Is the bone marrow restored? Donor love

26 February 2016

"Our goal is to replace foreign donors with Russian ones"

The Rusfond charitable foundation for helping seriously ill children has published a program for the development of the Vasya Perevoshchikov National Registry of Bone Marrow Donors in 2016. Over the year, the number of volunteer donors included in the local registers of the fund is planned to almost double. The national register was created to gradually replace foreign donors with Russian ones. The selection of “one's own” donor is ten times cheaper, and the results of cell transplantation from the national registry are usually better, experts say.

Smart cells

Today, the process of stem cell transplantation is the most effective method of treating oncological, hematological, and autoimmune diseases. Hematopoietic stem cells are blood precursors. The cells transplanted to the patient multiply rapidly and produce healthy offspring, restore the body's hematopoiesis, and increase resistance to viruses. There is no other way to obtain these cells, except from a bone marrow donor.

Transplantation of hematopoietic cells into the recipient is performed intravenously through a catheter. These are very smart cells: 2 hours after injection, about 30% may disappear into the lungs or liver, but most of them reach the bone marrow niches released by chemotherapy to fit there and give rise to new hematopoiesis. In this case, the recipient's blood group is changed to donor's. It takes about a year to "shake down" the immunological situation, when the recipient must fully make friends with his new bone marrow and the cells that it produces.

Why do you need a national register

Bone marrow donor registries are needed to search for compatible unrelated donors from whom life-saving transplants can be performed for patients in need. Many countries are actively working to expand these registers. Currently, there are about sixty bases, which are united in a common worldwide. The total number of possible donors is approximately 20 million. Thanks to such international registries, it is possible to find a suitable option for 60-80% of sick patients.

In Russia, such programs are still in their infancy, the total number of potential donors tested is small, and does not allow for effective selection of cells for all patients in need of assistance. Over a quarter of a century of development in Russia of this direction in the treatment of leukemia, Russian hematologists have performed hundreds of unrelated transplants. But donors for patients, with rare exceptions, were foreigners, who had (and still have to) look for in international registries. Among the reasons for this is the absence of its own donor register.

“We have created and are developing the National Register for the purpose of gradual replacement of foreign donors by Russian donors,” said the Rusfond. - Searching in the National Register and using Russian donors is more than ten times cheaper than the same procedures using international databases and foreign donors. Moreover, a search in the National Register also gives a significant gain in time, which is often a decisive factor in the treatment of a patient. In our registry we find a compatible donor out of an average of 540 potential ones, while in the international bases of the world - only one out of 10 thousand potential ones. "

Issue price

The Vasya Perevoshchikov National Bone Marrow Donor Registry, created in 2013 by Rusfond together with the First St. Petersburg Medical University and a number of other organizations, currently consists of eight local registries and has about 45 thousand potential donors. This database also includes data from the register of Kazakhstan. Since the beginning of the project, more than 80 bone marrow transplants have been performed from donors from the registry. Since the beginning of the project, almost 240 million rubles of donations have been attracted for the development of the register.

Among the local registries funded by the state, the largest in the national base is Kirov, Novosibirsk and Moscow - the register of the Federal Hematological Research Center (SSC). Speaking about the program for 2016, Rusfond plans to develop the remaining seven registers (two new ones will join the five already operating this year), which are financed from donations to the fund. Reagents for typing, as well as consumables and equipment are imported, so the cost depends on the ruble exchange rate. In 2016, according to Rusfond's calculations, primary tissue typing of one potential donor will cost an average of 12 thousand rubles.

In particular, the St. Petersburg registry (R. Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantology) currently has 7,150 donors, 21 transplants have been performed. The plans for 2016 are to increase the list by 7,000 donors, for which 84 million rubles will be allocated. In general, the total number of St. Petersburg, Chelyabinsk, Samara, Rostov, Tatarstan and Yekaterinburg registers should almost double - from 12007 to 22307 donors. The issue price is 132 million rubles.

Finding a donor

Most of those who want to become bone marrow donors are among the relatives of a sick person. However, family ties are not always able to help in this matter: only about 30% of close relatives have full stem cell compatibility. The ideal option is bone marrow transplantation from a twin, but these are isolated cases.

