people living on earth! Hence the challenge is to find additional avenues to help our patients apart from increasing the number of stem cell donors. As we have discussed before, the use of cord blood as a stem cell source shows great promise (Curr. Opinion Immunology, 2009, 21 (5): ), but is hampered by the still small inventory of just over 400,000 units available for transplantation (see Figures 14 to 17), too often with a low number of nucleated cells. For that reason the steady increase of the number of cord blood added to the database is really good news! There are additional reasons for hope. The National Cord Blood Program in New York presented at the last ASH meeting (Blood (ASH Annual Meeting Abstracts) 2009, 114: Abstract 2297 findings, which indicate that cord blood units, which are homozygous at one locus but are otherwise fully matched with the recipient i.e. a Graft versus Host (GvH) mismatch, do as well as fully matched grafts and might have an improved take as well. This could increase the number of patients with an optimal graft outcome quite significantly. Likewise the same group published, together with undersigned, an analysis of the impact of re-exposure of the cord blood to its own Non Inherited Maternal Antigens (NIMA), when these are present - as mismatched antigens - in the recipient. Such a combination is called a NIMA match. Over 1,100 patients with leukemia with zero, one or two mismatched grafts were analyzed, of which 25 grafts had one mismatch with a NIMA match and 54 had two mismatches again with only one NIMA match. Transplant-related mortality was improved in the NIMA matched cases possibly because the take was improved and although only of borderline significance also relapse especially in patients with myeloid leukemia was reduced, while acute and chronic GvH were not changed (P.N.A.S. 2009, 206 (47): ). We hope to implement these two new matching algorithms in BMDW this year, in the hope that they will provide a larger group of patients with a cord blood graft with improved outcome On a more personal note we had our changes in the BMDW staff as well. Henk van der Zanden, one of the founding fathers of BMDW (and Europdonor) retired. We had a nice symposium and best of all, Henk decided to continue to work for one day a week, mainly to analyze the data in BMDW. Machteld Oudshoorn continues in her role as COO of the BMDW office, together with Carine Mijnarends (Henk s successor) who is, as General Director of Europdonor, responsible for IT, Finance and Human Resources. Jack Bakker is now head of the IT group and takes care of BMDW as he has done for years. Last but not least Bertjan Nijhuis joined the IT staff and will support with the implementation of the approved CRF s.

4 page II For me personally 2009 has also some very special memories. In the first place, as we already mentioned in the 2008 annual report, Aad van Leeuwen, my mate in so many scientific and translational adventures including BMDW, died May last year. Her memory lives with us daily in the activities of Eurotransplant, Europdonor, BMDW and the accreditation of the HLA typing laboratories, which she guided the last 15 years of her life. She was a wonderful person and we all miss her. Jon J. van Rood receiving the 2008 DKMS Mechteld Harf Award on March 30, 2009 in Göteborg. (from the left: Claudia Rutt, John Hansen and Jon van Rood). She was still with us when the news came that I had been selected to receive the 2008 Mechtild Harf Award for starting BMDW, which gave me a chance to discuss in my acceptance speech the challenges we are facing, when we try to find a suitable unrelated donor for our patients, as I discussed above. And then finally, finally, although it happened to me only a few weeks ago, already in 2009 some people - on the initiative of Andrea Bacigalupo - must have decided that it was time to recognize the fact that BMDW was not only a useful tool to help patients and their physicians to find an unrelated stem cell donor but that BMDW serves as a unique example of how people on Earth can work together, given an important goal, a good organization, and strong dedication to serve people in need in other words: YOU!! I knew that something was in the air, but was completely unprepared to be called to the podium - the last morning of the successful WMDA meeting in Dublin - to be informed by Bacigalupo that I was nominated by YOU as their representative for the Nobel Prize for Peace. Unprepared as I was I did not say much more than: Thank you very much and that I knew from past experience how nice it was to receive a prize, but that what really matters is that your peers are of the opinion that what you had done is so important, that you deserve a prize. As I said, I was unprepared and emotional, that explains but is not an excuse that I did not thank YOU more specifically. And with YOU I mean not only all the people working in donor centers, cord blood banks and registries, recognizing that without your continuous support BMDW would not exist, but also all the staff members of Europdonor with whom I had the privilege to work these last 20 years. To have nice and useful ideas is easy, to make them work you need the support, help and. corrections from others! Thank you all very much! You have given us a mandate; we will do our darn best not to disappoint you! Jon J. van Rood Chairman Editorial Board July 2010

5 Index page III page Preface I Index II 1 Introduction to Bone Marrow Donors Worldwide (BMDW) 1 2 Participating Stem Cell Donor Registries and Cord Blood Banks 3 1. Participating stem cell donor registries 3 2. Participating cord blood banks/registries 5 3 Number of Stem Cell Donors and Cord Blood Units 7 1. Number of stem cell donors 7 2. Number of cord blood units 9 4 Distribution of Stem Cell Donors and Cord Blood Units in the World Distribution of stem cell donors Distribution of cord blood units 14 5 Number of HLA Phenotypes 16 6 Information Technology Developments in Change Request Maintenance and fixes Data analysis and registry/third party support 2. Use of BMDW 20 Website On-line services 3. Plans for Financial Overview 22 8 Board and Staff 23 9 Advisory Committee References Publications Abstract for presentation Invited lectures 25

6 1Introduction to Bone Marrow Donors Worldwide (BMDW) page 1 Bone Marrow Donors Worldwide (BMDW) started as an initiative of the Immunobiology Working Party of the European Group for Blood and Marrow Transplantation (EBMT) in In February 1989 the first edition was distributed, which contained the donor files of eight registries with a total of 150,000 volunteer stem cell donors. The pioneer registries were: Anthony Nolan Research Centre (UK) France Greffe de Moelle (France) National Marrow Donor Program (USA) Europdonor Foundation (The Netherlands) German Registry of Bone Marrow Donors (Germany) Italian Bone Marrow Donor Registry (Italy) Austrian Bone Marrow Donors (Austria) Marrow Donor Program Belgium (Belgium) The original goals of BMDW are still adhered to, but new initiatives have been added. The main goals are: To maximize the chance of finding a stem cell donor/cord blood unit by providing access to all donors and cord blood units available in the world. To minimize the effort put into stem cell donor/cord blood unit searches: only registries/ banks with potential stem cell donors/cord blood units need to be contacted. To provide an estimate of the chance of finding a stem cell donor/cord blood unit for a given patient. To provide advanced search programs to identify partially matched stem cell donors/cord blood units. To facilitate search request advices via Internet. To provide relevant general information for the benefit of the patient. To provide statistics on the increase of donors of different registries, the number of DNA typed donors etc. What is BMDW? BMDW Bone Marrow Donors Worldwide is a service provided by Europdonor. It provides a listing of HLA phenotypes of unrelated volunteer stem cell donors and cord blood units from participating stem cell donor registries and cord blood banks together with matching programs. The participants pay an operational fee to have the right to have their own data files uploaded in BMDW and to consult those from other registries and cord blood banks in a secure fashion. BMDW Office The office consists of Europdonor (ED) staff, responsible for keeping BMDW operational, but also to improve the operation as decided by the Editorial Board (EB). NB: the staff size is flexible, which has meant in practical terms that if necessary, extra staff is provided to BMDW by ED.

