Be The Match changes name because 'perfect' match no longer as necessary for transplants

The Minneapolis organization that arranges life-saving blood and bone marrow donations for thousands of transplant recipients across the U.S. is changing its name because promising research is making its old identity irrelevant.

The name "Be The Match" reflected the goal to perfectly match donors and recipients by key genetic characteristics to improve the odds of transplants for cancers such as leukemia and blood disorders such as sickle cell disease. However, the name could create confusion in a future when a perfect match isn't needed, said Erica Jensen, the agency's senior vice president.

"The 'The' was capitalized, as in 'The Match,'" she said. "Instead of us looking at finding people 'The Match', we are now trying to help as many patients as possible find their best match."

More research is needed to establish the safety and effectiveness of imperfect matches, but the early findings are so strong that the organization didn't want to wait. Be The Match officially became NMDP on Monday — with new signs adorning the nonprofit agency's offices in the North Loop.

NMDP is based on the organization's original name, the National Marrow Donor Program, which was replaced by Be The Match a decade ago to increase attention to its donor registry.

The organization has increased its U.S. registry since that time to 7 million potential donors, and it provided cellular therapies to a record 7,435 patients in 2023.

But it has encountered some brand-identity problems along the way. As many as 30% of people in focus groups thought Be The Match was a dating service.

The matching of unrelated donors and recipients is commonly based on eight genetic markers of human leukocyte antigens (or HLAs), the proteins that tell the body's immune system which cells are safe. An eight-of-eight match has long been the standard, because it reduces the threat of graft vs. host disease, which occurs when donor cells don't recognize the recipient's cells and attack them.

However, a perfect match can be elusive. Even siblings only have a one-in-four chance of perfectly matching with brothers or sisters needing transplants. About 41 million people worldwide have volunteered as potential nonrelative donors, but the registry would need to be exponentially larger to guarantee perfect matches for all of the HLA combinations.

"It's crazy in terms of how many people you would need in the registry in order to do that," said Dr. Jeffery Auletta, NMDP's chief scientific director. "We know that is the case, and that's why we started studying mismatched unrelated donors, because in the background the ethnic diversity of America is only increasing."

NMDP also has encountered a higher-than-desired refusal rate among registrants after being matched to recipients. Patients need donated bone marrow after treatments that kills cancerous or unhealthy cells in order to grow new blood cells and restore their immune systems.

Imperfect matches could address inequities in the transplant system, because racial and ethnic minorities tend to have more diverse ancestry and lower match rates. African American people needing blood or bone marrow transplants have about a 29% chance of matching perfectly to a donor, but an 84% chance of matching to someone with seven of eight HLA types in common.

Every one-off in HLA types is associated with a 10% decline in five-year survival from transplants, Auletta said, but imperfect matches still are used when there are no better alternatives.

The enthusiasm driving Monday's name change is because of a new way to prepare patients that is evening the odds of success.

Use of a chemotherapy drug, know by the acronym PTCy, after transplant resulted in comparable survival rates for roughly 2,000 patients with perfect and imperfect matches, according to an observational study that NMDP researchers presented last month. A recently published clinical trial offered similar results, and another one is awaiting publication, Auletta said.

Gabriel Arias enrolled in the latest trial, receiving a transplant with imperfectly matched bone marrow in March 2022 to prevent a relapse of leukemia. An ideal donor from Poland wasn't available, so doctors recommended a less-perfect match with a U.S. man in his 20s.

Arias said he felt confident in the decision at the time. "For me and my wife, it was really a matter of trusting that people were taking care of me," he said.

Arias said he hopes the trial helps others receive timely transplants. The 37-year-old from Miami is nearing the two-year milestone at which point he is considered cured. He celebrated the birth of his first child last month and has returned to work and tennis.

"It feels like the happy ending of a very long movie," he said.

If more studies continue to back the safety and effectiveness of the drug for transplants with imperfect matches, it will have solved a major access barrier, Auletta said. It also could change matching criteria, because a seven-of-eight match might be better for some transplant recipients if it involves younger donors with more robust immune systems.

Other barriers exist that result in fewer transplants, especially for low-income or minority patients, Jensen said. The old name focused on the match but oversimplified the organization's mission, considering that it does extensive research on better transplants and pursues solutions to socioeconomic barriers as well.

Success in all these areas will be needed for NMDP to hit its target of 8,000 cellular therapies in 2024 and its goal of 10,000 a year by 2028, she said.

"Be The Match worked for the registry," she said, "but we are way more than a registry."