“In the case of a related donation, it can only be a brother or sister, from the same parents,” explained to MedNovosti the deputy general director of the Hematological Research Center for Transfusiology, Head of the Department of Blood Cell Processing and Cryopreservation, Ph.D. Tatiana Gaponova. - It is very difficult to find an unrelated donor compatible with the recipient at the cellular level. It is very important here that donor cells, once in the patient's body, do not begin to conflict with his immune tissue and do not kill him with their young and healthy immune response. Therefore, unfortunately, even in Germany, where the national donor registry has been operating for a long time, which is linked to the world, only 80% of those who need transplantation can find a donor in it.

In Russia, where the register is just being formed, the situation is much worse. According to the deputy. General Director of the State Research Center, doctors are trying to recruit bone marrow donors among blood donors. But the likelihood that having entered the register, a person will suit someone as a donor is very small. This is such a rough, rough analysis that is simply needed as an information system. And already the transplant doctors can put in the register the data of a particular patient and see if there are donors compatible with him. And if you're lucky, after a rough analysis, they ask for information about the donor, clarify whether his intentions have changed, and conduct additional studies parallel to the recipient.

“We are actively using other Russian registries for our transplants,” Gaponova said. - Because it costs a lot of money to get a donor in Germany. You have to pay even for the search itself in the database - this information is not provided free of charge. Plus, you still have to go after him, take the material, bring it here. A whole bunch of risks is associated with this, up to natural disasters that will not allow you to fly out on time. Here, the transplant can be covered by insurance and be free for the patient. And besides, the results of cell transplantation from their national registry are better, because we are all a little more similar to each other than, say, Germans or anyone else. "

"There are no global complications associated with exfusion"

Bone marrow donation all over the world is based on three mandatory principles: voluntariness, gratuitousness, anonymity. A potential donor is included in the register in the absence of any health contraindications. Like a blood donor, he should not be sick with tuberculosis, AIDS, hepatitis B and C, malaria, cancer, and mental disorders. For typing, it is enough to donate 20 milliliters of blood. However, the stem cells themselves are in the hematopoietic substance contained in the bones.

“Hematopoietic cells - hematopoietic stem cells of the bone marrow - are taken from the flat bones of the donor's pelvis in the operating room,” said the deputy. General Director of the State Research Center. - And we in the donor center then carry out the necessary manipulations with them - separation and cryopreservation of bone marrow suspension. The procedure is carried out under epidural anesthesia and lasts 40 minutes. A special needle passes through the periosteum directly into the bone tissue, and a small volume of liquid is drawn with a syringe - up to 3 cubes. Then another puncture is made and the next 3 ml is taken. In this case, one hole is made on the skin, but the bone itself is “picked” from all sides ”.

2
Photo: Terese Winslow

So many cells must be collected so that the patient for whom this is done is guaranteed to recover. On average, it is 1.5 liters of bone marrow suspension. “The donor, of course, then it hurts,” Gaponova admits. - Bruises appear in the area of \u200b\u200btaking, on the first day the temperature may rise, as a reaction to the procedure itself, anemia may occur. But all these symptoms in a healthy person disappear within 3-5 days and do not require hospitalization or additional anesthesia. There are no global complications associated with exfusion. "

"Become a bone marrow donor - save a life." Such an inscription looks at people from a billboard on Moscow streets, someone seems to want to help, but knows nothing about the bone marrow itself, or how it will be collected. We are looking into this together with Marina Fainberg, a hematologist at the K + 31 clinic.

What is bone marrow

Bone marrow is the soft tissue of the inner cavity of the bone, where hematopoiesis (maturation of blood cells, hematopoiesis) occurs in humans. In humans, the bone marrow accounts for an average of 4% of body weight. Distinguish between red and yellow bone marrow. Red (active) bone marrow is myeloid tissue, which consists of two main components: stromal (stroma, which serves as a microenvironment for hematopoietic cells) and haemal (blood cells at different stages of development). The yellow (inactive) bone marrow is adipose tissue. It is located in the medullary canals of the tubular bones.

