Development and Evaluation of a Library of TikToks to Support Recruitment of Committed Hematopoietic Stem Cell Donors from Needed Demographic Groups

Introduction TikTok is a rapidly growing social media platform that allows users to develop and share short videos. We hypothesized that a library of videos developed through TikTok (TikToks) would support the recruitment of committed hematopoietic stem cell donors from needed demographic groups (i.e. young, male, from diverse ancestries). Methods Members of the community of practice (CoP) in stem cell donor recruitment in Canada (facebook.com/groups/stemcellclub) were activated to develop TikToks. Training was provided during e-meetings of the CoP (8/2020, 1/2021, 5/2021) and in a video published online (stemcellclub.ca/training), highlighting the principles of effective TikTok design. These principles included the use of engaging hooks, music, and calls to action; short duration (< 30s); high educational value; and appeal to diverse donors. The training also outlined how to: record content, adjust clip lengths, apply audiovisual effects, and share across social media platforms. A CoP TikTok committee was formed to develop and review TikToks prior to publication. Following launch, we evaluated stakeholder perspective on these TikToks and the impact 1) across social and traditional media and 2) on eligible donors' knowledge and attitudes towards donation. Results Between 9/2020-7/2021, a network of TikTok channels was launched by CoP members, including a national donor recruitment TikTok library (tiktok.com/@stemcellclub). A total of 217 TikToks were produced across these channels (median length 17s, range 4-52s), covering a range of educational topics, designed for use in specific recruitment campaigns, and featuring unique video effects (Fig. A). The TikToks accumulated over 234,000 Views, 42,000 Likes, 3,000 Comments, and 14,200 Shares on TikTok, were republished by Canadian media outlets (e.g. CBC [twitter.com/cbcnewsbc/status/1361511367426080773], CTV News [ctvnews.ca/health/meet-the-women-hoping-to-recruit-more-stem-cells-donors-from-black-communities-1.5314038, ctvnews.ca/health/pride-month-tiktok-drive-encourages-stem-cell-donations-from-gay-bi-men-1.5475113], Victoria News [vicnews.com/news/most-black-canadians-wont-find-a-stem-cell-donor-in-time-this-group-is-working-to-change-that]) and were highlighted by major medical organizations (e.g. Canadian Blood Services [blood.ca/en/stories/meet-stem-cell-club, blood.ca/en/stories/stem-cell-club-volunteers-aim-save-lives-pride-month-campaign], American Association of Blood Banks [aabb.org/news-resources/news/article/2021/02/01/twitter-tiktok-aabb-virtual-journal-club-assesses-use-of-multimedia-resources-for-donor-recruitment]). 33 CoP members from 6 provinces across Canada, with a median of 2 years of recruitment experience, completed a post-launch survey. The majority felt that TikToks promote donation in an attention-grabbing way (94%), engage younger donors (100%), and teach key points in a short time period (94%). The majority were confident in their ability to make TikToks (63%), but felt they would benefit from additional training (63%). 46 eligible stem cell donors (from 12 different non-Caucasian ancestral groups; living in 5 provinces across Canada) completed surveys evaluating the impact of TikToks on their knowledge and attitudes towards donation. No participants were registered as donors and only four had a personal connection to an individual who needed a stem cell transplant. After being shown a series of TikToks, mean scores on a 6-question stem cell donation knowledge test improved from 59% to 73% (p=0.0012) (Fig. B); mean scores on a modified Simmons Ambivalence Scale decreased from 52% to 30% (p<0.0001) (Fig. C); and participants were more willing to register as donors (70% vs. 39%, p=0.0011). Participants reported that viewing TikToks positively impacted on their decision to register (87%), helped them understand stem cell donation (89%), and would help them talk about stem cell donation with friends/family (78%). Conclusions We report the first published experience using TikToks in a donor recruitment context. Our TikToks achieved significant social and traditional impact in a short period of time, and supported recruitment of committed stem cell donors from needed demographic groups. Our work is relevant to recruitment organizations worldwide seeking to modernize their recruitment approaches. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Haploidentical Natural Killer Cell Therapy As an Adjunct to Stem Cell Transplantation for Refractory Acute Myeloid Leukemia