7 page 2 Editorial Board (EB) of BMDW The Editorial Board is a forum of one representative from each of the registries and cord blood banks, which meets at least once a year. It approves the budget and is authorized by the Europdonor Board to decide on new developments. Advisory Committee (AC) The Advisory Committee consists of eight members elected from and by the EB to assist the BMDW Office and the chair of the Editorial Board to select and prepare topics to be discussed and decided upon by the EB. How is the relationship between the individual registries and/or cord blood banks in relation to BMDW as part of Europdonor regulated? The requirements of the users to participate in the BMDW operation are described in the house rules (see where also the services to be delivered by the BMDW Office are defined. They are in brief as follows: The clients will submit their data according to a format as determined by the BMDW Office. The clients pay a fee to be agreed upon by the Editorial Board. BMDW verifies the submitted data and makes them available on Internet together with matching programs. The BMDW budget depends on the tasks to be performed and is approved in advance by the Editorial Board. How is the relationship between the BMDW Office, the Editorial Board, Advisory Committee and Europdonor regulated? Briefly the following has been agreed upon: The Board of Europdonor has authorized the Editorial Board to decide on new features and improvements to be developed. The Editorial Board will negotiate with the BMDW Office as part of Europdonor the necessary budget to keep BMDW running and to develop the requested new features. The Advisory Committee assists the BMDW Office in preparing the agenda of the Editorial Board meeting and the items on which the Editorial Board has to decide. It will report to the Editorial Board not only the opinions of the majority of the Advisory Committee members, but also minority opinions. The Advisory Committee has the option to consult the IT Working Group of the WMDA. (see Figure) Advisory Committee (AC) Advises Advises IT WG WMDA Europdonor Board (ED) Authorises Editorial Board (EB) Decides on New developments to be implemented by the BMDW office and the neccesary budget

8 2Participating Stem Cell Donor Registries and Cord Blood Banks page 3 1. Participating stem cell donor registries At the end of 2009, 62 stem cell donor registries from 45 countries participated in BMDW (Table 1). Three new stem cell donor registries participated in BMDW, these are the New Sunshine Charity Foundation from China, DKMS-Poland temporarily hosted at ZKRD in Germany and the Singapore Bone Marrow Donor Programme from Singapore. Together they supply 26,271 new donors to BMDW. Table 1 PARTICIPATING STEM CELL DONOR REGISTRIES Registry (N = 62) City Country (N = 45) Argentine CPH Donors Registry Buenos Aires Argentina Armenian Bone Marrow Donor Registry Charitable Trust Yerevan Armenia Australian Bone Marrow Donor Registry including the New Zealand Bone Marrow Donor Registry Sydney Australia Austrian Bone Marrow Donors Vienna Austria Marrow Donor Program Belgium Mechelen Belgium Bulgarian Bone Marrow Donor Registry Sofia Bulgaria OneMatch Stem Cell and Marrow Network Ottawa Canada Hong Kong Bone Marrow Donor Registry (HKBMDR) Hong Kong China New Sunshine Charity Foundation (NSCF) Beijing China Croatian Bone Marrow Donor Registry Zagreb Croatia Cyprus Paraskevaidio Bone Marrow Donor Registry (CPBMDR) Nicosia Cyprus The Cyprus Bone Marrow Donor Registry (CBMDR) Nicosia Cyprus Czech Stem Cells Registry (CSCR) Prague Czech Republic Czech National Marrow Donor Registry (CNMDR) Plzen Czech Republic The Danish Bone Marrow Donor Registry (DBMDR) Aarhus Denmark Bone Marrow Donors Copenhagen (BMDC) Copenhagen Denmark Finnish Bone Marrow Donor Registry Helsinki Finland FGM - France Greffe de Moelle St-Denis la Plaine France ZKRD - German National Bone Marrow Donor Registry Ulm Germany Unrelated Hematopoietic Stem Cell Donor Registry Greece Athens Greece Hungarian Bone Marrow Donor Registry Budapest Hungary Asian Indian Donor Marrow Registry New Delhi India The Irish Unrelated Bone Marrow Panel Dublin Ireland Hadassah Bone Marrow Donor Registry (HBMDR) Jerusalem Israel Ezer Mizion Bone Marrow Donor Registry (EMBMDR) Petach Tikvah Israel Sheba Medical Center Donor Registry (SMCDR) Tel-Hashomer Israel Italian Bone Marrow Donor Registry Genova Italy Japan Marrow Donor Program Tokyo Japan Lithuanian National Bone Marrow Donor Registry Vilnius Lithuania Mexican Bone Marrow Donor Registry Mexico City Mexico Europdonor Foundation Leiden The Netherlands The Norwegian Bone Marrow Donor Registry Oslo Norway Against Leukemia Foundation Marrow Donor Registry (ALF-MDR) Warsaw Poland DKMS Poland * Warsaw Poland National Polish Bone Marrow Donor Registry (NPBMDR) Wroclaw Poland Polish Central Bone Marrow Donor Registry (POLTransplant) Warsaw Poland Unrelated Bone Marrow Donor Registry (UBMDR) Warsaw Poland Ursula Jaworska Foundation - Bone Marrow Donor Registry (FUJ) Warsaw Poland Portuguese Bone Marrow Donors Registry Lisbon Portugal Russian Bone Marrow Donor Registry (RBMDR) Moscow Russian Fed. Karelian Registry of Unrel. Donors of Hematopoietic Stem Cells Petrozavodsk Russian Fed. San Marino Bone Marrow Donor Registry Borgo Maggiore Republic San Marino Singapore Bone Marrow Donor Programme Singapore Singapore