Bone marrow stem cell transplantation (bone marrow transplantation) is a medical procedure used in hematology and oncology, for diseases of the blood and bone marrow, as well as some other malignant diseases.

Depending on the source of hematopoietic cells, there are:

• autologous transplantation (pre-prepared cells obtained from the patient himself);
• allogeneic transplantation (from a donor, including relatives).

Who can become a bone marrow donor

The selection of a bone marrow donor for a specific patient is a very complex procedure, which is performed according to the principle of tissue compatibility between the donor and the recipient. In this case, the coincidence of blood groups according to the AB0 system is optional. The greatest chances of finding a donor are to examine the patient's siblings: the probability of full compatibility with a brother or sister is 25%. If there are no siblings suitable for donation, you will have to look for unrelated bone marrow donors.

Any capable person aged 18 to 55 who has never had hepatitis B or C, tuberculosis, malaria, malignant diseases, mental disorders, is not a carrier of HIV and meets some other requirements can become a potential bone marrow donor.

In order to become a potential bone marrow donor (to be enrolled in the registry), it is necessary to undergo HLA-typing in one of the centers providing this service. The procedure involves taking 5-10 milliliters of blood from a vein. If you are eligible as a potential donor for a patient, another 10 ml sample of your blood will be required to ensure you are compatible with the patient. If compatibility is confirmed, you will be immediately informed about the methods of harvesting bone marrow or peripheral hematopoietic stem cells and the preferred method for the individual patient.

How bone marrow is taken from a donor

Thanks to the use of drugs that stimulate the release of bone marrow cells into the peripheral blood, it is possible to avoid taking the bone marrow from the donor. In this case, blood is taken from a vein and subjected to apheresis, as a result, the cells needed by the recipient (patient) are removed, and the blood itself is returned to the donor's body. Outwardly, the procedure is similar to hemodialysis. Then the patient is injected intravenously with a suspension of donor hematopoietic cells, which gradually populate his bone marrow from the bloodstream and restore hematopoiesis.

Are you between 18 and 45 years old? Have you had any serious illnesses?
Are you ready to take the time to save someone's life?
Want to join the bone marrow donor registry?
But not sure how to do it?

THIS IS HOW - STEP BY STEP

1. From October 1, 2018, any volunteer who decides to become a potential bone marrow donor can donate blood for typing at the nearest medical office of "Invitro" or CMD. If there are no Invitro or CMD laboratories in your city, check out the list of the nearest donor shares... If your city is not on the list, write a letter to [email protected] ... Our staff will contact you and help organize a donor attraction campaign in your region.

2. You sign an agreement to join the Bone Marrow (Hematopoietic Stem Cell) Donor Registry.

3. You donate 4-9 ml of blood to determine your HLA phenotype - a set of genes responsible for tissue compatibility.

4. Your HLA phenotype is determined in the laboratory.

5. You are registered, you are a potential bone marrow donor. After some time, you may become a real donor, but you may never become one. It depends on whether your HLA phenotype will ever suit a particular patient.

6. You will be asked to inform the registry staff about the change of residence, phone number, changes in health status.

7. If a particular patient needs cells compatible with yours, and you confirm your consent to become a donor, you will be asked to come to the clinic, where they will tell you in detail about the procedure for harvesting hematopoietic stem cells. Before becoming a real donor, you will undergo a complete medical examination, the purpose of which is to make the collection of cells as safe as possible.

8. Harvesting your hematopoietic stem cells can be done in one of the ways you choose.

Directly from the bone marrow: puncture the pelvic bone, a small part of the bone marrow will be taken from you under anesthesia using a sterile syringe; the operation will take about 30 minutes; you will be in the hospital for about two days; after the operation, you will experience painful sensations that can be easily relieved by pain pills; your bone marrow will fully heal in one week to one month.

From peripheral (venous) blood: you will first be given a drug that "expels" hematopoietic cells from the bone marrow into the blood; blood will be taken from a vein in one arm, it will pass through a cell separating device and return to a vein in the other arm; you will spend about five to six hours in a chair, while you will be able to read, watch TV; anesthesia is not required; your cells will fully recover in one week to one month.