Refractory acute myeloid leukemia (AML), defined as failure of 2 cycles of induction therapy at diagnosis or of 1 cycle at relapse, represents a subgroup with poor clinical outcomes. In our transplant cohort, the 5-year overall survival in this subgroup was 16% (Ganapule at al. JGO 2017). Haploidentical natural killer cell (NK) therapy is a strategy that is being explored in refractory malignancies. Our in-vitro and animal model data suggest that exposure to arsenic trioxide (ATO) results in enhanced NK cytotoxicity (Alex AA et al. Front. Immunol 2018). Historically, at our center, patients with refractory AML have been treated with cytoreductive therapy (FLAG ± idarubicin or mitoxantrone + etoposide for 3 to 5 days) followed by 1-week rest and then a reduced-intensity transplant with fludarabine + melphalan conditioning while in peak cytopenia. From February 2019, we initiated a phase II single arm clinical trial (CTRI/2019/02/017505) enrolling patients with refractory AML planned for a stem cell transplant in peak cytopenia. Patients received CD56-positive cells from an HLA haploidentical related family donor (other than the stem cell donor, wherever feasible) following cytoreductive chemotherapy. The NK cell donor preference strategy included presence of KIR ligand mismatch, greater number of KIR B motifs (or the B score), lower donor age, and negative donor specific antibodies tested using flowcytometry crossmatch (Figure 1a). CD56-positive selection was done using CliniMACS prodigy system. This was followed by overnight incubation of the CD56 positive cells in autologous plasma with 2 micromolar ATO and 500 U/mL of interleukin-2. The CD56 positive cells were then infused to the patient 1-day after the completion of cytoreductive chemotherapy. This was followed by a reduced intensity stem cell transplant (Figure 1b). The primary outcome variable was 1-year relapse free survival. From February 2019, 14 patients with median age 28 years (IQR: 15.75-31.5) were enrolled in this trial. Six were females. Six had primary-refractory AML while 8 had relapsed-refractory AML. The cytoreductive chemotherapy was FLAG ± idarubicin (n=7), Mitoxantrone + Etoposide (n=6) and GCLAC (n=1). The median blast percentage on flowcytometry MRD testing prior to NK infusion was 15.9% (IQR: 9.1%-54.5%) (n=11). The median B score for the NK cell donors was 2 (IQR: 1-3). The median age of the NK cell donor was 43 years (IQR: 36-49.5). KIR ligand mismatch with the patient was noted in 2 donors. The median CD56-cell dose infused was 46.16 x 10 6/kg (IQR: 25.06-70.36) (Figure 1c). Pre-defined release criteria, including sterile cultures, and endotoxin negativity were met in all cases. There was no infusion related toxicity. The median blast percentage on flowcytometry MRD testing done following NK cell infusion was 11.9% (IQR: 4.9%-47.6%) (n=8). One patient withdrew consent after NK cell infusion and did not undergo transplant. For the remaining 13 patients, the stem cell donor was HLA matched (n=4), HLA 9/10 matched (n=1) or HLA haplomatched (n=8). The median CD34 cell dose infused was 10 x 10 6/kg (IQR:7.51-11.6). Five (38.5%) patients died of immediate post-transplant complications (sepsis (n=3) on days 1, 2 and 28, cerebral venous sinus thrombosis (n=1) on day 1 in a patient treated with hormonal contraceptives for menorrhagia, and veno-occlusive disease (n=1) on day 15 in a patient undergoing a second transplant) while 2 (15.4%) did not engraft (both subsequently died of infective complications following engraftment post-second transplant). Of the remaining 6 (46.2%) patients who engrafted and survived beyond 1 month of the transplant, the day 28 post-transplant MRD was negative for 5 patients while it was positive in 1 patient (0.13%). On follow up, 2 (15.4%) patients developed disease relapse (on days 54 and 218 respectively) and died. The remaining 4 (30.8%) patients are alive and relapse free at last follow up (mean follow up of surviving patients is 16 months). One patient received a CD34 cell boost on day 96 (cell dose - 8.55 x 10 6/kg) for poor graft function. For the entire cohort, the estimated 1-year event free survival is 28.8% ± 13.1%(Figure 1d). Whereas, acute GVHD was noted in 3 patients (50%; out of 6 evaluable patients) and chronic GVHD was noted in 3 patients (50%; out of the 6 evaluable patients). Thus, haploidentical NK cell therapy as an adjunct to transplant is safe and merits further evaluation in patients with AML. Figure 1 Figure 1. Disclosures Mathews: Christian Medical College: Patents & Royalties: US 2020/0345770 A1 - Pub.Date Nov.5, 2020; AML: Other: Co-Inventor.

Saving Lives with Pride: Development and Evaluation of Multimedia Resources to Engage Gay, Bisexual, and Queer Men in Canada As Stem Cell Donors

