When you are a match, there are 2 methods that can be used to retrieve white blood cells: Bone Marrow Transplant (BMT) or Peripheral Blood Stem Cell Transplant (PBSCT). The method chosen is usually up to the doctor who makes this decision based on what is best for the patient. With BMT, a needle is inserted into one of your larger bones (hip, pelvis, etc.), and the marrow is drawn out. It's an outpatient surgery requiring a general anesthesia. The recovery period can be upwards of 3 weeks.
A little background on what bone marrow is used for (all of you medicos out there - please forgive my layman's explanation!). Bone Marrow Transplants are used for cancers of the blood (leukemia), aplastic anemia, lymphomas such as Hodgkin's disease and other diseases. What the doctors are really after when taking bone marrow from a healthy donor are the white blood stem cells that live in the marrow.
My patient's doctor chose the PBSCT route. The same blood-forming cells (blood stem cells) that can be donated from the bone marrow are also found in the circulating (peripheral) blood. In this method, the donor (me), gets injections of a drug called Neupogen (also known as Filgrastim) for five days prior to the donation. The drug puts the donor's bone marrow on overdrive and starts producing a multitude of white blood cells. Rather than hanging out in the bone marrow, these stem cells move into the blood stream where they can then be collected for donation.
A process called apheresis or leukapheresis is used to obtain PBSCs for transplantation. In apheresis, blood is removed through a large vein in the arm or a central venous catheter (a flexible tube that is placed in a large vein in the neck, chest, or groin area). The blood goes through a machine that removes the stem cells. The blood is then returned to the donor and the collected cells are stored. Apheresis typically takes 4 to 6 hours.
PBSCT is still in the clinical study phase. Neupogen (and Filgrastim) has been approved by the FDA to be used on cancer patients only. What I find fascinating is that my experience will be part of this clinical study. They've been using this drug for more than 15 years with no know long-term side effects, so I'm not worried. The short-term side effects of Neupogen are achy bones, a general feeling of malaise, insomnia, etc.
While all of this may sound complicated and a little scary, it pales in comparison to what the patient receiving the stems cells goes through. To prep for the transplant, the patient must go through intensive chemotherapy and radiation to kill the diseased cells as well as the blood forming cells to make room for the new cells. The scary thing to me is that it also destroys the patient's immune system so that the body can't attack the new cells. The doses of chemotherapy and radiation therapy are much higher than would be used to treat the same disease in a patient who was not getting a transplant. While these higher doses may cause more severe side effects, they may also destroy more disease cells. So you won't see me complaining about getting stuck with a bunch of needles. There but for the grace of God go I.
I don't know the woman to whom I'm donating. But as I sit here rather comfortably writing this blog, I'm realizing that for the last 10-15 days she has been going through utter hell to prepare for this transplant. Not to mention the hell she's been through since she was diagnosed with Leukemia. Can she even get excited for this prospect of a cure for her? Where does she get her strength? How long has she had to live this way? Is this the beginning of the end of her personal hell? I pray to God that it is...
And what about all of the people who can't find a match? Please, please, please. If you have read this far, please consider joining the Bone Marrow Donor Registry (www.marrow.org). There is no greater gift than to be able to give someone a second chance at life.
Tuesday, August 3, 2010
Wednesday, July 28, 2010
Peripheral Blood Stem Cell Donation: Getting the Call
On April 12, 2010, I received a call from Patty from the Colorado Marrow Donor Program explaining that I might be a match for a patient. I went down to Denver to have some secondary blood tests done that would determine whether I was a match or not. All of the paper work that they had sent me said that it's rare to be a match, so I should not get my hopes up. However, Patty said that the odds were really good based on my preliminary tests - so my hopes were up. Way up.
They told me that it would be at least 6 weeks before I would hear anything, so all I could do was wait. About 2 months later I got a letter from the Bone Marrow Donor Program stating that for any number of reasons, my patient was not going to have a transplant. This could be for one of three reasons. The patient's condition got better and didn't need a transplant. The patient's condition got worse and couldn't handle a transplant at this time. Or the all-encompassing "some other reason". All they could tell me is that they didn't need me at this time.
Needless to say, I was sad. I wanted to believe that the patient's condition got better, but I couldn't help but think that it got worse. And despite the fact that this was supposed to be a selfless act, I was sad that I couldn't help out.
On Saturday, July 10th, I received another call from Patty. The patient was ready for a transplant! I was thrilled. What I felt when I got that call was simply overwhelming. My patient was alive, and I was going to help him or her get better. I didn't know who (s)he was. I didn't know where (s)he lived. I didn't care. I just wanted to be part of the process of giving him or her a second chance.