9. For at least two years your recipient will not know who the donor is.

10. You can at any time, without giving any reason, give up your intention to become a real donor. But before you refuse, remember about the patient - the genetic "twin" with whom your HLA phenotype coincided.

All materials on the site have been prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative and inapplicable without consulting your doctor.

Author:, MD, PhD, pathologist, lecturer at the Department of Pathological Anatomy and Pathological Physiology, for Operation.Info ©

Bone marrow transplant is one of the most complex and very expensive procedures. Only this operation can bring a patient with severe hematopoiesis pathology back to life.

The number of transplants carried out in the world is gradually increasing, but it is not able to provide all those in need of such treatment. Firstly, transplantation requires the selection of a donor; secondly, the procedure itself implies high costs for the preparation of both the donor and the patient, as well as for subsequent treatment and monitoring. Only large clinics with the appropriate equipment and highly qualified specialists can offer such a service, but not every patient and his family will “pull” the treatment financially.

Bone marrow transplantation (BM) is a very serious and lengthy procedure. Without transplantation of donor blood-forming tissue, the patient will die. Indications for transplant:

• Acute and chronic leukemia;
• Aplastic anemia;
• Severe hereditary forms of immunodeficiency syndromes and some types of metabolic disorders;
• Autoimmune diseases;
• Lymphomas;
• Certain types of extra bone marrow tumors (breast cancer, for example).

The main group of people in need of transplantation are patients with hematopoietic tissue tumors and aplastic anemias. A chance for life with leukemia that does not respond to therapy is the transplantation of a donor organ or stem cells, which, with successful engraftment, will become the recipient's functioning bone marrow. With aplastic anemias, the correct differentiation and multiplication of blood cells does not occur, the bone marrow tissue is depleted, and the patient suffers from anemia, immunodeficiency, and bleeding.

Today there are three types of hematopoietic tissue transplant:

1. Bone marrow transplantation.
2. Blood stem cell transplant (BSC).
3. Cord blood transfusion.

In stem cell transplantation, stem cells are taken from the peripheral blood of the donor during an appropriate procedure and preparation. Umbilical cord blood is a good source of stem cells; donor preparation and complex material collection are not required for this type of transplantation. The very first method of transplanting hematopoietic tissue was bone marrow transplantation, therefore, other types of operations are often called this phrase.

Depending on where the stem cells are obtained from, a transplant is distinguished:

• Autologous;
• Allogeneic.

Autologous transplant consists in the transplantation of the patient's “native” stem cells, prepared in advance. This treatment option is suitable for people whose bone marrow was not initially affected by a tumor. For example, lymphoma grows in the lymph nodes, but over time it is able to invade the bone marrow, turning into leukemia. In this case, it is possible to take intact bone marrow tissue for subsequent transplantation. The planned SCC transplant in the future allows resorting to more aggressive chemotherapy.

Autologous bone marrow transplant

What a hematopoietic tissue donor should know

Anyone who has reached the age of majority and up to 55 years old, who has never had hepatitis B and C, who is not a carrier of HIV infection and does not suffer from mental illness, tuberculosis, or malignant tumors, can be a donor. Today, registers of KM donors have already been created, numbering over 25 million people. Most of them are residents of the United States, Germany is leading among European countries (about 7 million people), in neighboring Belarus there are already 28 thousand, and in Russia the donor bank is only about 10 thousand people.

Finding a donor is a very difficult and responsible stage. When selecting a suitable donor, the first step is to examine the closest relatives, the degree of coincidence with which in terms of histocompatibility antigens is the highest. The probability of compatibility with brothers and sisters reaches 25%, but if there are none or they cannot become donors, the patient has to turn to international registries.

The racial and ethnicity of the donor and recipient is of great importance, since Europeans, Americans, or Russians have a different spectrum of histocompatibility antigens. It is almost impossible for small nations to find a donor among foreigners.

