By Airman 1st Class Jonathan Bass, 20th Fighter Wing Public Affairs
/ Published October 03, 2014
SHAW AIR FORCE BASE, S.C. -- There is a chance I may have to experience some pain so that a stranger might live; there is a chance I may literally have to give some of me to someone whose body has failed them.
I am a potential bone marrow donor. And you should be too.
I know that's a bold statement but this is why I make it.
I joined the registry because of my aunt and grandfather, who both have chronic lymphocytic leukemia. Seeing them go through chemotherapy and other experimental drug trials firmly placed in me the desire to make sure someone else doesn't have to do that.
Every year, more than 12,000 people need a transplant of Hematopoietic stem cells, immature blood cells which mature into red or white blood cells. These cells are found in the marrow and can be used to treat diseases including different types of leukemia and lymphoma.
There is a registry specifically for Department of Defense members known as the C.W. Bill Young Bone Marrow Program.
"When a patient is identified as potentially needing a donor, we call it 'failing,'" said Capt. Kimberly Brewer, 20th Medical Operations Squadron clinical nurse. "Because you've failed two rounds of chemo, after that we will start the process of looking for a donor."
As a potential donor, the first step is to sign up in the registry. This involves a simple swab of the mouth.
Those swabs are submitted to the DOD registry and tested for initial requirements.
"When the potential donor gets notified," said Brewer. "They get asked if they still want to donate, the person on the other end of the phone cannot influence them, the caller cannot talk them into it, even if they are the only person in the world who matches, the caller cannot tell them that."
Once they've agreed to donate, the DOD registry will send a series of labs to the medical center closest to their base. The labs are then taken and sent to Walter Reid National Military Medical Center in Washington, D.C.
Once the labs arrive, the testing for Human Leukocyte Antigens begins. HLAs are a "map" of who you are. Everyone has a profile inside of them composed of 10 antigens.
Doctors are looking for a six of ten match in the HLA testing.
"Six out of 10 is a great match, said Brewer. "They want it to be as close of a match as possible to eliminate the risk of hardcore graft versus host disease."
If a donor is a match, they're flown to Walter Reid where they receive a drug called Neupogen. This drug causes the body to create Hematopoietic stem cells.
"(After taking Neupogen) they will feel like they have the worst flu of their life," said Brewer. "They will ache, run a fever, and be more tired than they've ever been before."
The thing to remember is, they'll get over that feeling. If they didn't donate, the recipient would most likely die.
After about a week of receiving the drug, they'll be hooked up to an apheresis machine. This machine pulls blood out of them, separates it by weight, stores the stem cells, then puts the rest of the blood back into their system.
That's basically where the story ends for the donor. They return home, back to their life.
For the recipient, another journey begins, one that has a 30 percent chance of failure.
The recipient has been waiting for this day. For the week the donor has been taking Neupogen they've been having their immune system killed off.
"I've seen people so terrified they had to be sedated," said Brewer. "This is very stressful because they could die."
Now it's transplant day, the patient is in the hospital, and the cells are brought to them.
The patient is given Dimethyl Sulfoxide, a preservative used in the cryogenic freezing of the cells. DMSO can cause violent anaphylactic reactions including tightness of chest, inability to breathe, a sense of impending doom, and possibly cardiac arrest.
Most transplant patients, who die, do so within the first 20 days after transplant.
"If the transplant doesn't kill them, and the graft versus host disease doesn't kill them, they've got a pretty good chance at life," said Brewer.
The next few days are critical for the recipient. Infection is almost inevitable, they will run a fever, and they will get sick.
"We start giving prophylactic drugs to fight off infection," said Brewer. "They get antibiotics because we're trying to prevent opportunistic infection."
After day five, most patients develop mucositis. This is the inflammation and ulceration of the lining of the digestive tract.
"The entire lining of their digestive tract sheds," said Brewer. "Instead of that protective lining, you have raw open flesh from your mouth to your buttocks."
During this time the patient has stomach pain, heartburn, and nausea.
By day seven, the patient's body will have started to fight back and produce white blood cells. Once their white blood cell count is above 500, the doctors know cells are going to grow.
After 30 days, barring a horrendous case of graft versus host disease, or neurogenic fever, the patient is released from the hospital. For the next six months they will have constant medical supervision to ensure that not a single cut goes unnoticed.
After 180 days the patient can start returning to their everyday lives. After one year, doctors consider the patient cured.
"How radical is it," said Brewer. "That you kept someone alive for even another six months?"
The Air Force core values tell me why I need to be ready to donate. Exhibiting integrity first and knowing that I could save a life by signing up, honoring service before self and taking care of my wingmen. Being excellent in all I do, taking the time to do things the right way, to make sure that if and when I'm called upon that I can tackle the challenge, rise to the occasion, and save a life.