For patients suffering from leukemia, lymphoma, or another blood condition, like Harvard College senior Samuel Cross, receiving a hematopoietic stem cell transplant may be the best chance of achieving a cure.
Choosing to lend support by becoming a bone marrow donor is a simple step that many of us can take to potentially save a life. By undergoing a simple cheek swab, a person can join the ranks of more than six million people listed in the National Marrow Donor Program (NMDP) registry as potential donors of bone marrow or peripheral hematopoietic stem cells. If a donor is later identified as a possible immunological match for a patient suffering from one of these debilitating conditions, he or she will have additional testing and, if deemed a match, may choose to give hematopoietic stems cells from bone marrow or peripheral blood.
As captain of the varsity fencing team, Cross was on pace to graduate from Harvard in June of 2007 with a dual degree in physics and mathematics. All that changed, however, when he was diagnosed with acute myelogenous leukemia (AML) after a routine blood test last December. With leukemic cells proliferating in his bone marrow and smothering the production of normal red and white blood cells and platelets, Cross underwent induction chemotherapy and began a sequence of consolidation chemotherapy. Though his cancer is in remission, he may need a hematopoietic stem cell transplant to avoid relapse and achieve a cure.
The Donor Search
According to Dr. Edwin Alyea, an HMS assistant professor of medicine at Brigham and Women’s Hospital and Dana–Farber Cancer Institute and associate director of their joint Stem Cell/Bone Marrow Transplant Program, “The chance of finding a match in the unrelated registry is based on how common [a patient’s] human leukocyte antigen (HLA) type is as well as how common that HLA type is in the registry. In some ethnic populations, HLA types are more diverse; therefore their frequency is less, resulting in fewer matches.” HLA compatibility is a critical predictor of the success of hematopoietic stem cell transplantations. Partial matches are very high risk, Dr. Alyea said.
For Cross, whose mother is Korean and father is of Western European heritage, finding an ideal match has proven especially difficult. Though the NMDP registry contains information on more than six million people, his physicians have only been able to identify two individuals who are close—but not ideal—matches. Cross’s challenge to find a potential donor is one that many people suffering from leukemia and lymphoma face, including those whose ethnic origins are more amply represented in the registry. It is also a challenge that we can all help ameliorate by expanding the pool of potential donors.
DFCI’s donor center is a major site for recruitment of potential donors in the New England area and enlists thousands of new donors each year. According to donor center manager Elisè Collins, DFCI focuses its recruitment efforts on “increasing the diversity of tissue types available and registering donors who are committed to helping any patient in need.” Their donor center “works closely with families, communities, businesses, and other groups to raise awareness about lifesaving marrow donation.” Last fall, they sponsored a bone marrow drive with the Student National Medical Association group at HMS.
How to Give
The process of donating bone marrow has been dramatically simplified over the last several years. Whereas it used to involve uncomfortable extraction of hematopoietic stem cells from the pelvic bone marrow of a donor, patients now have the option of simply taking filgrastim, a medication that stimulates release of these stem cells into the peripheral blood. After a few days of treatment with this medication, a physician draws the patient’s blood and filters out only the hematopoietic stem cells, in a process called apheresis. According to Dr. Joseph Antin, HMS professor of medicine and chief of the Stem Cell/Bone Marrow Transplant Program at DFCI, the risks of either procedure are very small. Moreover, he emphasized that the ability of the bone marrow registry to function is dependent on the number of people who are in it. He added that “in order to make the registry as functional and flexible as possible and to ensure that we have donors for a variety of people of different ethnic types, [we] have to keep it as ethnically diverse and heterogeneous as possible.”
The easiest way to become a donor is to participate in one of the community’s many bone marrow drives, which are held periodically at universities, businesses, and community centers. Outside of drives, potential donors may register at DFCI or their local donor center. The tissue-typing process usually costs approximately $50, but some states, like Massachusetts, require insurance companies to cover the expense. Members of ethnic minority groups who are underrepresented in the registry may have their tissue-typing costs defrayed by the NMDP, since these populations typically have a lower chance of finding a donor in the registry. These groups include multiracial people and individuals who are American Indians or Alaska Natives, African Americans, Latinos, Asians, Native Hawaiians, and other Pacific Islanders.
In Cross’s words, “Bone marrow donation is an easy way to personally help fight leukemia and other blood cancers, and I encourage everyone to consider joining the registry.” He’s right and for families like the Crosses, it can also be a fight for life.
Joseph Ladapo is a Harvard medical student and a PhD student in health policy.
The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.