The principles of donor selection are based on the coincidence of the antigens of the HLA histocompatibility system. As you know, leukocytes and many other cells of the body carry a strictly specific set of proteins that determine the antigenic individuality of each of us. On the basis of these proteins, the body recognizes "its own" and "foreign", provides immunity to foreign and its "silence" in relation to its own tissues.

The leukocyte antigens of the HLA system are encoded by DNA regions located on the sixth chromosome and constituting the so-called major histocompatibility complex. At the time of fertilization, the fetus receives half of the genes from the mother and half from the father, so the degree of coincidence with close relatives is highest. Identical twins have the same set of antigens, so they are considered the best donor-recipient pair. The need for transplants between twins is very rare, and the vast majority of patients have to look for unrelated bone marrow.

Selection of a donor implies the search for a person who matches the recipient as much as possible in terms of the set of HLA antigens. Antigens are known that are very similar in structure to each other, they are called cross-reacting, and they increase the degree of coincidence.

Why is it so important to choose the most suitable option for donor bone marrow? It's all about immune responses. On the one hand, the recipient's body is able to recognize the donor tissue as foreign, on the other hand, the transplanted tissue can cause an immune response against the recipient's tissues. In both cases, a reaction of rejection of the transplanted tissue will occur, which will reduce the result of the procedure to zero and may cost the recipient's life.

bone marrow collection from a donor

Since during bone marrow transplantation there is a complete elimination of its own hematopoietic tissue and suppression of immunity, this type of transplantation is more likely to have a graft versus host reaction. In the recipient's body, there is no immune response to a foreign one, but the transplanted active donor bone marrow is able to develop a strong immunological reaction with transplant rejection.

Potential donors are typed for HLA antigens using the most complex and expensive tests. Before the transplant procedure, these tests are repeated to ensure that donor and recipient are well matched. It is considered mandatory to determine the so-called pre-existing antibodies that could have formed in a potential donor during previous blood transfusions, pregnancies in women. The presence of such antibodies, even with a high degree of coincidence in histocompatibility antigens, is considered a contraindication for transplantation, since it will cause acute rejection of the transplanted tissue.

Collection of donor hematopoietic tissue

When a suitable donor is found, he will have to undergo tissue collection for transplantation to the recipient. Bone marrow donation itself involves complex and even painful procedures.Therefore, potential donors, being informed about the upcoming development of events, already realize the importance of their participation and the degree of responsibility in the transplantation process, and there are practically no cases of refusal.

Refusal of donation is unacceptable at the stage when the patient has already passed the conditioning stage, that is, 10 days before the planned transplant. Having lost his own hematopoietic tissue, the recipient will die without a transplant, and the donor must be clearly aware of this.

To remove hematopoietic tissue, the donor is placed in a hospital for 1 day. The procedure is performed under general anesthesia. The doctor uses special needles to puncture the ilium (there is the most bone marrow tissue), there can be up to a hundred or more injection sites. Within about two hours, it is possible to obtain about a liter of bone marrow tissue, but this volume is able to give life to the recipient and provide him with a new hematopoietic organ. In an autologous transplant, the resulting material is pre-frozen.

After receiving the bone marrow, the donor may feel soreness in the puncture sites of the bone, but it can be safely relieved by taking analgesics. The removed volume of hematopoietic tissue is replenished over the next two weeks.

When transplanting SCC, the method of obtaining the material is somewhat different. For five days before the planned withdrawal of cells, the volunteer takes drugs that enhance their migration into the vessels - growth factors. At the end of the preparatory stage, an apheresis procedure is prescribed, which takes up to five hours, when the donor is on a device that "filters" his blood, taking stem cells and returning all the rest.

apheresis procedure

During apheresis, up to 15 liters of blood flows through the apparatus, while it is possible to obtain no more than 200 ml containing stem cells. After apheresis, bone tenderness is possible due to stimulation and an increase in the volume of one's own bone marrow.

BM transplant procedure and preparation for it

The procedure for bone marrow transplantation is similar to a conventional blood transfusion: the recipient is injected with liquid donor bone marrow or SCC taken from peripheral or umbilical cord blood.

