Become a bone marrow donor

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

Irina Reznik, "Mednovosti"

The Charitable Foundation for Seriously Ill Children Rusfond published a program for the development of the Vasya Perevoshchikov National Register of Bone Marrow Donors in 2016. During 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 with the aim of gradually replacing foreign donors with Russian ones. The selection of "your" donor costs ten times cheaper, and the results of cell transplantation from the national registry are usually better, experts say.

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Photo: rk.karelia.ru

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 precursors of blood cells. The cells transplanted to the patient multiply rapidly and give healthy offspring, restore the hematopoiesis of the body, increase resistance to viruses. There is no other way to get these cells, except from a bone marrow donor.

Hematopoietic cell transplantation to the recipient is performed intravenously, through a catheter. These are very smart cells: 2 hours after administration, about 30% may disappear into the lungs or liver, but most of them get to the bone marrow niches released by chemotherapy to fit there and give rise to a new hematopoiesis. At the same time, the recipient's blood type changes to the donor's. It takes about a year to "settle" the immunological situation, when the recipient must fully make friends with his new bone marrow and the cells that he produces.

Why do we need a national register

Bone marrow donor registries are needed to find compatible unrelated donors from whom life-saving transplants can be performed for patients in need. Many countries are actively working to expand such registers. Currently, there are about sixty bases that are combined into a common worldwide one. The total number of possible donors is approximately 20 million people. 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 cell selection for all patients in need of help. For 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 with rare exceptions, foreigners became donors for patients, who had to be looked for (and still have to be) in international registers. Among the reasons for this is the lack of its own donor registry.

"We have created and are developing a National Register with the aim of gradually replacing foreign donors with Russian donors," Rusfond said. – 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 serious gain in time, which is often a decisive factor in the treatment of a patient. We find a compatible donor in our registry out of an average of 540 potential donors, while in international databases of the world – only one out of 10 thousand potential donors."

Question price

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

Among the local registers funded by the state, the largest in the national database are the Kirov, Novosibirsk and Moscow registers of the Federal Hematology 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 funded 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 the calculations of the Rusfond, primary tissue typing of one potential donor will cost an average of 12 thousand rubles.

In particular, the St. Petersburg Register (Research Institute of Pediatric Oncology, Hematology and Transplantology named after R.M. Gorbacheva) currently has 7150 donors, 21 transplants have been performed. The plans for 2016 are to increase the list by 7000 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 price of the issue is 132 million rubles.

In search of a donor

The most willing 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 compatibility of stem cells. The ideal option is a bone marrow transplant from a twin, but these are isolated cases.

"In the case of a related donation, it can only be a sibling, from the same parents," explained Tatiana Gaponova, Deputy General Director of the Hematology Research Center for Transfusiology, head of the Department of Blood cell Processing and Cryopreservation, PhD, to Mednovosti. – It is very difficult to find an unrelated donor compatible with the recipient at the cellular level. It is very important here that the donor cells, once in the patient's body, do not start 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 register has been functioning for a very long time, connected with the world, only 80% of those who need a transplant 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 SSC, doctors are trying to recruit bone marrow donors among blood donors. But the probability that once in the registry, a person will fit someone as a donor is very small. This is such a rough, rough analysis, which is simply needed as an information system. And already transplant doctors can put the data of a specific patient in the register and see if there are compatible donors there. And if you're lucky, after an estimated analysis, they request information about the donor, clarify whether his intentions have changed, and conduct additional, parallel studies with the recipient.

"We actively use other Russian registers 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 for free. Plus, we still need to go after him, take the material, bring it here. There are a whole bunch of risks associated with this, up to natural disasters that will not allow you to take off on time. Here, transplantation can be covered by insurance and be free for the patient. And besides, the results of cell transplantation from our national registry are better, because we all look a little more like each other than, say, Germans or anyone else."

"There are no global complications associated with exfusion"

Bone marrow donation worldwide is based on three mandatory principles: voluntary, gratuitous, and anonymous.A potential donor is included in the register in the absence of any health contraindications. Like a blood donor, he should not be ill with tuberculosis, AIDS, hepatitis B and C, malaria, cancer, 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 – stem hematopoietic 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 GNC. – And we at the donor center then carry out the necessary manipulations with them – separation and cryopreservation of bone marrow suspension. The procedure is performed under epidural anesthesia and lasts 40 minutes. A special needle passes through the periosteum directly into the bone tissue itself, and the liquid part of a small volume is stretched with a syringe – up to 3 cubes. Then the next puncture is made, and the next 3 ml are taken. At the same time, one hole is made on the skin, but the bone itself is "picked" from all sides."

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Photo: Terese Winslow

You need to collect so many cells so that the patient for whom this is being done is guaranteed to recover. On average, this is 1.5 liters of bone marrow suspension. "The donor, of course, is a little sick later," admits Gaponova. – Bruises appear in the area of taking, the temperature may rise on the first day, as a reaction to the procedure itself, anemia may occur. But all these symptoms in a healthy person pass within 3-5 days and do not require hospitalization or additional anesthesia. There are no global complications associated with exfusion."

More information about how to become a bone marrow donor can be found on the Rusfond website.

Portal "Eternal youth" http://vechnayamolodost.ru 26.02.2015