Tuesday, February 1, 2011

Bone marrow donation and transplant info

Several folks have asked me for more information about bone marrow donation. I'm rapidly becoming an expert :-) Just press the delete key if you are not interested.

The first thing to know is that you cannot donate to Nancy, or be easily tested just to donate to her. She needs one donor, who is a perfect or near-perfect match. The odds of one person matching her are 1-in-20,000 or less. Her donor will be either her brother or sister, or someone in the pool of a quarter-million registered donors that matches her.

I've asked folks to become registered bone marrow donors to support the system that will save her life. This is a "pay it forward" system...someone who registered last year or last decade is likely to be her donor. And as I've said before, the odds of getting selected as a donor are tiny. But if you are, you can save someone's life.

The second thing to know is, we are really talking about a stem cell donation and transfusion. This is not a transplant requiring surgery, like a kidney or something.

The donation is actually composed of neutrophils (one kind of white blood cell) and stem cells, which circulate in your blood along with all the other cells. You can think of your blood circulation system and bone marrow as one big organ, where the individual parts travel freely through your body.

If you become a registered donor, and happen to be one of the few who someday match a patient who needs stem cells, the donation can be done in two different ways. 95% of stem cell donations are "peripheral blood stem cell" (PSBC) donations, which are done at a blood center or outpatient clinic. Basically, you get a needle in each arm, and are hooked up to a machine similar to a plateletpheresis machine, which takes your blood out of one side, removes the neutrophils and stem cells, and puts it back in the other side. The donation takes several hours.

(Some people cannot donate this way. So a small percentage of donations are done by removing marrow from the pelvis of the donor, using a big needle and anesthetics. But nearly all are PSBC donations like I describe above.)

For 5 days before the donation, the donor will get a shot of Neupogen each day, a drug to boost your stem cell production. It takes about 4 weeks after the donation for your neutrophil and stem cell levels to return to normal. The article at marrow.org (http://www.marrow.org/DONOR/When_You_re_Asked_to_Donate_fo/Steps_of_Donation/index.html?src=Steps#step2) says that you will recover quickly, go back to work in 1 to 7 days, and feel completely back to normal within 2 weeks.

During the 5-day Neupogen treatment, the donor may have headaches or other aches. This will vanish as soon as you make the donation.

The transplant is done just like a normal blood donation. The unit of neutrophils and stem cells is given to the patient just like a unit of blood, through an IV. The stem cells find their way to the bone marrow, settle in, and start doing their job. Along with the donation, the patient gets a whole new immune system, which will attack any remaining leukemia cells in the body. The patient will also get some medication to control any reactions during the period when the donation is taking effect.

It takes 10 to 14 days for the stem cell transplant to work, and for the new blood and immune system to take over. Nancy will be in the hospital for 4 weeks when she gets her stem cell transplant, one week to get the chemotherapy that will kill all her bone marrow and stem cells, and to recover from the chemo, then three weeks after the transplant to enable the transplant to take effect.

The chance of the donation being accepted and becoming effective is something like 75 to 85%.

If you’ve gotten this far, I congratulate you. Let me know if you have more questions!

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