Preparation for bone marrow transplantation has certain differences from other operations and is the most important measure aimed at ensuring the engraftment of donor tissue. At this stage, the recipient goes through conditioning, which includes aggressive chemotherapy necessary for the complete destruction of its own BM and tumor cells in it with leukemia. Conditioning leads to suppression of possible immune responses that prevent the donor tissue from engrafting.

The total elimination of hematopoiesis requires a mandatory subsequent transplant, without which the recipient will die, about which a suitable donor is repeatedly warned.

Before the planned bone marrow transplantation, the patient undergoes a thorough examination, because the outcome of treatment depends on the state of the function of his organs and systems. The transplant procedure requires as good a health of the recipient as possible in the given situation.

The entire preparatory stage takes place in the transplant center under the constant supervision of highly qualified specialists. Due to the suppression of immunity, the recipient becomes very vulnerable not only to infectious diseases, but also to common microbes that each of us carries on ourselves. In this regard, the most sterile conditions are created for the patient, excluding contact even with the closest family members.

After the conditioning stage, which lasts only a few days, the actual hematopoietic tissue transplant is started. This operation is not like the usual surgical interventions, it is performed in the ward, where the recipient is injected with liquid bone marrow or stem cells intravenously. The patient is under the supervision of the staff, who monitors his temperature, fixes the appearance of pain or deterioration of health.

What Happens After Bone Marrow Transplant

After bone marrow transplantation, donor tissue engraftment begins, which takes weeks and months, requiring constant monitoring. It takes about 20 days for the hematopoietic tissue to engraft, during which the risk of rejection is maximum.

Waiting for the donor tissue to engraft is a difficult stage, not only physically, but also psychologically. A patient with virtually no immunity, very susceptible to various kinds of infections, prone to bleeding, finds himself in almost complete isolation, unable to communicate with those closest to him.

At this stage of treatment, unprecedented measures are taken to prevent infection of the patient. Drug therapy consists of antibiotics, platelet mass to prevent bleeding, medications to prevent graft-versus-host disease.

All staff who enter the patient's ward wash their hands with antiseptic solutions and put on clean clothes. Blood tests are performed daily to monitor engraftment. Visits to relatives and transfer of belongings are prohibited. If it is necessary to leave the ward, the patient puts on a protective gown, gloves and a mask. You cannot give him food, flowers, household items, there is only everything that is necessary and safe in the ward.

Video: example of a ward for a bone marrow recipient

After transplantation, the patient spends about 1-2 months in the clinic, after which, in case of successful engraftment of the donor tissue, he can leave the hospital. It is not recommended to go far, and if the house is in another city, then it is better to rent an apartment near the clinic for the near future, so that at any time there would be an opportunity to return there.

During bone marrow transplantation and the engraftment period, the patient feels very sick, experiences severe fatigue, weakness, nausea, lack of appetite, fever, and stool disturbances in the form of diarrhea are likely. The psychoemotional state deserves special attention. Feelings of depression, fear and depression are common companions of donor tissue transplantation. Many recipients note that psychological stress and experiences were more difficult for them than the physical sensations of ill health, therefore it is very important to provide the patient with maximum psychological comfort and support, and, perhaps, the help of a psychologist or psychotherapist may be required.

Almost half of the patients requiring bone marrow transplant are children with malignant blood tumors. In children, a bone marrow transplant involves the same steps and activities as in adults, but treatment may require more expensive drugs and equipment.

Life after a bone marrow transplant imposes certain obligations on the recipient. In the next six months after the operation, he will not be able to return to work and his usual lifestyle, he will have to avoid visiting crowded places, since even going to the store can be dangerous due to the risk of infection. In case of successful engraftment of the graft, the life expectancy after treatment is not limited. There are cases when, after bone marrow transplantation in children, small patients grew up safely, created families and had children.

For about a year after the bone marrow transplant procedure, the patient is under the supervision of doctors, regularly takes blood tests and undergoes other necessary examinations. This period is usually necessary for the transplanted tissue to start working as its own, providing immunity, proper blood clotting and the work of other organs.

