the importance of donors Donated bone marrow must be tissue-


matched between donors and recipients to reduce chances that the donor’s cells will attack the recipient’s body (or vice versa) and to increase the likelihood of a cure.


“Matching is based on markers called


human leukocyte antigens (HLA),” said Jeanne Palmer, MD, a Medical College of Wisconsin medical oncologist. “HLA tissue typing determines how closely matched a donor is to the recipient.”


n jeanne palmer, md


Finding a matched donor can be challenging, and a matched


sibling is optimal. Trudy’s four siblings were all willing to donate bone marrow, and she was lucky enough to discover one brother and one sister were matches.


Her brother Fred Fischbach, 66, of Bend, Ore., was selected as


the best choice. If a brother and a sister both match, the male donor is generally preferred because of a slightly lower risk of developing graft vs. host disease, a serious potential side effect. (See page 13 for details on the disease.) Trudy received a transplant in June 2010, and the strong family support of her husband, siblings, five children and grandchildren, was a huge part of her success.


“A matched sibling is the ideal donor,” Dr. Palmer said.


“However, only about 30 percent of people will have a sibling match.” If there is no sibling match, the search begins for an unrelated donor through a registry.


“People all over the world have agreed to donate marrow to


anybody who needs a transplant,” Dr. Palmer said. “It’s all in one registry, so if there’s a match in Germany, we’ll find that when we do the search.” In the United States, the Be the Match Registry (marrow.org) is run by the National Marrow Donor Program.


“It’s simple to register as a donor,” Dr. Palmer said, “and it


can be done online at marrow.org.” After registering and filling out a brief health history, Be the Match mails a kit.


“You swab the inside of your mouth and send that back in,” Dr. Palmer said. “You don’t have to go anywhere.”


If the swab indicates you are a match, blood tests will confirm it.


The donation will occur at a time that works for the patient’s health condition. Usually, unrelated donors don’t have to travel to donate. They go through the cell collection process at the closest donation center, and donated cells are sent to the patient’s location. Sibling donors usually travel to their recipient’s medical center.


how transplant works Once a donor match is found, the most common method


for donating is peripheral blood stem cell (PBSC) donation, a nonsurgical, outpatient procedure. This is how Trudy’s brother’s cells were collected. For four or five days leading up to donation, donors receive injections of a medication called filgrastim to increase the number of blood-forming cells in the bloodstream.


“The donor is then hooked up to a cell separator machine,”


Dr. Hari said. “The blood is removed through a needle in one arm and goes into the machine. It takes out the blood forming cells, then returns the blood to the body into the other arm. The donation process usually takes several hours.”


Another option is marrow donation, a surgical outpatient


procedure whereby a needle is used to withdraw liquid marrow from the pelvic bone.


Recovery times vary depending on the individual and type


of donation. Most donors are able to return to work, school and other activities within a day or two after PBSC and two to seven days after marrow donation. Blood-forming cells or marrow are back to their normal levels within four to six weeks.


While the donor is getting the injections, the patient is in the


hospital getting chemotherapy alone or with radiation to destroy diseased cells and blood-forming cells in the bone marrow to make room for the new cells. It also destroys the immune system so it cannot attack the donated cells after the transplant. Common side effects of the preparatory regimen include nausea, vomiting, diarrhea, lack of appetite and mouth sores.


The transplant itself is more like a transfusion, and no


surgery is involved. But it takes time to develop a new immune system, so patients are closely monitored for months, sometimes years, to treat and prevent complications.


international research hub right here Part of what makes the Froedtert & The Medical College of Wisconsin Blood and Marrow Transplant


Program unique is the Center for International Blood and Marrow Transplant Research (CIBMTR), which is housed at the hospital’s Clinical Cancer Center. In 1972, four years after the world’s first successful transplant, Mortimer M. Bortin, MD, and his colleagues established what is now the CIBMTR to foster research. At the time, there were only about 12 transplant centers and fewer than 50 patients worldwide each year receiving transplants. Today, it is a combined research program of the National Marrow Donor Program and the Medical College of Wisconsin, with a second location in Minneapolis.


n mary horowitz, md, ms


“We collect data on the outcome of blood and marrow transplants from hundreds of centers around


the world and use it for research,” said Mary Horowitz, MD, MS, a Medical College of Wisconsin medical oncologist and chief scientific director of the CIBMTR. “We also make data available to the medical


community and with our statistical and medical expertise, we help investigate important issues in transplantation.” The CIBMTR also coordinates the Blood and Marrow Transplant Clinical Trials Network. “We’ve activated more than 20 prospective trials and enrolled more than 3,500 patients in those trials since 2003,” Dr. Horowitz


said. “It is the largest clinical trials effort in transplantation in the world. Because of collaborations with researchers worldwide, the percentage of people who need and receive transplants has increased substantially. That’s, in part, due to our demonstrating the effectiveness of alternative donor transplants — transplants involving donors other than a matched sibling or a matched unrelated donor.”


12 Froedtert Today September 2011 froedtert.com


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