November is National Bone Marrow Awareness Month, and the month has played a large role in Patricia Weitsman’s life.
Weitsman, director of war and peace studies and a political science professor at Ohio University, received her first bone marrow biopsy on Nov. 22, 2010, which came back positive one week later for myelodysplastic syndrome.
Myelodysplastic syndrome (MDS) is a medical condition that involves the ineffective production of blood cells. The disease can transform into acute myeloid leukemia, and the only known cure is hematopoietic stem-cell transplantation, commonly called bone marrow transplantation.
Graft-versus-host disease (GVHD) can occur after a bone marrow transplant but is more common after a blood stem-cell transplant, said Dr. William Blum, associate professor of internal medicine at Ohio State University’s Wexner Medical Center and doctor at the James Cancer Hospital.
“The patient is the host, and the graft is the donor’s cells,” Blum said. “(GVHD is when) the donor’s immune system is put into the patient, and it rejects the patient.”
In Weitsman’s case, the GVHD actually helped save her life.
After another bone marrow biopsy was performed in August 2011, 100 days after her transplant, Weitsman still had abnormal host cells in the marrow, so her doctors decided to incite GVHD in order to attack the abnormal host cells.
Within two weeks of a rapid decrease of immunosuppressants, which had been used to jump-start the donor cells in her marrow, she developed a bad case of GVHD, which affected her skin, liver, eyes and joints, but also effectively destroyed the remaining abnormal cells.
Weitsman discovered that all 20 cells cultured were of donor origin and was officially declared to be in remission on Nov. 22, 2011.
Blood stem cells are generally located in the marrow, which is why the procedure is often referred to as a bone marrow transplant, Blum explained.
There are two ways to perform such a transplant: collect stem cells directly from the bone marrow of an immune-matched donor, or collect stem cells from the peripheral blood of the donor.
“In either case, blood stem cells are infused into the recipient through the blood, just like a blood transfusion,” Blum said. “They home into the marrow environment and begin to grow.”
There are many reasons why a physician might choose either process, but the donor’s preference determines the procedure, Blum said.
“For peripheral blood stem-cell collection, the donor receives a small subcutaneous shot that stimulates the marrow stem cells to overgrow and then spill over into the blood,” he said. “Then, IVs are placed and the blood stem cells are collected in a manner similar to donating platelets at the Red Cross.”
When collecting marrow, there is an operating procedure that requires anesthesia, in which a needle is placed into the posterior iliac crest — the bony prominence in the area of the buttocks — and the liquid bone marrow is pulled out into a syringe, Blum said.
Blum said that the processes sound more grotesque than they are, and are easy, low-risk procedures for donors.
“The risks of stem cell collection is that you have to have a shot that stimulates the marrow to grow, and that can make the bones hurt a little bit,” he said. “There is a theoretical risk that the shot could cause a problem, but that has never happened.”
Those who are potential matches have to go through multiple tests to ensure they are close enough counterparts.
Amanda Gleason, a 2012 OU graduate, took the tests and was a match, but the patient became too ill to undergo the procedure.
“They told me that if the patient is ready to receive the transplant, it could occur within a week or several months within them telling me,” Gleason said. “I’m just kind of waiting around now.”
Transplants are done with non-perfect matches, but the greater the mismatch, the more likely GVHD will occur and be more life-threatening, Blum explained.
Weitsman’s donor was the only 10-for-10 match out of 16.5 million people in the worldwide registry at the time of the transplant.
A year later, Weitsman said she is still navigating GVHD, but she spent Nov. 22, 2012, this past Thursday, celebrating Thanksgiving with her family and being thankful for the gift of a second life.
ao007510@ohiou.edu
