IDENTIFY THE DONOR
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In Allogeneic Transplant, patient’s gets healthy blood-forming cells donated by someone else. The donor can be afamily member or someone unrelated to you. Sometimes, people get donated blood-forming cells from umbilical cord blood. This is the blood collected from the umbilical cord and placenta after a baby is born. Donor for BMT has to be matched with the patient in their ‘tissue type’. This is confirmed by typing their Human Leukocyte Antigen (HLA) antigens.
There are 3 main types of stem cell donors:
- Matched related –Within a family, there is about 25-30% chance of finding such a match in a brother or a sister. If there is no match within the close family, the chances of finding a fully HLA matched donor in distant relatives is remote. Brothers and sisters are matched through special test called Human Leukocyte Antigen (HLA) typing test.
- Matched Unrelated – To find a match with a random person is less than one in a billion. However, if we screen million people of similar ethnic background, we might find a close match. Based on this concept, volunteer unrelated donor registries have been set up in all developed countries and they are the major source of blood stem cells in all these countries. Several such registries worldwide provide over a million donors who volunteer to donate marrow if needed. The best chances of finding a match are within the same ethnic community.
- Half-Matched/Haplo-identical – We inherit two sets of HLA ANTIGENS; one from each parent Thus, parents are always half matched with us. In addition, even if the brothers and sisters are not fully matched with the patient, there is 90% chance that they shall be half-matched. BMT from a half matched or HAPLOIDENTICAL donor is feasible in centres with adequate infrastructure and expertise. Our Hospital and Research Centre is the only hospital of India to have created the desired infrastructure and has the expertise for this procedure. This remains the only hope for patients who don’t have matching donor.
Stem cells can be obtained from the donor’s bone marrow or peripheral blood (blood in the veins). Or in some cases, stem cells are collected from the umbilical cord at the time of birth.
Our team of Bone Marrow Experts will advise you if Allogeneic Transplant is the best option for you, we will begin the process of finding a match. A match is found by doing Human Leukocyte Antigen (HLA) typing testing.
Firstly, doctor tests Patient’s blood to find out their Human Leukocyte Antigen (HLA) type. HLA is a protein — or marker — found on most cells in the body. Doctor will look for a donor or umbilical cord blood that closely matches patient’s HLA. Our immune system uses HLA to recognize which cells belong in our body and which do not.
The best transplant outcomes (results) happen when a patient’s HLA closely matches the donor’s HLA. A close HLA match also helps lower the risk for problems after transplant. Matching HLA markers is much more complex than matching blood types.
Usually, doctor will first look for a matching donor in your family usually a brother or sister. That’s because we inherit HLA markers from our parents. HLA types are inherited so siblings can sometimes be a match for each other. Each brother and sister has a 25% (1 out of 4) chance of completely matching the patient, if same mom and dad are there. Parents and children always match exactly half of patient’s HLA markers. For some people a transplant from a half-matched donor, or a haploidentical transplant, is a treatment option. One person is more likely to match someone with a similar ethnic background or ancestry.
A close match is important because it:
- Improves the chances for a successful transplant.
- Helps patient’s donor cells engraft (grow and make new blood cells in the body).
- Reduces the risk of complications like graft-versus-host disease (GVHD). GVHD happens when the immune cells from the donated cells (the graft) attack the recipient’s cells (the host).
If you do not have the facility to get High resolution Human Leukocyte Antigen (HLA) Typing Test done in your home country, don’t worry you can CONTACT BMTClinic.com anytime for assistance.
To plan a Bone Marrow Transplant, firstly we need to identify the donor through Human Leukocyte Antigen (HLA) typing test of patient, siblings and parents in order to identify the right donor for the patient’s transplant.
There are two options:
- Patient, Siblings and Parents can go for HLA typing test once they arrive in India for the BMT procedure of the patient. But in this case the whole family needs to travel.
- You can provide BMTClinic.com team your contact details and postal address of your home so that we can send you FREE HLA Test Kits at your doorstep for Patient, Siblings and Parents.
HLA Test Kit
HLA typing test sample collection is a very simple procedure. In the HLA kits there are cotton swabs through which you need to take sample of the cheek cells from inner mouth and pack it again safely. For test you need to send the samples via courier service to us in India and transfer 200 US dollars per kit in our company account via wiretransfer and then we ship the samples to standard laboratories that do High Resolution HLA typing Test.