9 page 4 Registry (N = 62) City Country (N = 45) Slovak National Bone Marrow Donor Registry Bratislava Slovakia Slovenia - Donor Ljubljana Slovenia South African Bone Marrow Registry Cape Town South Africa REDMO, Jose Carreras International Leukemia Foundation Barcelona Spain Tobias Registry of Swedish Bone Marrow Donors Stockholm Sweden Swiss Blood Stem Cells Bern Switzerland Buddhist Tzu Chi Stem Cells Center Hualien City Taiwan Thai Stem Cell Donor Registry Bangkok Thailand TRAN - Ankara University Faculty of Medicine Ankara Turkey Blood and Bone Marrow Donor Registry of Istanbul Medical Fac. (BBMDR-IMF) Istanbul Turkey Emirates Bone Marrow Donor Registry Sharjah United Arab Emirates Anthony Nolan Trust (ANT) London United Kingdom British Bone Marrow Registry (BBMR) Bristol United Kingdom Welsh Bone Marrow Donor Registry (Welsh BMDR) Pontyclun United Kingdom SINDOME Montevideo Uruguay National Marrow Donor Program (NMDP) Minneapolis, MN USA American Bone Marrow Donor Registry (ABMDR) Mandeville, LA USA Caitlin Raymond International Registry (CRIR) Worcester, MA USA Gift of Life Bone Marrow Foundation (GOL) Boca Raton, FL USA *) DKMS-Poland is temporarily hosted at ZKRD in Ulm, Germany. The number of participating stem cell donor registries is shown in Figure 1. Figure 1 Participating Stem Cell Donor Registries Number of registries Year

10 page 5 2. Participating cord blood banks/registries In 2009, 43 cord blood banks/registries located in 26 countries participated in BMDW (Table 2). Two new cord blood banks from Croatia and China joined BMDW in These new banks supplied data of 19,950 units to BMDW. Table 2 PARTICIPATING CORD BLOOD BANKS/REGISTRIES Registry (N = 43) City Country (N = 26) Argentina National Cord Blood Bank Buenos Aires Argentina Australian Cord Blood Registry * Sydney Australia Austrian Cord Blood Registry Vienna Austria Belgium Cord Blood Registry (BCBR) ** Mechelen Belgium Leuven Cord Blood Bank (LCBB) * Leuven Belgium Shandong Cord Blood Bank Jinan China Croatian Cord Blood Bank Zagreb Croatia Czech Cord Blood Registry * Prague Czech Republic Finnish Cord Blood Registry * Helsinki Finland The French Cord Blood Registry * St-Denis La Plaine France German Branch of the European Cord Blood Bank (GBECBB) * Düsseldorf Germany ZKRD - German Cord Blood Bank Ulm Germany Hellenic Cord Blood Bank * Athens Greece Hadassah-MDA Cord Blood Bank (H-MDACBB) * Jerusalem Israel Sheba Medical Centre Cord Blood Registry (SMCCBR) * Tel-Hashomer Israel Italian Cord Blood Bank Network ** Genova Italy Tokyo Cord Blood Bank * Tokyo Japan Korea Catholic Hematopoietic Stem Cell Bank (KCHSCB) Seoul Republic of Korea Korea Cord Blood Bank (KCBB) Seoul Republic of Korea Mexican Unrelated Cord Blood Bank Mexico City Mexico EuroCord Nederland Foundation * Leiden The Netherlands Polish Central Cord Blood Bank Warsaw Poland Unrelated Cord Blood Registry Warsaw Poland Eurocord Slovakia Slovak Placental Stem Cell Registry Bratislava Slovakia REDMO Spanish Cord Blood Registry * Barcelona Spain Tobias Cord Blood Registry Stockholm Sweden Swiss Cord Blood Registry Bern Switzerland Buddhist Tzu Chi Stem Cells Center Hualien City Taiwan BIONET Corp./BabyBanks Jhonghe City, Taipei Taiwan Healthbanks Biotech Co. Ltd. Taipei Taiwan StemCyte Inc. Taiwan LinKou, Taipei Hsien Taiwan Ankara Cord Ankara University Faculty of Medicine Ankara Turkey British Bone Marrow Registry Cord Blood Bank ** Bristol UK StemCyte Inc. Covina, CA USA University of Colorado Cord Blood Bank (UCCBB) Aurora, CO USA Gift of Life Cord Blood Program (GOL) Boca Raton, FL USA Celgene Cord Blood Bank Cedar Knolls, NJ USA Cleveland Cord Blood Center (CCBC) Cleveland, OH USA Michigan Blood Grand Rapids, MI USA National Marrow Donor Program Cord Blood Bank (NMDP) Minneapolis, MN USA National Cord Blood Program, New York Blood Center * (NCBP-NYBC) Long Island City, NY USA New Jersey Cord Blood Bank & Elie Katz Umbilical Cord Blood Program (NJCBB-EKUCBP) Allendale, NJ USA Caitlin Raymond International Registry/Cord (CRIR) Worcester, MA USA *) Cord Blood Banks included in NetCord **) Cord Blood Bank partly included in NetCord

11 page 6 The number of participating cord blood banks/registries are shown in Figure 2. Figure 2 Participating Cord Blood Banks/ Registries Number of registries Year