According to the reviews of patients who have undergone a successful transplant, their life has improved after the operation. This is quite natural, because before the treatment, the patient was one step away from death, and the transplant allowed him to return to normal life. At the same time, the feeling of anxiety and anxiety may not leave the recipient for a long time due to the fear of complications.

The survival rate of patients who underwent bone marrow transplantation is influenced by age, the nature of the underlying disease and its duration before surgery, gender. In patients under 30 years old, female, with a disease duration of no more than two years before transplantation, the survival rate of more than 6-8 years reaches 80%. Other initial characteristics reduce it to 40-50%.

Bone marrow transplants are very expensive. The patient will have to pay for all the preparatory steps, medications, the procedure itself and follow-up. The cost in Moscow starts from 1 million rubles, in St. Petersburg - 2 million and more. Foreign clinics offer this service for 100 or more thousand euros. Transplantology in Belarus is trusted, but the cost of treatment for foreigners is comparable to that in European clinics.

Free transplantations in Russia are negligible due to the limited budget and the lack of suitable donors from among compatriots. When looking for foreign donors or referral for a transplant to another country, it is only paid.

In Russia, BM transplantation can be performed in large clinics in Moscow and St. Petersburg: the Institute of Pediatric Hematology and Transplantology named after I. R.M. Gorbacheva in St. Petersburg, Russian Children's Clinical Hospital and hematological scientific center Ministry of Health of the Russian Federation in Moscow and some others.

In Russia, the main problem of bone marrow transplantation is not only a small number of hospitals providing such treatment, but also a huge shortage of donors and the absence of its own registry. The costs of typing are not borne by the state, as well as the search for suitable candidates abroad. Only the active involvement of volunteers and a high level of citizens' consciousness can, to some extent, improve the donation situation.

Who becomes a bone marrow donor? Now let's look at this issue. But first, consider the indications for the use of the material.

Application

Bone marrow donation is essential for the treatment of cancer. Therapy is used for the following diseases:

1. Leukemia.
2. Diseases of the lymphatic system.
3. Neuroblastoma.
4. Aplastic anemia.
5. Hereditary blood diseases.

Description of the procedure

There is a misconception that a sick person is replaced with a foreign bone marrow. In fact, the patient is injected with stem cells from a healthy person. This procedure is performed through a vein. Hematopoietic stem cells, which receive a sick person, provide the function of hematopoiesis. Their peculiarity is that they can be transformed into erythrocytes or leukocytes. Their transformation into platelets is also possible.

In our country, these cells began to be used at the end of the last century, namely in the 90s. If a person being treated for cancer receives radiation therapy, hematopoiesis may begin to be suppressed. In this case, the use of stem cells will help establish the recovery process.

There are cases when the injection of stem cells is the only way that can help a person survive. But you should be aware that there are certain risks. It is possible that the body of a sick person recognizes donor cells as foreign. In this case, the rejection process will begin.

How to become a bone marrow donor?

It is worth saying that a person can become a donor to himself. This method eliminates the risk of cell rejection. The main thing is that the patient's bone marrow is not affected by cancer cells. In this case, before starting chemotherapy or radiation, stem cells are taken from the patient. Then, after the course of treatment, they are administered to the patient through a vein.

But there are also cases when it is not possible to take bone marrow from a sick person. In this case, a third-party donor is needed. Before taking bone marrow, it is necessary to do a special study on the compatibility of the patient and the donor. In order for people to be compatible, it is necessary that certain sets of genes be present in their organisms.

Usually brothers and sisters are compatible. Less often parents and children. But you can find an ideal donor who will have a high degree of compatibility with a sick person. It may turn out that this one is in another part of the world. It is possible to detect it through special registers.

What are donor registers?

Databases or registers in America and Europe began to be made in the eighties of the last century. There are several large registries of potential donors around the world:

1. Anthony Nolan Foundation, England.
2. Stefan Morsch Foundation, Germany.
3. National Register NMDP, USA.
4. National DKMS, Germany.
5. International register IBMTR. It contains information from all national registers and private foundations.

