Bone Marrow Donor for Leukemia
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My aunt (my mother's sister) has leukemia, and she needs stem cell and/or bone marrow treatments in order to recover. Might I be her best match? I'm willing to do what I can to help.
— Rina, Ontario
A bone marrow or hematopoietic cell transplant can result in the cure of the disease. These transplants work best when the donor is someone other than the patient herself. Unfortunately, matching for a transplant is far more complicated than matching performed simply for routine blood transfusions.
Specifically, the transplant physicians are trying to match five different immune genes, known as HLA," or human leukocyte antigen, genes, that determine self from nonself. Everyone has two copies of each HLA gene. These genes are some of the most diverse in the human population, with many varieties. Differences in these genes can lead to a very aggressive immune attack by the donor’s cells against the recipient’s body, a phenomenon called graft-versus-host disease — at its worst, it is a deadly and feared complication.
The ideal scenario for a transplant would be that all 10 HLA genes (5 genes times 2 copies) of interest are perfectly matched; matching all of them between two random individuals is very difficult, however. Because siblings have the same father and mother, and their HLA diversity is thus limited, there is a 25 percent chance that any two siblings are perfectly matched. Because you and your aunt are more distantly related, it is unlikely that you would represent her best match.
Your aunt still has several options. First, if she has any other siblings, their HLA genes can be checked. Second, the bone marrow registry has enough donors for common races and ethnicities (say, European descent) that most people will find a potentially well-matchedunrelated donor. If no full match is identified, mismatched related (children, nonmatched siblings, and even parents) or unrelated registry donors can be considered, but their use requires specialized transplant centers with expertise in these potentially more dangerous procedures. Finally, there are a handful of high-quality transplant centers that perform cord blood transplants (often unmatched), and this might represent another option for your aunt.
Video: Bone Marrow Transplant - Mayo Clinic
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