12 page 7 3Number of Stem Cell Donors and Cord Blood Units 1. Number of stem cell donors The number of HLA-A, -B and HLA-A, -B, -DR typed stem cell donors per registry is shown in Table 3. In Figure 3 the total number of HLA-A, -B and HLA-A, -B, -DR typed stem cell donors per year is given. The number of stem cell donors increased by 1,170,704 from 12,405,694 to 13,576,398 on December 22, The percentage of HLA-DR typed donors has increased by 2%, from 77% in 2008 to 79% in In the total group of donors the percentage of HLA class I DNA typed donors is 59% and HLA class II DNA typed donors is 73%. Table 3 THE NUMBER OF HLA-A, -B AND HLA-A, -B, -DR AND DNA TYPED STEM CELL DONORS PER REGISTRY Number of Percentage HLA-A, -B, of HLA-A, -B, Number of Number of Total number -DR typed -DR typed class I DNA class II DNA Registry of donors donors donors typed donors typed donors Argentina 27,165 22, ,165 22,795 Armenia 14,514 14, ,514 14,513 Australia and New Zealand 181, , , ,595 Austria 60,551 24, ,825 15,059 Belgium 47,383 38, ,810 24,284 Bulgaria Canada 250, , , ,176 China, HKBMDR 66,598 43, ,215 24,266 China, NSCF 2,365 2, ,365 2,210 Croatia 12,096 10, ,444 10,362 Cyprus, CPBMDR 6, , Cyprus, CBMDR 109,167 60, ,324 48,199 Czech Republic, CNMDR 34,477 28, ,817 28,505 Czech Republic, CSCR 19,981 7, ,208 7,782 Denmark, DBMDR 24,104 22, ,767 22,366 Denmark, BMDC 12,260 11, ,200 Finland 19,964 19, ,345 3,945 France 175, , , ,777 Germany 3,708,985 2,513, ,212,949 2,428,374 Greece 21,255 7, Hungary 4,933 2, ,896 India Ireland 19,851 19, ,974 11,748 Israel, HBMDR 69,516 37, ,300 36,650 Israel, EMBMDR 499, , , ,807 Israel, SMCDR 1, Italy 328, , , ,263 Japan 351, , Lithuania 3,980 3, ,349 3,978 Mexico 10,377 10, ,333 The Netherlands 38,181 36, ,044 26,512 Norway 28,595 27, ,368 27,070 Poland, NPBMDR 5,816 5, ,739 5,556 Poland, ALF MDR 7,992 3, ,577 3,554 Poland, DKMS 22,632 22, ,631 22,392 Poland, FUJ 11,509 3, ,131 3,031 Poland, POLTransplant 24,871 24, ,817 24,312 Poland, UBMDR 7,

13 page 8 Total number Number of HLA-A, -B, -DR typed Percentage of HLA-A, -B, -DR typed Number of class I DNA Number of class II DNA Registry of donors donors donors typed donors typed donors Portugal 170, , , ,436 Russian Fed., RBMDR 13,926 1, Russian Fed., Karelian Reg. 2, , Russian Fed., BMDRBBR Republic San Marino Singapore 1,274 1, ,274 1,273 Slovakia 1,205 1, ,022 Slovenia 9,836 9, ,208 9,831 South Africa 63,851 6, ,602 Spain 79,876 50, ,096 33,933 Sweden 40,645 23, ,382 22,553 Switzerland 22,733 22, ,877 22,359 Taiwan 297, , , ,476 Thailand 55,936 51, ,294 51,614 Turkey, TRAN 2,367 1, ,442 Turkey, BBMDR-IMF 25, UK, ANT 404, , , ,993 UK, BBMR 310, , , ,836 UK, Welsh BMDR 56,864 56, ,515 56,864 United Arab Emirates Uruguay USA, ABMDR 29,635 3, ,989 USA, CRIR 102,239 67, ,327 66,349 USA, GOL 150, , , ,157 USA, NMDP 5,499,738 4,833, ,677,850 4,713,219 Total 13,576,398 10,780, ,034,374 9,877,999 Figure 3 Total number of HLA-A, -B and HLA-A, -B, -DR typed stem cell donors Number of stem cell donors (X million) 15 Number above bars is % HLA-A, -B, -DR typed stem cell donors HLA-A,-B,-DR HLA-A,-B The increase of the number of stem cell donors per year is given in Figure 4. The number of additional donors (1,170,704) in the database in 2009 is more than in 2008 (876,831 donors). On average there was an increase of 547,175 donors per year in the first ten years of the existence of BMDW ( ). This has increased to an average of 700,953 donors per year in the last 11 years ( ) Year

14 page 9 Figure 4 The number of stem cell donors added to the database per year Number of stem cell donors (x thousand) added per year 1,200 1, Number of cord blood units The number of HLA-A, -B and HLA-A, -B, -DR typed cord blood units per cord blood bank/ registry is shown in Table 4. The cord blood units are practically all fully typed for HLA-A, -B and -DR, in addition 66% is class I DNA typed and 90% of the units is class II DNA typed. The total nucleated cell count is given for over 99% of the units and for 81% of the units the net volume collected is provided. In Table 5 the mean number of total nucleated cells (TNC) of the cord blood units in the cord blood banks is given. For all cord blood units in BMDW the mean number of TNC is 99.5 x 10 7, the median of TNC is 98.5 x Year Table 4 THE NUMBER OF HLA-A, -B AND HLA-A, -B, -DR TYPED CORD BLOOD UNITS PER CORD BLOOD BANK/REGISTRY Number of HLA-A, -B, Number of Number of Total number -DR typed class I DNA class II DNA Registry of units donors typed units typed units Argentina Australia 21,785 21,785 16,406 21,785 Austria Belgium, BCBR 7,015 7,015 4,664 7,015 Belgium, LCBB 6,374 6,374 6,374 6,374 China 5,794 5, Croatia Czech Republic, CSCR 3,323 3,323 3,203 3,321 Finland 3,010 3,010 1,210 3,010 France 8,303 8,303 3,160 7,760 Germany, ZKRD 8,224 8,224 6,685 8,214 Germany, GBECBB 13,701 13,701 9,570 13,695 Greece, HCBB Israel, H-MDACBB 4,680 4,675 4,310 4,673 Israel, SMCCBR 1,503 1, ,503 Italy 19,567 19,565 9,037 17,556 Japan 4,213 4, ,213 Republic of Korea, KCBB 19,379 19, Republic of Korea, KCHSCB 1,431 1, ,425 Mexico The Netherlands 2,742 2,742 2,150 2,737 Poland, POLTransplant Poland, UBMDR-CBR Slovakia Spain 41,773 41,773 27,988 37,709 Sweden Switzerland 2,581 2,581 2,576 2,581

15 page 10 Total number Number of HLA-A, -B, -DR typed Number of class I DNA Number of class II DNA Registry of units donors typed units typed units Taiwan, Buddhist Tzu Chi 11,668 11,666 10,104 10,157 Taiwan, StemCyte 9,537 9,536 9,537 9,536 Taiwan, Healthbanks 3,516 3,516 3,516 3,516 Taiwan, BIONET/BabyBanks 22,095 22,095 22,095 22,094 Turkey, TRAN UK, BBMR 12,597 12,594 12,512 12,592 USA, StemCyte 14,663 14,663 14,663 14,663 USA, UCCBB 4,945 4, ,945 USA, GOL USA, Celgene 3,878 3, ,588 USA, CCBC USA, Michigan Blood 2,895 2,895 2,895 2,895 USA, NMDP 80,933 80,933 80,192 80,873 USA, NCBP-NYBC 47,012 47,012 1,177 41,438 USA, NJCBB-EKUCBP 1,834 1, ,834 USA, CRIR CORD 8,694 8,694 8,659 8,663 Total 405, , , ,445 The steady increase of cord blood units in BMDW is shown in Figure 5. The total number of cord blood units at the end of 2009 is 405,508. Figure 5 Total number of cord blood units Number of cord blood units (x thousand) Figure 6 The number of cord blood units added to the database per year The increase of the number of cord blood units per year is given in Figure 6. The increase of cord blood units added to the database in 2009 is 66, Number of cord blood units (x thousand) added per year Year Year