Or Second option is that you directly send the HLA Test Sample collected to HISTOGENTICS Lab in USA and transfer 200 US dollars per kit in their account via wiretransfer.
HLA typing of the patient must be undertaken in an accredited laboratory. HLA typing of the patient & donor must be by DNA methods, and include at a minimum HLA-A, -B -C and DRB1. This may be supplemented by serology to ascertain protein expression. HLA-DRB3, DRB4, DRB5 and DQB1typing are considered desirable and DPB1 optional. The resolution of typing should ideally be high resolution for HLA-A, B and DRB1.
Donors for patients who require an Allogeneic Bone Marrow Transplant, whether they are related to the recipient or not, are selected based on a number of factors that are known to influence the outcome for the patient.
- The HLA (tissue) type of the donor and recipient, which should be closely matched and at least 5 of the 6 most important “antigens” (2 “A”, 2 “B”, and 2 “DR” antigens) must be matched. Ideally, all 6 antigens will be a match between the donor and recipient, and preferably, 10 out of 10 antigens (including 2 “C” and 2 “DQ” antigens) will match.
- If a patient has more than one 10/10 match available, a male (or a female that has never been pregnant) is preferred.
- If multiple matches are still available, the youngest donor will usually be selected, but the donor’s health and prior exposure to common viruses (especially the CMV virus) will also be considered in the decision.
Testing to determine whether individuals are a good match only requires blood tests to be done, not a bone marrow test. Potential donors have to come to India for testing to ensure they are the right donor for the patient.
All donors will need pre-collection blood tests. These will include a screening test for hepatitis viruses and HIV (the AIDS virus), urine tests and a medical history and physical examination by a physician. In addition, for donors over 40 years of age, a chest X-ray and an electrocardiogram (ECG) are often done.
For donors having a bone marrow harvest, an anesthetist will also see the donor to review their medical history, conduct a physical examination and to discuss the method of anesthesia. The anesthetic is usually a general but freezing from the chest down (spinal anesthetic) can also be used.
Find out the truth behind common false beliefs about bone marrow donation.
1. Donors between the ages of 18 & 44 provide the greatest chance for transplant success.
Doctors request donors in the 18-44 age group more than 95% of the time. Age guidelines are not meant to discriminate. They are meant to protect the safety of the donor and provide the best possible outcome for the patient.
2. Patients are most likely to match someone of the same ancestry.
Adding more members who increase the ethnic diversity of the registry increases the variety of tissue types available, helping more patients find the match they need. We especially need members who identify as: Members with these backgrounds are especially needed: Black or African American, American Indian or Alaska Native, Asian, including South Asian, Native Hawaiian or other Pacific Islander, Hispanic or Latino, Multiracial.
3. All donors are carefully prescreened to ensure they are healthy and the procedure is safe for them.
There are two methods of donation: peripheral blood stem cells (PBSC) and bone marrow. The patient's doctor chooses the donation method that is best for the patient.
- PBSC donation is a nonsurgical procedure and the most common way to donate. For 5 days leading up to donation, you will be given injections of a drug called filgrastim to increase the number of cells in your bloodstream that are used for transplant. Some of your blood is then removed through a needle in one arm and passed through a machine that separates out the blood-forming cells. The remaining blood is returned to you through the other arm. To learn more, watch the PBSC donation video.
- Bone marrow donation is a surgical, usually outpatient procedure. You will receive anesthesia and feel no pain during the donation. Doctors use a needle to withdraw liquid marrow from the back of your pelvic bone. To learn more, watch the marrow donation video.
Though no medical procedure is without risk, there are rarely any long-term side effects donating either PBSC or bone marrow. Your cells replenish themselves in 4 to 6 weeks.
Because only 1 to 5% or less of your marrow is needed to save the patient’s life, your immune system stays strong.
4. Donors never pay to donate marrow.
All medical costs for the donation procedure are covered by Registries or organinisations or by the patient’s medical insurance.
5. Your gift saves lives.
- Grow the registry of potential marrow donors
- Help patients with crippling transplant costs
- Advance the science of transplant
There are many ways you can help even if donation is not an option:
- Host a drive
- Spread the word