Well: Lifesaving Procedure With an Image Problem

Personal Health

Jane Brody on health and aging.

Sandra Haber, a 65-year-old psychologist in Brooklyn, wants everyone to know how easy it is now to donate bone marrow. Hers was failing.

She was anemic, bled easily and had little resistance to infection. As her condition progressed toward leukemia, doctors at Memorial Sloan-Kettering Cancer Center urged her to get a bone-marrow transplant. Fortunately, there was a donor: Testing showed that a sister living in New Mexico was a perfect match.

But at first Ms. Haber's sister was hesitant about donating, fearful of the general anesthesia, painful withdrawal of marrow from a hip bone and difficult recovery she thought was involved. Nonetheless, she came to New York for further tests and learned that the process was simple and safe: basically a lengthy blood donation after a week of daily injections to spur her own bone marrow to produce an oversupply of stem cells.

About 90 percent of bone marrow "transplants" are now done this way, most often with stem cells from a matched donor's blood, sometimes from a baby's umbilical cord and placenta or the patient's own stem cells. After the recipient's own dysfunctional marrow is destroyed by intensive chemotherapy and sometimes total body radiation, the donated stem cells are infused into the recipient's blood through a special intravenous line, called a central line. The cells find their way to bone marrow, where they gradually restore the recipient's ability to produce red and white blood cells and platelets.

"A stem cell transplant is not a walk in the park," Ms. Haber said. "It's more like a marathon than a sprint, and the healing process is long and not linear."

It typically takes six months to a year to regain full blood cell production and immune function.

But it is far from the ordeal that traditional marrow transplantation can be. Even Ms. Haber's weeks in the hospital in relative isolation were not especially difficult. She described the fatigue afterward as more of a hardship, but that too abated as she has gradually regained her former energy. Last week she prepared a Seder for 27 relatives.

Now Ms. Haber wonders why a sign in her hospital still reads "Bone Marrow Transplant Unit," when in fact marrow donation is a rarity and the thought of it may scare off potential donors.

Many in need of healthy bone marrow die before a good match can be found. Ms. Haber thinks if the language changed, far more people from diverse ethnic and racial groups might be willing to join bone marrow donor registries — whose names perhaps should also be changed.

Donors must be healthy and age 18 to 60. All that registration involves is a cheek swab from which the donor's tissue type is analyzed and stored in a national database.

When someone who needs new bone marrow has no close match among eligible relatives, doctors check the registry for a matching volunteer elsewhere. The need is especially great for patients who are African-American, Asian or of mixed ethnic or racial backgrounds.

A match is determined by checking proteins called HLA antigens present on cells from the donor and recipient. As with other traits, people inherit the genes that determine these antigens from each parent; the more genetically distant the parents, the less common the mix of antigens is likely to be. Without a very close match, the donor's cells are likely to attack the recipient's tissues, a potentially fatal complication called graft-versus-host disease.

Stem cell transplants can help people whose bone marrow is diseased or dysfunctional and unable to produce the red blood cells that carry oxygen, white blood cells that fight infections, or platelets that enable the blood to clot. Such conditions include cancers like leukemia, certain lymphomas, multiple myeloma and aplastic anemia; inherited disorders like sickle cell anemia and thalassemia; and severe immune deficiency disorders in newborns.

For cancer patients, a stem cell transplant offers an additional benefit: The new blood cells can attack errant cancer cells that may have survived the original chemotherapy.

Two years ago Steven Satrom, 66, a retired engineer in Allentown, Pa., developed acute myeloid leukemia, a disease that responds fully to chemotherapy in fewer than half of cases. Mr. Satrom decided to try chemo first, but when his cancer recurred eight months later, a stem cell donation gave him a renewed lease on life.

Like Ms. Haber, he was lucky enough to have a well-matched sibling. Treatment began with chemotherapy to kill off the cancer cells. His brother flew in from Oklahoma, and after a thorough health checkup, was hooked up to two intravenous lines, one to remove blood and pass it through a machine that extracted stem cells, the other to return his blood.

Mr. Satrom was hospitalized in modified isolation for several weeks while the donated stem cells repopulated his bone marrow and reduced his susceptibility to infection. Like Ms. Haber, he was given drugs to fight bacterial, fungal and viral infections. Mr. Satrom also took anti-rejection drugs to quell a graft-versus-host reaction.

Upon returning home, both Mr. Satrom and Ms. Haber were told to avoid fresh, uncooked foods (unless they could be peeled at home), red meat, shellfish and raw fish, and not to eat restaurant or takeout food.

"I simply cooked everything myself and had small dinner parties for family and friends," Ms. Haber said. Both patients also had to avoid handling pets and their waste, and to reduce their exposure to people, especially young children, who might have an infectious disease.

Now, six to eight months after their transplants, the restrictions have been greatly reduced, though both recipients soon must be revaccinated against childhood diseases, because they lost that protection when their own bone marrow was destroyed.

Stem cell transplants are also expensive, averaging $100,000 to $200,000. Prospective patients are urged to check with their insurance carriers before embarking on the process. Both Ms. Haber and Mr. Satrom said they were fortunate to be covered for everything except deductibles and co-pays.

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