16 page 11 Table 5 THE MEAN NUMBER OF TOTAL NUCLEATED CELLS OF THE CORD BLOOD UNITS IN THE CORD BLOOD BANKS/REGISTRIES Total number Mean number Registry of units of TNC x 10 7 Slovakia USA, CCBC Sweden France 8, Poland, POLTransplant Israel, SMCCBR 1, China 5, Belgium, BCBR 7, Italy 19, Czech Republic, CSCR 3, USA, StemCyte 14, USA, Michigan Blood 2, Germany, GBECBB 13, Spain 41, USA, NMDP 80, Republic of Korea, KCHSCB 1, The Netherlands 2, Australia 21, Switzerland 2, Turkey, TRAN Belgium, LCBB 6, Taiwan, StemCyte 9, USA, NCBP-NYBC 47, Israel, H-MDACBB 4, USA, NJCBB-EKUCBP 1, UK, BBMR 12, USA, UCCBB 4, Germany, ZKRD 8, USA, GOL Republic of Korea, KRCB 19, Croatia Taiwan, Healthbanks, TECB 3, Finland 3, Argentina USA, CRIR CORD 8, Greece, HCBB USA, Celgene 3, Taiwan, BIONET/BabyBanks 22, Austria Taiwan, Buddhist Tzu Chi 11, Mexico Poland, UBMDR-CBR Japan 4,

17 page 12 4Distribution of Stem Cell Donors and Cord Blood Units in the World 1. Distribution of stem cell donors As shown in Figure 7, almost half of the donors (45%) reside in North America, 42% in Europe, 11% in Asia and the remaining 2% originate from other continents. The distribution of donors in 2009 was identical to Figure 7 The distribution of stem cell donors per continent Other Asia North America Europe Figure 8 shows the distribution of stem cell donors in the world and in Europe. Figure 8 Distribution of stem cell donors in the world < 20,000 donors India, Mexico, Singapore, United Arab Enirates, Uruguay, Armenia, Bulgaria, Croatia, Finland, Hungary, Ireland, Lithuania, Russia, Republic San Marino, Slovakia, Slovenia 20, ,000 donors Argentina, China, South Africa, Thailand, Austria, Belgium, Czech Republic, Denmark, Greece, Norway, Poland, Spain, Sweden, Switzerland, The Netherlands, Turkey > 100,000 donors Australia (incl. New Zealand), Canada, Israel, Japan, Taiwan, USA, Cyprus, France, Germany, Italy, Portugal, United Kingdom

18 page 13 Table 6 contains the number of stem cell donors per 10,000 inhabitants sorted by HLA-A, -B, -DR because over 99% of patients transplanted received a graft from a donor that had already been typed for HLA-A, -B, -DR. The mean number of HLA-A, -B, -DR typed donors per 10,000 inhabitants in the participating countries is 77.5 and median is 27.0; for HLA-A, -B plus HLA-A, -B, -DR donors the mean is and median is It is obvious that there are still large differences in the number of donors per 10,000 inhabitants between countries. Of the world population 0.2% is registered as a hematopoietic stem cell donor. Table 6 THE NUMBER OF STEM CELL DONORS PER 10,000 INHABITANTS (SORTED BY HLA-A, -B, -DR PER 10,000 INHABITANTS) Number of Number of Number donors per inhabitants stem cell donors 10,000 inhabitants Country x 106 (*) ABDR Total ABDR Total Cyprus , , ,485 Israel , , Germany ,513,177 3,708, Republic San Marino USA ,035,302 5,781, Portugal , , Taiwan , , United Kingdom , , Australia/New Zealand , , Denmark ,800 36, Norway ,585 28, Canada , , Ireland ,641 19, Armenia ,512 14, Slovenia 2.0 9,834 9, Italy , , Belgium ,279 47, Finland ,424 19, Czech Republic ,399 54, Austria ,418 60, Switzerland ,578 22, Japan , , Sweden ,781 40, France , , Croatia ,582 12, The Netherlands ,813 38, Spain ,447 79, Lithuania 3.6 3,980 3, Poland ,799 57, Thailand ,733 55, Greece ,592 21, Argentina ,903 27, Singapore 4.4 1,273 1, Hungary ,289 4, Slovakia 5.4 1,022 1, South Africa ,038 63, Mexico ,373 10, Uruguay China 1, ,236 68, Bulgaria Turkey ,751 27, United Arab Emirates Russian Fed ,445 16, India 1, < 0 * Data extracted from CIA factbook (July 2008).

19 page Distribution of cord blood units As shown in Figure 9, the majority of the cord blood units are stored in North American (41%) and European (33%) cord blood banks. The remaining cord blood units are from Asia (21%) and other continents (5%). Figure 9 Distribution of cord blood units per continent Other Asia North America Europe Figure 10 shows the distribution of unrelated cord blood units in the world and in Europe Figure 10 Distribution of cord blood units in the world < 10,000 units Argentina, China, Israel, Japan, Mexico, Austria, Czech Republic, Croatia, Finland, France, Greece, The Netherlands, Poland, Slovakia, Sweden, Switzerland, Turkey 10,000-20,000 units Belgium, Italy, United Kingdom > 20,000 units Australia, Republic of Korea, Taiwan, USA, Germany, Spain

20 page 15 The number of cord blood units per 10,000 inhabitants is given in Table 7. The data is sorted by the number of cord blood units per 10,000 inhabitants, starting with the highest number. The mean number of cord blood units per 10,000 inhabitants in the participating countries is 4.0 and the median 1.9. Table 7 THE NUMBER OF CORD BLOOD UNITS PER 10,000 INHABITANTS Number of inhabitants Number of cord blood Number of units per Country Taiwan x 10 6 (*) 22.8 units 46,816 10,000 inhabitants 20.6 Belgium , Australia , Spain , Israel 6.2 6, Finland 5.2 3, USA , Republic of Korea , Switzerland 7.5 2, Italy , Czech Republic , Germany , United Kingdom , The Netherlands , France , Croatia Austria Sweden Slovakia Japan , Greece Argentina Poland China 1, , Mexico Turkey < 0.00 * Data extracted from CIA factbook (July 2008).

