Saving leukemia patients with a stem cell donation

Saving leukemia patients with a stem cell donation

Every 16 minutes, someone in Germany is diagnosed with leukaemia. If chemotherapy or radiation is unsuccessful, a stem cell or bone marrow transplant is often the patient’s last chance. A family donation is an option for about a third of patients, but an unrelated donor who can be found through a donor centre is often needed. Read here how you can be typed and learn more about the process and risks of a stem cell donation.

Search for a “genetic twin”

For a leukaemia patient to receive a stem cell donation, a “genetic twin” must be found: a donor with specific tissue characteristics and surface markers on the white blood cells that match the patient’s. If these characteristics are scarce, under certain circumstances, only one in millions of people can be considered as a donor. That is why the search often takes several months.

To make the search more accessible, it is essential that as many people as possible register in a donor file. The largest and most well-known organization in Germany is the DKMS – the German Bone Marrow Donor Center. Since 1991, 3.7 million people have been typed there.

 

Become a donor by typing.

Anyone aged between 18 and 55 who is physically fit and weighs over 50 kg can register in a donor database. A blood sample was required for typing in the past, but today, a swab of the cheek mucosa with a cotton swab is sufficient. You can register online with DKMS and then have a set sent to your home. After the swab has been taken, send the cotton swab back – free of charge. However, typing costs the DKMS 50 euros, which covers the laboratory costs for determining the characteristics. Therefore, the donor files are constantly dependent on donations and financing campaigns.

The DKMS or other organizations often organize typing campaigns where everyone can obtain information and register without registering. There, helpers take the swab and are available to answer questions.

Find a suitable donor.

After typing, the anonymous donor data is passed on to the Central Bone Marrow Register Germany (ZKRD), collected and passed on to patients worldwide. Once a leukaemia patient and a potential donor have found something in common, a blood sample is used to check the donor’s additional tissue characteristics. The potential donor is subjected to a thorough physical examination if there is also a sufficient match.

Only when all the requirements are met, and a doctor has explained the procedure and all possible side effects does the potential donor decide whether to donate. If a donation is made, stem cells can be removed using two methods.

 

Donate stem cells or bone marrow?

Nowadays, the so-called peripheral stem cell donation (apheresis) is carried out in 80 per cent of cases. A hormone-like substance (growth factor C-GSF) is injected under the donor’s skin for five days. This causes the stem cells, which usually are mainly found in the bone marrow, to multiply and are flushed into the blood. During this stimulation phase, flu-like symptoms can occur.

At the end of this phase, the so-called apheresis follows, which works similarly to a blood donation: the blood is drained through venous access, the stem cells are filtered out, and the rest of the blood is returned to the donor simultaneously. This method takes about four hours and is more comfortable for the donor than a bone marrow donation because it is an outpatient procedure and requires no anaesthesia. If not enough cells can be collected, the process must be repeated the next day.

Bone marrow donation surgery

In the conventional method – bone marrow donation – bone marrow and the life-saving stem cells are removed from the iliac crest under general anaesthesia. Bone marrow is not to be confused with the spinal cord, which is part of the central nervous system and has nothing to do with stem cell donation. The body quickly reproduces the bone marrow, so the donor has no deficiency. As with any operation, there is a minimal risk of anaesthesia and infection, and wound pain can also occur. Most of the time, the donor stays in the hospital for one to two nights.

This method has been increasingly replaced by peripheral stem cell donation since 1996 and is only used in exceptional cases. For example, a bone marrow donation is resorted to when the recipient is a child or has a particular form of leukaemia for which bone marrow is more effective.

Overall, the risks with both methods are low, and the donor is usually fit again after a few days. The donation is usually made in a collection centre near the donor to keep the effort for them as low as possible. The recipient’s health insurance company covers all costs incurred. After collection, the cells are taken by a courier to the patient’s clinic, where they are transplanted the same day.

What do stem cells do?

In the preparatory phase (conditioning), the patient’s diseased bone marrow is destroyed by chemotherapy and other medication . This is important for two reasons:

  1. On the one hand, the cancer cells from the bone marrow must be destroyed as far as possible.
  2. On the other hand, the patient’s immune system must be suppressed so that the foreign stem cells are not rejected.

After this phase, the donor’s healthy stem cells are transplanted, which the recipient receives like a blood transfusion into the veins. The cells From the bloodstream find their way into the patient’s bone marrow. The stem cells settle there, forming new, healthy blood cells that kill the remaining cancer cells. Ideally, the donated stem cells will defeat leukaemia and cure the patient.

 

risks and complications

The success rate of a stem cell transplant is around 40 to 70 per cent and depends on many factors, such as the age and condition of the patient and the type of disease. In addition, as with any treatment, complications can occur: Since the patient lives for a few weeks without an immune system, infections are prevalent despite extensive hygiene measures.

The “graft-versus-host disease” can also occur: the “foreign” immune system created by the donated stem cells attacks the recipient’s body. This manifests itself, for example, in inflammation of the skin and mucous membranes or in problems in the gastrointestinal tract. Last but not least, there is always a chance that the cancer will come back.

contacting the patient

You don’t get any money for the stem cell donation – the reward is the good feeling of possibly having saved someone’s life. The donation is anonymous, but contacting the patient by letter is possible. At the request of both sides, the anonymity will be lifted after two years, and a meeting between donor and patient can occur.

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