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Imagine what it would be like to know that your bone marrow or blood stem cells could save the life of someone who needed them, even a complete stranger. Grace Yang, a nurse at Memorial Sloan Kettering Cancer Center (MSK), got just that call in March 2024.
“This is something I never thought would happen to me,” Yang said. “But I work in the field of bone marrow transplantation, so… [BMT] “Through volunteering, I saw what an impact it could have on other people's lives. It felt like a privilege to be able to help in a different way,” said Yang, who works as a clinical nurse under Heather Landau, MD, a BMT and cellular therapy specialist.
Stem cell and bone marrow donations can give patients with blood cancer and other blood disorders the best chance of a cure. Donors aged 18 to 40, particularly those of non-European or mixed race, are urgently needed. Yang, who is of Asian descent, was 29 when he donated.
You may be wondering how to donate, whether bone marrow or blood stem cell donation hurts, and what a bone marrow or stem cell transplant procedure involves. Here's what you need to know.
What are bone marrow and stem cells and how are they used?
First, some background: Transplanting donor stem cells, which form new blood cells, into a patient is a life-saving treatment for many patients with blood cancers such as leukemia and lymphoma.,There are other blood disorders too. Contrary to what many people think, the cells used in transplants are usually taken from the donor's bloodstream. Only in rare cases are stem cells taken from bone marrow.
These donor cells are needed because patients undergo chemotherapy and sometimes radiation therapy to eradicate the cancer before receiving the transplant. These treatments also destroy the patient's blood-making cells, which is why healthy blood stem cells must be infused into the body. This transplant procedure allows the patient to grow new blood cells and recover from treatment.
Why is it important to donate bone marrow and blood stem cells?
Each year in the United States, approximately 18,000 people are diagnosed with a life-threatening illness for which a stem cell transplant from a donor is the best treatment option. Unfortunately, only about 30% of these patients have a family member who is a perfect match, meaning that approximately 12,000 people need to find an unrelated donor.
One way to find donors is NMDPmaintains a registry that connects unrelated volunteer donors with patients who need them. Unfortunately, many people are hesitant to join the registry because they don't realize how easy the process is and don't fully understand how desperate the need for donors is.
Yang signed up for the NMDP registry through a community initiative even before she worked in the BMT field. More than a decade later, she learned she was a match for a patient. “I encourage everyone I know to sign up,” Yang says. “People are amazed at how easy it is to sign up.”
Can't someone who needs a transplant receive an organ donation from a sibling or other family member?
Even if a patient has an adult sibling who is old enough to donate organs, there is only a one in four chance that the sibling will be a perfect match.
Siblings or other family members are often half matches, so this can be a good option for many patients, but for some, the best way to maximize their chances of a successful transplant is to find an exact match with a donor, even if they are unrelated.
Bone Marrow and Stem Cell Donation Process
There are many misconceptions about bone marrow and stem cell donation, such as that it is burdensome or painful.
When Yang first told her parents that she had been matched with a patient in need of a bone marrow transplant, she learned that her father had also donated bone marrow to someone else more than 20 years ago, when the procedure was more complicated. Given her past experience, her father was a little worried about how his daughter would feel, but Yang explained that with advances in technology, the bone marrow donation process has become much easier than before.
Below is a step-by-step guide:
Participating in the donor registry
To enroll, people must be between 18 and 40 years old, as studies have shown that patients who receive blood stem cells from younger donors have higher long-term survival rates.
Registration is easy. Click here for details You can order a test kit, which will be sent to your home. The website may also direct you to a registration drive in your area. Once you get your kit, all you have to do is swab the inside of your cheek, seal it in a designated container, and send it back.
What happens when you match with a patient?
If you are a full or partial match with a patient in need of a bone marrow or stem cell transplant, we will contact you. Congratulations! Your cells may be the best option to save that person's life.
To ensure that a transplant using your cells has a high chance of success, there will be some extra steps involved, including filling out a health questionnaire, undergoing additional blood tests, and undergoing a physical exam.