21 page 16 5Number of HLA Phenotypes Figure 11 states the number of stem cell donors and cord blood units typed for HLA-A, -B, -DR split antigens, the number of different HLA-A, -B, -DR split phenotypes and the number of unique phenotypes. Unique phenotypes are defined as occurring only once in the BMDW database. In 2009 there were 7,720,717 HLA-A, -B, -DR split typed stem cell donors and cord blood units representing 1,084,288 different phenotypes. Forty-nine percent of these were unique phenotypes (532,631). These donors were mainly typed by serology or low resolution DNA typing, the number of unique phenotypes rises even more if typing is performed on the allele level for the HLA-A, -B, -C, -DR and -DQ loci. Figure 11 The number of stem cell donors and cord blood units per year Figure 12 Increase in the number of different phenotypes added to the BMDW database Number of stem cell donors and cord blood units and phenotypes (x million) HLA-A, -B, -DR split typed stem cell donors and cord blood units HLA-A, -B, -DR different phenotypes HLA-A, -B, -DR unique phenotypes Figure 12 shows that new stem cell donors and cord blood units still add new HLA-A, -B, -DR split phenotypes to the BMDW database. Number of different phenotypes (x thousand) 1,200 1, ,000 1,500 2,000 2,500 3,000 3,500 4,000 4,500 5,000 5,500 6,000 6,500 Number of ABDR split typed donors/units (x thousand) 7,000 7,500 8,000 The number of different HLA-A, -B, -DR phenotypes per 1,000 new stem cell donors and cord blood units is given in Figure 13. In 1990 more than half of the new donors and cord blood units had an HLA-A, -B, -DR split phenotype that was not yet present in the BMDW database. In 2009 one out of twelve donors and cord blood units still add a new HLA-A, -B, -DR split phenotype to the database. Year

22 page 17 Figure 13 Number of different HLA-A, -B, -DR split phenotypes per thousand new stem cell donors and cord blood units Number of different phenotypes per thousand new stem cell donors and cord blood units The relative contribution to BMDW of stem cell donors per country with an HLA-A, -B, -DR split phenotype is shown in Figure 14. There are large differences between the countries; countries on the left-hand side of the curve such as Mexico, Argentina and South Africa have a relatively high contribution of adding new HLA phenotypes to BMDW, while countries on the right-hand side such as Norway, Ireland, Sweden and Denmark added relatively few new HLA phenotypes to BMDW. This means that many of the phenotypes of those countries are already in BMDW, which is of course good news for the patients in those countries. Year Figure 14 The relative percentage of unique HLA-A, -B, -DR split phenotypes of stem cell donors per country contributed to the entire database in BMDW Relative percentage of unique phenotypes in 2009 Remark: Bulgaria, India, United Arab Emirates and Uruguay had too few HLA-A, -B, -DR split typed donors to be depicted in Figure Norway Ireland Sweden Denmark Slovenia Australia Finland Japan Slovakia Netherlands Austria Canada Belgium Germany Lithuania Czech Republic Taiwan Croatia Switzerland Hungary Hong Kong Israel United Kingdom Poland Portugal San Marino Turkey Italy France Cyprus United States Spain Greece China Thailand Singapore Armenia Russian Fed. South Africa Argentina Mexico Country Figure 16 shows the percentage of unique HLA-A, -B, -DR split phenotypes of stem cell donors contributed to the donor BMDW file (excluding cord blood units). The difference between Figure 14 (entire BMDW database) and Figure 16 (only the stem cell donor data in BMDW) is minimal. Figure 15 depicts the relative contribution of cord blood units with new HLA phenotypes in the entire BMDW database. In virtually all countries the cord blood units have a much higher relative contribution of adding new HLA phenotypes to BMDW than the stem cell donors of the same country, indicating the success of the cord blood banks in recruiting cord blood units from minority groups.

23 page 18 In Figure 17 the percentage of unique HLA-A, -B, -DR split phenotypes of cord blood units contributed to the cord blood unit data only (excluding donors) is given. The large difference between Figures 15 and 17 indicates that the number of phenotypes of the cord blood units within BMDW is still limited. Figure 15 The relative percentage of unique HLA-A, -B, -DR split phenotypes of cord blood units per country contributed to the entire database in BMDW Relative percentage of unique phenotypes in Remark: Turkey had too few HLA-A, -B, -DR typed cord blood units to be depicted in Figure 15. Data from Greece requires further clarification Japan Finland Taiwan Poland Slovakia Israel Belgium Germany Austria Czech Republic Australia Korea Croatia Sweden Netherlands Italy France United States Spain Switzerland United Kingdom Argentina China Mexico Country Figure 16 The relative percentage of unique HLA-A, -B, -DR split phenotypes of stem cell donors per country contributed to the stem cell donor database in BMDW Relative percentage of unique phenotypes in 2009 Remark: Bulgaria, India, United Arab Emirates and Uruguay had too few HLA-A, -B. -DR split typed donors to be depicted in Figure Norway Sweden Ireland Denmark Lithuania Slovenia Australia Finland Japan Netherlands Austria Canada Slovakia Belgium Germany Czech Republic Croatia Switzerland Taiwan Israel Hong Kong United Kingdom Poland Hungary San Marino Turkey Portugal Italy France Cyprus United States Spain Greece China Armenia Thailand Singapore Russian Fed. South Africa Argentina Mexico Country Figure 17 The relative percentage of unique HLA-A, -B, -DR split phenotypes of cord blood units per country contributed to the cord blood unit database in BMDW Relative percentage of unique phenotypes in 2009 Remark: Turkey had too few HLA-A, -B, -DR typed cord blood units to be depicted in Figure 17. Data from Greece requires further clarification Finland Taiwan Japan Austria Belgium Korea Czech Republic Australia Poland Slovakia Germany Croatia Netherlands Sweden Israel Switzerland France United Kingdom United States Mexico Argentina Italy China Spain Country