Background: Since 2009, gay, bisexual, and other men who have sex with men (gbMSM) have been eligible to register as stem cell donors in Canada and donate to patients in need. However, many gbMSM are unaware of their eligibility to be donors. Targeted recruitment of gbMSM could augment efforts to recruit donors from needed demographic groups and support a more inclusive donor registry. Here, we describe the development and evaluation of multimedia to engage gbMSM in Canada as stem cell donors. Methods: Multimedia resources were developed by gbMSM in Canada, in collaboration with recruiters from Stem Cell Club (stemcellclub.ca) and were designed to highlight gbMSM eligibility and educate about the need for donors from diverse ancestries. Resources were reviewed for accuracy by transplantation experts and appeal by focus groups of gbMSM. The resources were published to stemcellclub.ca/savingliveswithpride/ and disseminated to members of the community of practice (CoP) in stem cell donor recruitment in Canada during an e-meeting. We evaluated stakeholder perspective on these multimedia and their impact 1) across social and traditional media; 2) on gbMSM eligible donors' knowledge and attitudes towards donation; and 3) on reducing barriers for gbMSM donation. Results: Multimedia developed included: infographics emphasizing gbMSM eligibility regardless of recent sexual contact (Fig. A); @WhyWeSwab (twitter.com/whyweswab) story arcs featuring a stem cell donor and a stem cell recipient (Fig. B) from the LGBTQ2+ community; TikToks and other short videos (Fig. C), and testimonials (Fig. D) featuring gbMSM advocating for their communities to register as donors; and statements from Transplant Hematologists emphasizing that gbMSM donors will be treated sensitively and with respect (Fig. E). 33 CoP members from 6 provinces across Canada, and with a median of 2-years recruitment experience, participated in a survey post-publication. The majority felt the resources would engage gbMSM as donors (84%) and clarify gbMSM eligibility (87%); noted experiencing a lack of awareness from potential registrants on whether gbMSM were eligible to donate stem cells (69%); and felt that a national campaign to recruit gbMSM is needed (97%), would support a more inclusive registry (97%), and would augment recruitment of diverse donors (94%). 37 gbMSM eligible stem cell donors (84% gay men and 11% bisexual men; from 13 different ancestral groups; living in 5 provinces across Canada) completed surveys evaluating the impact of these multimedia on their knowledge and attitudes towards donation. After being shown these multimedia, mean scores on a 4 question knowledge test improved from 66% to 93% (p<0.001, Fig. F); mean scores on the Simmons Ambivalence Scale significantly decreased from 38% to 24% (p<0.001, Fig. G); and participants were more willing to register as donors (59% vs 84%, p=0.027) and less likely to believe there are significant barriers to donation for gbMSM (51% vs 11%, p=0.033). Qualitative analysis of feedback from focus groups with these participants identified examples of how the multimedia decreased barriers to donation impacting gbMSM (Fig. H). Multimedia were included in a Pride Month (6/2021) Campaign in Canada, "Saving Lives With Pride", and were shared on social media by LGBTQ2+ groups including on campuses (e.g. SFU Out On Campus), in the community (e.g. Abbey of the Long Cedar Canoe, JQT Vancouver), and nationally (e.g. Canadian Queer Medical Students Association). They were also profiled and shared by major medical organizations (e.g. Canadian Blood Services blood.ca/en/stories/stem-cell-club-volunteers-aim-save-lives-pride-month-campaign) and by media across Canada including CityNews (ctvnews.ca/health/pride-month-tiktok-drive-encourages-stem-cell-donations-from-gay-bi-men-1.5475113) and CTV News (toronto.citynews.ca/video/2021/06/17/doctors-turn-to-queer-communities-for-stem-cell-donors), who also highlighted the resources and their message as one of the top stories in Canada on 6/18/21 (ctvnews.ca/mobile/5-things/5-things-to-know-for-friday-june-18-2021-1.5475813). Conclusions: We developed an array of high-quality multimedia to support recruitment of gbMSM as potential stem cell donors and reduce barriers to donation. Our work is relevant to recruitment organizations worldwide seeking to develop more inclusive recruitment approaches. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

The Resurrection of Mabrokan: Production of Multiple Cloned Offspring from Decade-Old Vitrified Tissue Collected from a Deceased Champion Show Camel

Somatic cell nuclear transfer (SCNT) provides a unique opportunity to reproduce animals with superior genetics. Viable cell lines are usually established from tissues collected by biopsy from living animals in the SCNT program. In the present study, tissues were collected and preserved from a suddenly deceased champion camel. We established cell lines from these decade-old tissues and used them as nuclear donors. After 42 h of in vitro maturation, 68.00 ± 2.40% of oocytes reached the metaphase II (M II) stage while 87.31 ± 2.57% in vivo collected oocytes were matured at collection (p < 0.05). We observed a higher blastocyst formation rate when in vivo matured oocytes (43.45 ± 2.07%) were used compared to in vitro matured oocytes (21.52 ± 1.74%). The live birth rate was 6.45% vs. 16.67% for in vitro and in vivo matured oocytes, respectively. Microsatellite analysis of 13 camel loci revealed that all the SCNT-derived offspring were identical to each other and with their somatic cell donor. The present study succeeded in the resurrection of 11 healthy offspring from the decade-old vitrified tissues of a single somatic cell donor individual using both in vitro and in vivo matured oocytes.