Patty explained that the doctor had chosen a Peripheral Blood Stem Cell transplant rather than a Bone Marrow Transplant. For a full explanation of the difference, keep reading this blog!
They told me that it would be at least 6 weeks before I would hear anything, so all I could do was wait. About 2 months later I got a letter from the Bone Marrow Donor Program stating that for any number of reasons, my patient was not going to have a transplant. This could be for one of three reasons. The patient's condition got better and didn't need a transplant. The patient's condition got worse and couldn't handle a transplant at this time. Or the all-encompassing "some other reason". All they could tell me is that they didn't need me at this time.
Needless to say, I was sad. I wanted to believe that the patient's condition got better, but I couldn't help but think that it got worse. And despite the fact that this was supposed to be a selfless act, I was sad that I couldn't help out.
On Saturday, July 10th, I received another call from Patty. The patient was ready for a transplant! I was thrilled. What I felt when I got that call was simply overwhelming. My patient was alive, and I was going to help him or her get better. I didn't know who (s)he was. I didn't know where (s)he lived. I didn't care. I just wanted to be part of the process of giving him or her a second chance.
Patty explained that the doctor had chosen a Peripheral Blood Stem Cell transplant rather than a Bone Marrow Transplant. For a full explanation of the difference, keep reading this blog!
Tuesday, July 27, 2010
Peripheral Blood Stem Cell Donation: Joining the Registry
Back in 2000, after donating blood regularly for years, I was told that I could no longer donate due to new restrictions for people who had lived in the United Kingdom. The ban was designed to prevent the risk of spreading Creutzfeldt-Jakob disease from those who were living in the UK during the outbreak of Mad Cow disease. In 1984 I spent my second college junior semester studying at the University of London - an amazing experience, and one which would indirectly change my life nearly 30 years later.
At the time, I was really disappointed. My father had gotten me involved in donating blood, and I found it to be an easy and rewarding way to "pay it forward". Now that I was no longer able to participate in this effort, I wondered what I would do in its place.
I don't remember who suggested that I join the National Bone Marrow Donor Registry, now known simply as Be The Match (http://www.marrow.org/), but whoever it was, to him or her I am eternally grateful.
I do remember that it was a pretty easy decision to join the Registry. I read the basic information about what it meant to be on the Registry and what it would mean if I were ever a match for a patient. I knew that it might mean being stuck with a big needle to draw out my bone marrow. I knew that it might result in a lot of pain. But I also knew that these risks and obsticles would pale in comparison to what the patient would be living through.
10 years would pass before I would get my first call from the Colorado Marrow Donor Program. Since that first call on April 12, 2010, I have read and researched and have spoken to doctors and have learned so much more about this amazing process.
I encourage you to read this blog about my experience with Be The Match as a donor. I hope that it inspires you to join the Registry yourself.
To my non-white friends and readers: There is currently an urgent need for minority donors including African American, Asian/Pacific Islander, Hispanic/Latino, and American Indian/Alaska Native. Patients and donors must have matching tissue types, and these matches are most often found between people of the same racial and ethnic background. A large, ethnically diverse group of prospective donors will give more patients a chance for survival.
At the time, I was really disappointed. My father had gotten me involved in donating blood, and I found it to be an easy and rewarding way to "pay it forward". Now that I was no longer able to participate in this effort, I wondered what I would do in its place.
I don't remember who suggested that I join the National Bone Marrow Donor Registry, now known simply as Be The Match (http://www.marrow.org/), but whoever it was, to him or her I am eternally grateful.
I do remember that it was a pretty easy decision to join the Registry. I read the basic information about what it meant to be on the Registry and what it would mean if I were ever a match for a patient. I knew that it might mean being stuck with a big needle to draw out my bone marrow. I knew that it might result in a lot of pain. But I also knew that these risks and obsticles would pale in comparison to what the patient would be living through.
10 years would pass before I would get my first call from the Colorado Marrow Donor Program. Since that first call on April 12, 2010, I have read and researched and have spoken to doctors and have learned so much more about this amazing process.
I encourage you to read this blog about my experience with Be The Match as a donor. I hope that it inspires you to join the Registry yourself.
To my non-white friends and readers: There is currently an urgent need for minority donors including African American, Asian/Pacific Islander, Hispanic/Latino, and American Indian/Alaska Native. Patients and donors must have matching tissue types, and these matches are most often found between people of the same racial and ethnic background. A large, ethnically diverse group of prospective donors will give more patients a chance for survival.
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