24 6Information Technology page Developments in 2009 The year 2009 has been an exciting year. The BMDW Office received a large number of new Change Requests Forms (CRF s). Almost all of the change requests were approved by both the Advisory Committee and the Editorial Board, which resulted in the need for additional IT staff. Bertjan Nijhuis was welcomed in September as a new member of the Europdonor IT department. Next to the regular maintenance tasks and updates of the BMDW database, the following changes have been implemented: Change Requests: CRF006: Cooperation with the WMDA IT Working Group has resulted in a new standard for Registry and Cord Blood Bank ID s. A proposal of the IT Working Group was accepted, which was also sent to the WMDA Board. CRF012: Changes were implemented to start updating the cord blood database on a daily basis as of January 1st, CRF013: A reported issue with DRB3/4/5 association was investigated, but it was not possible to reproduce the problem. CRF014: The search determinants used for the match are reported on the match report. CRF016: The registration information for participating cord blood banks and donor registries was extended to include the initial date of registration. CRF028: The WHO HLA Nomenclature changes 1, to be introduced in 2010, have been an important topic on WMDA IT Working Group meetings. BMDW has actively participated in the discussions, and the work on the file processing software started towards the end of 2009 in order to be able to handle both old and new nomenclature this will be implemented in the first quarter of Maintenance and fixes: BMDW services were migrated to a new server. To make sure that (for a couple of US cord blood banks) units were not registered more than once in the BMDW database, cooperation was sought with the NMDP and the banks. The security certificate for access to the online services has been updated, and to keep the systems safe, a number of critical security (operating system) updates were installed. As of January 1st, 2009 a number of cord blood units fields have been added. An update for the application to present lists of fees of registries was installed. Data analysis and registry/third party support: A number of new standard queries have been implemented to more easily provide data for the BMDW Office to complete the BMDW Annual Report. Data was provided for a study to look at HLA-A, -B and -C genotype data of donors with a B73 or B* www3.interscience.wiley.com/cgi-bin/fulltext/ /pdfstart

25 page Use of BMDW Website Looking at the statistics of the website, the number of visits in 2009 has increased with 15%, when compared to What is interesting to see is that in the last three months of 2009, a small percentage of the visitors to the BMDW website have started to access the website from mobile devices. Figure 18 Website visits for 2009, compared to 2008 Website visits 10, ,000 6,000 4,000 January February March April May June July August September October November December Month The most requested pages, other than the home page and excluding the on-line match programs, include the pages with contact information for the participating registries and cord blood banks (29%), the pages with statistics on the number of donors/cord blood units in BMDW (9%), the pages with HLA information and DNA downloads (8%), and the pages with general information on BMDW, information for participating registries and cord blood banks, or information for patients or donors (5%). On-line services By the end of 2009 there were 726 users authorized to access the on-line services of BMDW (Figure 19). Transplant centre users remain the most active users of BMDW. In Figure 19 the monthly usage of the BMDW online match programs is given and in Figure 20 the usage of the BMDW on-line match programs per year is given. Figure 19 The users of on-line services: In total % Registry users: % Transplant Centre users: 557

26 page 21 Figure 20 The monthly usage of new BMDW on-line match programs in ,000 8,000 6,000 4,000 Number of match runs 1,860 1,822 1,879 1,805 1,738 1,858 1,689 1,528 1,469 1,336 1,482 1,511 1,820 1,598 1,479 1,455 1,574 1,455 1,749 1,526 1,333 1,427 1,367 1,342 Cord Blood Match Program Mismatch Program Regular Match Program 2, ,239 4,726 5,121 4,918 4,986 5,092 5,316 4,375 4,793 5,038 4,466 4,204 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month Figure 21 Usage of BMDW on-line match programs per year Number of match runs 100,000 80,000 15,695 19,064 21,716 21,997 20,344 Cord Blood Match Program Mismatch Program 60,000 7,904 8,413 7,752 11,209 12,156 11,277 10,668 12,744 14,946 17,767 Regular Match Program 40,000 7,516 6,590 10,140 10,523 12,552 13,663 20, ,543 4,620 1,354 2,713 8,269 2,573 10,655 20,154 32,295 40,072 41,000 41,378 48,830 59,675 59,054 59, , , Year 3. Plans for 2010 As a preview into the next year, implementation of the CRF s will continue. An overview of the status the CRF s will be placed on the website. For the first quarter of 2010 the HLA nomenclature will have top priority, and if needed the registries and cord blood banks will be supported by the BMDW IT staff with the migration. Other than the new nomenclature, the focus will be on a number of change requests that have been prioritized by the Advisory Committee and Editorial Board in a Top 10. As of January 2010, the update frequency of BMDW for cord blood units (CRF012) is increased to a daily update. It will be investigated if a weekly (or also a daily) update of the donor database is also feasible. Looking at the list of potential new registries in the world, the joint efforts to persuade these registries to participate in BMDW will be continued. For example, the Brazilian INCA/REDOME registry and the Chinese Marrow Donor Program will hopefully take a step forward and will make their donors available to patients worldwide through BMDW.

27 page 22 7Financial overview Results 2009 and 2008 ( ) Personnel 86,357 89,541 Travel expenses 4,275 5,738 Hardware, components 5,613 7,150 Tel/fax/mail/annual report/sdsl 10,621 9,359 BMDW Consultancy 21,284 18,002 Software Development 49,660 14,263 Enhancement Security with tokens 5,771 Total costs 177, ,826 Revenues BMDW 214, ,041 Balance 36,250 12,215 Cumulative balance 62,767 26,517 Extra IT staff was hired and an increase in software development hours is already visible (compared to the previous years). The hours are spent on the approved top-10 list of CRF s (including preparing for the new Nomenclature). Consultancy costs include partial reimbursement of the Chairman of the BMDW EB as well as search advice which is provided upon request. Revenues consist of the fees from participating registries. The increase in 2009 was the result of a change in the fee structure implemented in July The amount written of for doubtful debts is 7,670,-. Five registries did not pay their fees for 2007 and 2008.