In comparison with the world ones, there are very few registered donors in our country. Their number is only forty-three thousand people. Although the population of the country allows us to make a large register of potential donors.

This amount is not enough to select the right person. While national searches are inexpensive and affordable way find a person who can become a donor to any patient.

Can I become a bone marrow donor in St. Petersburg? Yes. But where exactly?

Currently, there is a national fund in our country, which includes the following registers:

1. Petersburg register.
2. Chelyabinsk.
3. Samara register.
4. Rostov.
5. Yekaterinburg register.

How is the procedure carried out?

There is an opinion of doctors that bone marrow harvesting is a much more gentle procedure than surgery. The person who gives it is punctured in the upper part of the pelvic bones. They are made with a hollow needle. Next, the fluid is drawn into the syringe. Several punctures are needed in order to gain a sufficient number. After this procedure, the person is under observation in the hospital for a couple of days. It is also worth knowing that the bone marrow is collected using anesthesia. It can be both local and general.

After donating bone marrow, the body recovers rather quickly. Hemoglobin levels return to normal after a few days. And the pain from punctures disappears in two days. The bone marrow is restored in a month.

Another way to become a donor is to donate blood from a vein. The donor is given a special drug in advance that expels the bone marrow into the blood. Then the material is taken. The blood is driven through a special device that breaks it down into components. Desired cells separated, and the remaining blood is injected back to the donor through the other arm. In order to collect the required number of stem cells, it is necessary to run blood through the device more than once. This usually takes up to six hours. After the cell selection ends, the donor does not feel well. Usually he is nauseous, the body temperature rises, joints ache.

What interferes with the procedure?

How to become a bone marrow donor? Let's figure it out now. Anyone who has turned 18 and not more than 50 can become a member of the register. Also, a potential donor should not have such diseases:

1. Hepatitis B or C.
2. Diabetes.
3. AIDS.
4. Malaria.
5. Tuberculosis.

Documents

Who becomes a bone marrow donor? In order to enter your data into the register, you need to donate nine milliliters of blood.

This amount is needed for typing. Next, you should write an agreement to enter the register. If a set of genes of a potential donor is needed for a patient, then he will need to undergo an examination before becoming such. It will also be necessary to give one more consent for donation.

How to become a bone marrow donor in St. Petersburg, Moscow? In which Russian centers can BMT be performed?

Currently there are only three centers where the procedure can be carried out. They are located in Moscow, St. Petersburg and Yekaterinburg.

There is a limitation on the free procedure and the number of equipped beds. This amount is not enough. You should know that a paid procedure will cost 40,000 rubles per day per bed. The entire course will cost around 2 or 3 million rubles.

For comparison: in clinics in Israel and Germany, this procedure will cost 250 thousand euros. The search for a donor through the international registry costs another 21 thousand euros. If you look for a donor in our country, then charitable foundations will pay for his search.

Features:

Unfortunately, in our country the register of potential donors is very small. Therefore, patients with cancer have to seek help abroad.

Charitable foundations are encouraging people to join the stem cell donation registry. The population of our country is large, but the situation in this area of \u200b\u200bmedicine is not developed in the required volume.

There are special actions that are held to attract donors to the registry. The fact is that the genetics of Russian people differ from the population of the USA or Europe. Therefore, it is easier for a Russian person to find a donor among Russian people than to search in foreign registers. Many in our country do not know how to become a bone marrow donor and the existence of registers. If you inform them about this and talk about the problems that every inhabitant of the planet may face, then more people will appear. The main idea of \u200b\u200bsuch people will be: "I want to become a bone marrow donor." If they not only want to, but become, then they will contribute to the patient's recovery. It is possible that such a person can even save the life of a sick child.

Some people think: what if I become a bone marrow donor for money, will I be able to earn money?

In fact, this procedure is considered charitable, anonymous and free of charge all over the world. These are the basic principles for creating donation registers. Therefore, remember this before deciding on any such actions.

Conclusion

Now you know how to become a bone marrow donor in Moscow and other cities of the Russian Federation. We hope our recommendations will help you.