MOSCOW, September 16, Salma Sultanova. Every year, approximately 30 thousand people in the country are diagnosed with blood cancer. Many people require a bone marrow transplant after chemotherapy. There are only about 204 thousand potential donors in the Russian register — this is very small. On the eve of World Bone Marrow Donor Day, he talks about the procedure and its importance in saving lives.
Why transplantation is needed
Blood cancer refers to acute leukemia, a disease caused by an increase in the number of white blood cells. The reasons for its occurrence are not reliably known. The normal functioning of the bone marrow is disrupted, and the damaged substance must be replaced with healthy hematopoietic stem cells.
In some cases, the patient may be given a transfusion of his own cells—this is called an autologous transplant. If the procedure is impossible, contact relatives. It is important that the donor and recipient have a complete match of the genes of the HLA system — histocompatibility. This is clarified using typing, that is, analysis to determine the genotype. To perform a transplant, all ten HLA gene loci must match.
“The probability that a patient will find a fully compatible donor in the person of a brother or sister is 25 percent. Another 25 percent are completely incompatible. If the genes on one chromosome are the same but not on the other, that is, partially compatible, it is 50 percent. In this case, transplantation is also real. Such haploidentical donors can also be mother, father, adult children, uncles and aunts. However, only siblings are fully compatible,» says Feruza, a hematologist at the National Medical Research Center (NMRC) of Hematology of the Russian Ministry of Health Omarova.
When there is no suitable relative, specialists turn to the Federal Bone Marrow Donor Registry. In the database you can find information about the HLA genotypes of all Russians who have expressed a desire to become potential donors. After a candidate is found, he is contacted and asked to carry out confirmatory typing.
If there are no compatible donors in the Russian registry, doctors send a request to the international data bank.
“At the National Medical Research Center for Hematology, we closely cooperate with Germany — there are about ten million donors in their register. We also had from Israel, Poland, the Czech Republic, Great Britain, the USA, Australia. From several candidates, we select the most preferable one. We evaluate various factors, including age and infectious status,” explains Omarova.
According to her, often the patient does not have time to wait for material from another country. Therefore, it is important to develop the Russian register. In addition, we have many small nationalities for whom it is difficult to select a donor in the international registry.
Anyone between the ages of 18 and 45 weighing more than 50 kilograms can join the register. Contraindications include infectious and parasitic diseases, cancer and blood diseases.
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How donation works
There are two ways to collect bone marrow. The first is directly from the pelvis. The doctor pierces the ilium with a needle and draws out a substance, which is then placed in a bag and taken for transplantation. The procedure is performed under anesthesia, so the donor does not feel pain. The process lasts about two hours.
«The only risk that can be encountered when collecting material from the pelvic bone is associated with the anesthesia itself. Therefore, the donor should first consult with an anesthesiologist. They are discharged the next day, and the person returns to normal life. Sometimes there is pain in the bones, but it goes away «, notes Feruza Omarova.
In the second method, blood is removed. It is believed that with this method, donation is more comfortable and effective, so it is used more often. The procedure does not begin immediately; before it, the donor is subcutaneously injected with a drug for four to five days that stimulates the release of homeopathic stem cells from the bone marrow into the blood. Then they are connected to the systems and needles are inserted into both arms. From one vein, blood flows into a separator — a machine that separates stem cells. The remaining components are returned to the donor via the second arm. During the procedure, he feels the same as during a regular blood donation.
The scientific community agrees that bone marrow donation carries minimal risks, and possible side effects quickly disappear.
Patient's story
Two years ago, Elizaveta Burtseva underwent a bone marrow transplant. She was diagnosed with acute leukemia.
“Everything happened unexpectedly. One day I was riding a bicycle with the children and accidentally hit myself. A large bruise appeared at the site of the impact, but I did not attach any importance to it. Then my nose bled all night. Three days later I was admitted to the hospital,” the patient recalls. The diagnosis was made immediately. The disease developed rapidly, and if I had not been hospitalized in time, I would have died.»
After studying the tests, the doctors said: a bone marrow transplant is necessary, otherwise he will not survive. Elizabeth has no siblings, and her parents’ HLA genes did not match. They began to look for an unrelated donor in the registry. Based on the typing results, four people were identified. The most coincidences were with Tatyana Korovina, a student from Nizhny Novgorod, who ended up in the system completely by accident.
What does it mean to be donor
In October 2018, Tatyana worked as a volunteer at an event to donate blood for typing.
“I was also offered to donate blood and join the registry. I filled out a questionnaire. There were no contraindications. They called only two and a half years later. They informed me that my HLA genes previously matched the genes of a girl in dire need of a transplant. I did not expect such a call, because the chances of a match are negligible — one in ten thousand. If you decide to become a donor, there can be no refusal: you cannot give the patient hope and then take it away. I agreed,» says Korovina.
Doctors from the National Medical Research Center for Hematology contacted her. Tatyana came to Moscow for the donation procedure. According to her, she felt equally good both during the blood draw and after. I even managed to pass my exams.
Two years have passed since then. All this time, Elizaveta and Tatyana knew practically nothing about each other — only age and gender. The opportunity to see each other in person appeared at an event dedicated to Bone Marrow Donor Day, organized by the Leukemia Foundation and the National Medical Research Center for Hematology of the Russian Ministry of Health. Now Elizaveta is recovering from treatment, and Tatyana hopes that the number of patients with leukemia will decrease. But if someone needs a stem cell transplant again, she will agree without hesitation.