Cancer  is  a  journey  not  to  be  travelled  alone

I ranian C ancer Support G roup

Stem Cell and Bone M ar row T ransplant

Introduction
Stem cell and bone marrow transplant is one of the treatments, and usually the last treatment, for
some of blood and lymph cancers. A wide range of diseases and disorders, such as certain types of
cancers (like leukemia, lymphomas, and myelomas) are treated by stem cell transplant. Also, patients
suffering from inherited immunologic or metabolic disorders may need stem cell transplant. Stem
cell transplant is a complicated and precise procedure and due to genetic and physiologic limitations,
finding a donor whose cells are compatible with patient’s body, is not easy. Obviously, by increasing
the number of donors who are willing to donate cells, the patients will have higher chance of finding
a matching donor and survive.  It’s important to know that stem cell donation is totally harmless to 
the donor.
Here, you will know more about the stem cell transplant procedure and the organizations that
coordinate this process in Canada.

Stem cells and transplant

Stem cells are blood forming cells that are sometimes called "hematopoietic" or "progenitor" cells.
These are immature cells that are capable of developing into any of the cells present in the
bloodstream: red blood cells, white blood cells, platelets and other blood components. Patients who
have a disease that inhibits their ability to produce these cells will need a transplant of healthy stem
cells from a donor.
There are two stem cell sources: bone marrow and circulating blood. Donors may be asked to donate
either bone marrow or peripheral blood stem cells depending on which product is considered to be
the best choice for the patient.
To prepare for a transplant, the recipient is usually given high doses of radiation, chemotherapy, or
both, to destroy the diseased marrow. Patients who receive a stem cell transplant must remain
isolated in a sterile room until the transplant has been successful and their new bone marrow has
produced sufficient white blood cells to protect their system against surrounding bacteria.

W ho needs stem cell transplants?

Hundreds of Canadians are in need of transplants every year. As of October 2008, there were about
600 Canadian patients waiting for a stem cell match. In 2007 alone, 233 Canadians received

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transplants, and many more could have been helped if more donors had been available. For most of
these patients, a transplant may be the last and best chance for recovery from a serious illness.
In 2006, 77 per cent of stem cells used by Canadian patients were imported from other countries,
rather than matched to Canadian donors. While the Canadian organizations that coordinate this task
have made advances in attracting more ethnically diverse registrants, there is still room to grow. As
of October 2008, 83 per cent of Canada's Network is Caucasian and the remaining 17 per cent is of
various ethnic backgrounds. In addition, research indicates that younger donors are associated with
better longterm survival rates. That is why these organizations are making a concerted effort to
recruit younger donors, as well as enhance the database by having a broader ethnic representation
that will meet the needs of all patients.

How Does M atching Wor k?

When an individual joins the registary, a sample of the registrant's DNA is collected by rubbing a
cotton swab inside his/her mouth. The DNA is used to identify a number of the registrant's Human
Leukocyte Antigens (HLA) which are then stored our database for patient searches.
Human leukocyte antigens are genetic markers found on the proteins of white blood cells. A number
of antigens have been identified as important when matching donor and patient. Obviously, the closer
the match between the patient and donor, the better the outcome will be for the patient.
The patient's transplant physician will first look for a compatible donor in the patient's family and
will arrange for testing of appropriate relatives. In general, the most likely family members to match
will be the siblings. However, chances of finding a compatible donor in the family are less than 30%
and the remainder of patients will rely on a volunteer to donate.
Once the transplant physician has determined that no suitable related donor is available, a request
will  be  made  to  the  “OneMatch  Stem  Cell  and  Marrow  Network”  to  coordinate  the  search  for  a 
donor. A patient search involves the Canadian network as well as all international donor registries.
Today, Canadian patients have access to over 11 million donors. Even with this many donors and the
best efforts of everyone involved a donor cannot always be found.
Patients are more likely to find a donor in their own ethnic community - that is why it is so important
to have as many Canadians from diverse ethnic communities as possible join.

How Donation Wor ks

Donation from bone marrow
If a donor makes a bone marrow donation, he or she is given either a general or regional anesthetic.
A special needle is inserted into the iliac crest (hip bone) and the marrow is extracted (the amount of
marrow taken ranges from 500 to 1500 millilitres). The procedure usually lasts from 45-90 minutes,
and donors are normally discharged from the hospital the same day. The marrow will then replenish
itself within approximately three weeks.
Bone marrow donors can expect to feel some soreness in their lower back, which feels like following
hard exercise or a fall on the ice. There have also been reports of donors feeling tired and having
some discomfort walking for a couple of days or longer. Most donors are back to their usual routine
in a few days. Some may take a few weeks before they feel completely recovered.

Iranian Cancer Support Group (905) 237-9037 www.iraniancancersupport.com info@iraniancancersupport.com

Donation from peripheral blood
For a peripheral blood stem cell donation, a donor receives injections of a granulocyte colony
stimulating factor (G-CSF) for a minimum of four days. These injections increase the number of
stem cells found in the blood. To collect these cells, the donor is connected to an apheresis machine
with a needle. Blood is drawn through a tube into a centrifuge and there the stem cells are collected
and the remaining blood components are returned to the donor through another needle. Peripheral
blood stem cell donors report varying symptoms including headache, bone or muscle pain, nausea,
insomnia and fatigue. These effects disappear shortly after donating.

A bout O ne M atch
The OneMatch Stem Cell and Marrow Network was originally established as the Unrelated Bone
Marrow Donor Registry (UBMDR) in 1989. OneMatch works under the Canadian Blood Services
supervision and has received accreditation through the World Marrow Donor Association (WMDA) -
the seventh of 62 member registries to achieve this status. OneMatch is dedicated to recruiting and
locating compatible, committed, healthy, unrelated donors for patients in Canada and around the
world.

Joining O neM atch Stem C ell and M ar row Networ k.

Anyone between the ages of 17 and 50 who is in good general health can join. Volunteers should be
committed to helping any patient in need. For registration, you will complete a short health
assessment questionnaire and consent to be listed on the database. Once we have received the health
assessment and consent form, we will contact you to make arrangements to have you tested. Your
typing results will be added to our database, and you will be included when we search for possible
donors for patients in need.
OneMatch conducts searches to find a donor whose HLA match that of the patient in need of a stem
cell transplant. In the event that you come up as a likely match, we will contact you. If you agree to
proceed, further blood tests will be scheduled to determine the full extent of your compatibility and
to test for transmissible diseases. Then a transplant physician will give a thorough physical
assessment at the collection centre (hospital where you will donate stem cells) closest to you. Once it
is determined that you are medically eligible and you agree to proceed, the patient will be notified
and the elimination of his or her diseased bone marrow will begin.
Sometimes during the period of time between registering and donating, there are other factors, such
as illness, that might change a donor's eligibility and may mean they need to withdraw as a potential
donor.
While it is certainly possible to withdraw from the Network, OneMatch counts on donor commitment
from the time of registering to becoming a potential match for a patient. Especially, when the patient
is under preparation process, your withdrawal may threaten his/her life. Recipients awaiting a stem
cell transplant, such as a cancer patient, receive intensive chemotherapy with or without radiation
before the transplant in an attempt to kill all cancerous cells. But this procedure also destroys the
patient's own stem cells and immune system. Once this preparation is completed, the recipient must
receive the donor's stem cells in order to survive. Should a potential donor decide not to donate at
this critical point the patient could die. This emphasizes the importance of the donor's commitment,
and underscores why OneMatch has developed a registration process that promotes this commitment.

Iranian Cancer Support Group (905) 237-9037 www.iraniancancersupport.com info@iraniancancersupport.com