28 page 23 8Board and Staff Editorial Board The 105 participating stem cell donor registries and cord blood banks/registries (see Table 1 and 2) Chairman Editorial Board Jon J. van Rood, MD, PhD Chief Operating Officer Machteld Oudshoorn, PhD Office Renée J.H. Bouwens-van der Klaauw Staff Carine J. Mijnarends, MSc, Managing Director (as of July 2009) Atjan J. Hop, Finance Henk G.M. van der Zanden, MSc, IT (till August 2009) Jack N.A. Bakker, MSc, IT Angelo E.E.A. Melis, BSc, IT Leo J. Ebeling, MD, Consultant

29 page 24 9Advisory Committee Dennis L. Confer, MD (chair) Paul A. Costeas, PhD Torstein Egeland, MD, PhD Sally Gordon Evelyne Marry, MD Carlheinz Müller, MD, PhD Cristina Navarrete, PhD Agathe Rosenmayr, MD, PhD

30 page 25 10References 1. Publications Van Rood, J.J. (2009) Jean Dausset ( ) Nobel Prize Winner Human Immunol. 70: Helgadottir, H., Andersson, E., Villabona, L., Kanter, L., van der Zanden, H., Haasnoot, G.W., Seliger, B., Bergfeldt, K., Hansson, J., Ragnarsson-Olding, B., Kiessling, R. & Masucci, G.V. (2009) The common Scandinavian human leucocyte antigen ancestral haplotype 62.1 as prognostic factor in patients with advanced malignant melanoma. Cancer Immunol. Immunother. 58 (10): Van Rood, J.J., Stevens, C.E., Smits, J., Carrier, C., Carpenter C. & Scaradavou, A. (2009) Re-exposure of cord blood to non-inherited maternal HLA antigens improves transplant outcome in hematological malignancies. P.N.A.S. November 24, 206 (47): Van Rood, J.J. & Oudshoorn, M. (2009) When selecting an HLA mismatched stem cell donor consider donor immune status. Curr. Opinion Immunol. 21: Abstract for Presentation Shaw, P., Kan, F., Ahn, K.W., Spellman, S.R., Aljurf, M., Ayas, M., Burke, M., Cairo, M.S., Chen, A., Davies, S.M., Frangoul, H., Gajewski, J., Gale, R.P., Godder, K., Hale, G., Heemskerk, M.B.A., Horan, J., Kamani, N., Kasow, K., Kawah, C., Lee, S.J., Leung, W., Lewis, V.A., Miklos, D., Oudshoorn, M., Petersdorf, E.W., Ringden, O., Sanders, J., Schultz, K.R., Seber, A., Setterholm, M., Wall, D.A., Yu, L. & Pulsipher, M.A. (for the Writing Committee of the CIBMTR) (2009) A comparison of transplant outcomes using HLA-identical siblings, single antigen mismatched related donors, phenotypically matched related donors or HLA-A, -B, -C, -DRB1 matched unrelated donors for treatment of malignant diseases in children. Tampa, FL, ASBMT/CIBMTR BMT Tandem Meeting, February Invited Lectures Oudshoorn, M.: Overview of unrelated adult and cord blood donation: the WMDA Annual Survey. WBMT Key Studies organized by the Worldwide Group for Blood and Marrow Transplantation, ASBMT/CIBMTR, Tampa, USA, February 11-15, (and Cochairman with D. Niederwieser, S. Davies, Y. Kodera) Van Rood, J.J.: The discovery of HLA or women in my scientific life and You will never forget your mother. Consequences of bidirectional microchimaerism between mother and fetus on transplant survival and susceptibility for immunepathogenic disease. Presentations for the Instituto Gulbenkian de Ciêcia, Lisbon, Portugal, March 13, Van Rood, J.J.: The immune status of our stem cell donors requests more attention. Acceptance speech for the DKMS 2008 Mechtild Harf Award Ceremony, Göteborg, Sweden, March 30, 2009.

31 page 26 Oudshoorn, M.: Overview of unrelated adult and cord blood donation: the WMDA Annual Survey. Joint Session of the WMBT (EBMT/CIBMTR/ASBMT/WMDA) held during the 35th Annual Meeting of the European Group for Blood and Marrow Transplantation (EBMT), Göteborg, Sweden, April 1, Participants of the Joint Session of the WMBT (EBMT/CIBMTR/ASBMT/ WMDA) held during the 35th Annual Meeting of the EBMT, Göteborg, Sweden, April 1, Oudshoorn, M.: Size and Composition of HSC Donor Registries in BMDW. (WMDA report) International Consensus Meeting for WBMT, Nagoya, Japan, April 24, Oudshoorn, M. (Chairman): Session 3, 8th Nagoya International Blood and Marrow Transplantation Symposium How to manage the hematopoietic stem cell transplantation Under normal and emergency situations, Nagoya, Japan, April 25-26, Oudshoorn, M.: Size and Composition of HSC Donor Registries in BMDW. Educational Session I: HSC Donor Search and Donor Selection, 23rd European Immunogenetics and Histocompatibility Conference, Ulm, Germany, May 9-12, Oudshoorn, M.: Computer tools for Donor Selection. Educational Session I: HSC Donor Search and Donor Selection, 23rd European Immunogenetics and Histocompatibility Conference, Ulm, Germany, May 9-12, Oudshoorn, M. (Cochairman, with H. Schrezenmeier): Plenary Session P4 Immunogenetics of Stem Cell Therapy, 23rd European Immunogenetics and Histocompatibility Conference, Ulm, Germany, May 9-12, Van der Zanden, H.G.M.: Bone Marrow Donors Worldwide 20 years: current status and practice 2nd Chinese Marrow Donor Program Annual Conference, Beijing, China, May 19-21, Bakker, J.N.A.: Bone Marrow Donors Worldwide: general information Presentation during the visit of Dr. J. Garcia of the International NetCord Foundation to BMDW and WMDA, Leiden, The Netherlands, June 18, Foeken, L.: WMDA Cord Blood Working Group and accreditation Presentation during the visit of Dr. J. Garcia of the International NetCord Foundation to BMDW and WMDA, Leiden, The Netherlands, June 18, Fechter, M.M.: Unrelated donor follow-up Europdonor. Donor Outcome Workshop of the WMDA/WBMT, Swiss Blood Stem Cells Registry, Bern, Switzerland, August 27, Van Rood, J.J.: The NIMA effect in cord blood stem cell transplantation. Anthony Nolan Trust, BBMR & NHS Cord Blood Bank and BSBMT Joint Symposium on Cord Blood Transplantation Future Challenges, London, UK, October 19-20, Van Rood, J.J.: Reexposure of cord blood to non-inherited maternal HLA antigens Presentation for the New York Cord Blood Bank, New York, USA, November 12, Van Rood, J.J.: Reexposure of cord blood to non-inherited maternal HLA antigens EBMT Immunobiology Working Party Meeting, Perugia, Italy, November 27-29, 2009.

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