Patients receive allogeneic transplants from living donors who have undergone testing to find the closest possible tissue match. Patients only have a 30% chance of finding a perfectly matched donor within their family. Which means that 70% of patients may need to find an unrelated donor through the National Marrow Donor Program.
There are two ways to donate the life-saving stem cells needed for an allogeneic transplant:
The procedure to collect donated bone marrow is called a bone marrow harvest. This is a surgical procedure that takes place in the operating room. During the procedure, the donor is given anesthesia so they will not feel pain. Once the donor is anesthetized, the surgeon removes bone marrow using a sterile needle that is inserted into the donor’s rear hip bones. He or she extracts the bone marrow – a thick red liquid and places it into a bag for the recipient. The harvested bone marrow, containing the life-saving stem cells, is then processed to remove impurities before being administered to the recipient.
While the donor may have several skin punctures during the harvest, there are no surgical incisions requiring stitches. After the harvest, a sterile dressing is applied and the donor is moved to a recovery area where he or she can be closely monitored until the anesthesia wears off. The donor may return home that day or stay overnight in the hospital if necessary.
Following the harvest, donors may feel pain or soreness in their lower back for several days. This can be controlled with over-the counter pain medications or for moderate pain, a prescription may be given. Most donors will feel fatigued for several days after the harvest and are able to resume normal activities within a week.
Peripheral blood stem cell (PBSC) donation is a non-invasive method of removing stem cells from the blood stream.
Prior to the PBSC donation, donors receive daily injections of filgrastim for four to five days. Filgrastim (also called G-CSF or Neupogen) is a manmade version of protein that occurs naturally in the body. It causes blood stem cells to move out of the bone marrow into the bloodstream. This medication is usually well-tolerated but typically causes mild discomfort in the donor. Side effects of this medication may include, but are not limited to: bone pain, fatigue, trouble sleeping, headaches, abdominal pain, nausea or vomiting.
During the stem cell donation, the donor has an IV (needle) inserted into each arm. Blood passes through one of the needles into a tube that is connected to an apheresis machine. This machine removes the stem cells and returns the remaining blood back to the donor via a tube connected to the needle in the other arm. The procedure takes about five hours and two sessions (or two days of donation) may be required.
Donors typically recover from this type of donation and are able to return to full normal activity in 1 to 2 days.