Donation Schedule
If testing confirms that you are a suitable donor, your donation will be scheduled at a time that works for you and your patient's treatment schedule. Depending on where you live, you may need to travel to a specialized facility where stem cells are harvested from your blood or bone marrow. If travel is required, the cost will be covered by NMDP.
Yang traveled to Chicago to make the donation, and NMDP not only organized her trip and paid all of her expenses, but also paid for her sister to accompany her so she didn't have to travel alone.
What happens when I donate blood stem cells? Does it hurt?
Thanks to techniques developed over the past decades, in 90% of cases, the stem cells needed for transplants are taken from the blood rather than the bone marrow – a process that doesn’t require surgery and is therefore much easier for the donor.
Donating stem cells from blood is virtually painless and very similar to donating platelets, with the main difference being that donors need to receive an injection of a drug called a “platelet donor” a few days beforehand. Filgrastim (Neupogen®) stimulates the bone marrow to overproduce hematopoietic stem cells. Donors may experience bone pain and slight fever while taking filgrastim, but these side effects are usually not serious and go away once the donation process is complete.
Most people can inject filgrastim at home so they don't have to go to the doctor every day.
On the day of donation, donors are hooked up to a machine called an apheresis machine. Blood is taken from one arm, passed through a machine that removes stem cells, and then put back into the other arm. Aside from the initial needle prick, the process is painless.
The process takes a few hours, during which the donor reads or watches a movie. Depending on the number of cells harvested, the donor may need to return on the second day.
For Yang, the donation took about three hours. “We started in the morning and finished before lunch,” she says. “The nurses were very good at putting me at ease and checked on me frequently throughout the operation.”
What happens when I donate bone marrow?
In just 10 percent of cases, doctors may recommend that patients donate bone marrow, which requires surgery. The donor is put under general anesthesia and bone marrow is harvested through a small hole drilled in the pelvic bone.
The procedure takes one to two hours, and donors are usually able to go home the same day.
Recovery after donation
If you donate stem cells from your own blood, you may feel fatigued for a few days, but many donors feel no effects the next day.
If you have donated bone marrow, you may experience pelvic or hip pain and bruising for a few days after surgery. These pains can be managed with over-the-counter painkillers such as Advil or Tylenol. Most people are able to return to normal activities immediately, but your medical team will provide you with details about certain activities.
How are patients and donors matched?
The process of matching donors and recipients HLA (Human Leukocyte Antigen) typing. Not the same as blood type. This has to do with immune proteins inherited from your parents at birth. Your immune system uses these proteins to determine which cells belong in your body and which don't. An exact match means that 8 out of 8 markers are the same.
Matching is not gender-specific, so people of any gender can donate as long as their HLA markers match.
Yang doesn't yet know anything about the patients who received her cells, but she hopes to find out in the coming months. “I feel really blessed to be able to do something so wonderful for someone,” she said.
Finding a match can be difficult for people of some ethnic groups
Not everyone who needs a donor can find a perfect match. Patients are most likely to find a donor within their ethnic group. Members of certain ethnic groups, including those of Latin American, Asian, African, and Middle Eastern ancestry, have more difficulty finding a compatible donor. These groups tend to be less represented in public registries.
For example, Latinos have less than a 50% chance of finding a compatible donor in a public registry; for black patients, the chance is only about 30%. For people of mixed race, finding a donor can be even more difficult because their HLA makeup is more complex.
This makes participation in public registries such as the NMDP particularly important for people from under-represented ethnic groups and people of mixed race.
What happens if a patient cannot find a compatible donor?
For patients who cannot find a perfectly matched donor, there are other options. These include:
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Using cells from a half-identical family member (called a half-identical transplant)
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Using cells from an unrelated donor who is only a partial match (called a mismatched transplant)
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Using stem cells Cord Blood Donation
Although these treatments can provide very good results for patients, there are times when it is better to have a perfectly matched donor.
Despite working as a BMT nurse, Yang says she had questions throughout the organ donation process. “The NMDP staff are all great at addressing any concerns you may have about the process, and there are lots of great resources,” she says. “Any time you have the opportunity to talk to someone about it, I encourage you to get involved.”