In Romania, the number of children with leukemia or other types of cancer is approximately 5,000, and for many of them a STEM cell transplant is the only chance for life. But not all patients find compatible donors. And that’s because, in general, when it comes to donating stem cells, the world doesn’t really crowd. “Most do not know exactly what it is about, there is a lot of confusion, others do not have time, they cannot travel to the donation center because of the great distance. However, there are also people who, although they initially give their consent, when they find out what the whole process consists of, they change their minds”. Alexandra Ionete, primary doctor Hematology, coordinator of the Stem Cell Bank at the Fundeni Clinical Institute, explained for “Adevărul”.
STEM cell transplantation saves lives. Source: archive
The doctor explained at length what STEM cells are, who needs a transplant and how to donate. “It is important that people know what it is about, that there is no more confusion between STEM cell donation and classic blood donation. They are totally different procedures”, continued the specialist.
What are STEM cells?
Stem cells are cells that form the basis of the formation of all tissues and organs. They contribute to the periodic renewal or healing of tissues and organs after various diseases or traumas.
STEM cell types
Stem cells are of two types: hematopoietic and mesenchymal. “Hematopoietic STEM cells are found in the bone marrow of the broad bones: bones of the skull, sternum, ribs, vertebrae and not in the spinal cord. They are those cells from which blood cells are formed: red blood cells, white blood cells and platelets. the doctor also said. Also available sources of hematopoietic STEM cells for obtaining a transplant graft are peripheral blood, placental blood, and umbilical cord blood.
Mesenchymal stem cells, unlike hematopoietic stem cells, give rise to other types of cells. For example, cartilaginous, bone, muscle, fat, integumentary, nerve, etc. cells. The placenta and umbilical cord are also sources of mesenchymal stem cells.
Who needs a transplant?
“In general, we are talking about patients suffering from malignant hematological diseases, certain metabolic diseases, but also non-malignant hematological diseases. Like, for example, beta-thalassemia major or aplastic anemia in severe form. Through this transplantation of hematopoietic stem cells, the process of formation of blood cell elements is restored”, continued doctor Alexandra Ionete. Any healthy person between the ages of 18 and 45 who weighs more than 50 kilograms can be a donor. “From a person under 50 kilograms, it will not be possible to harvest enough cells to do the transplant. Young men are preferred, and then women who have not given birth”says the specialist.
How to perform the transplant procedure step by step
The procedure by which STEM cells are donated is totally different from the classic blood donation and there should be no confusion. Here are the steps for a person who wants to become a donor:
Registration in the national register
“First, the donor must register with the National Hematopoietic Stem Cell Registry,” Dr. Traian Laurian Arghisan, interim director general of the Registry, explained to Adevărul. “Registration is done in two ways. The interested person presents himself at one of the blood transfusion centers where he signs a consent form and a blood sample is collected. Also, registration can be done online, directly on the National Registry website”, says the director.
Receiving the donation kit
The person is then mailed a kit to collect a saliva sample to check compatibility with the patient. “It is about two cotton swabs with which the donor collects from the oral mucosa, from the inside of the cheeks. He lets them dry thoroughly, puts them back in the envelope, seals it, and notifies the donor department. A courier is sent to pick up the sample“, explains Dr. Traian Laurian Arghisan. “The samples are sent to the laboratory where HLA typing is done, which establishes compatibility with the patient. Then the donor is listed in the databases and can be searched both in the international database and in the local database,” says the director.
Medical evaluation of the donor
If there is compatibility, the donor is called to a sampling center and will undergo a medical evaluation. “We have to make sure he’s a healthy man. He is consulted by a hematologist, a chest x-ray, an abdominal ultrasound, an EKG, and blood tests will be taken. If it is eligible, it goes to the actual harvesting”, explains Alexandra Ionete, Hematology primary physician.
Harvesting STEM cells
The most commonly used procedure is called apheresis. “The concentration of hematopoietic stem cells in the peripheral blood is low. To increase this concentration, a synthesized protein called growth factor is injected for 4 days. On the fifth day, it is determined whether enough hematopoietic stem cells have been mobilized and if so, the donation takes place”, the hematologist explains the procedure.
The procedure involves placing a catheter on the veins in the hands or on the femoral vein. “Through this catheter, the donor is connected to a machine that collects the stem cells needed for transplantation through filtration. The filtered blood returns to the body intravenously. The apheresis procedure is performed under local anesthesia if a catheter is used on the femoral vein and lasts an average of 3-7 hours. After the procedure, the catheter will be removed and the donor will be able to go home.” says the doctor.
Harvested STEM cells are kept at a low temperature, in the refrigerator, and it is recommended that they be administered within 72 hours. “If they cannot be administered in this interval, then the recommendation is that in the first 48 hours they should be cryopreserved, and then placed in liquid nitrogen where they can stay for up to 10 years”, the specialist also said.
Benefits for donors
Dr. Traian Laurian Arghisan, the interim general director of the National Registry of Voluntary Donors of Hematopoietic Stem Cells explained to Adevărul that donors who are not employed benefit from the payment of social health insurance for a period of 10 years. “The medical leave that the donors benefit from is paid with 75% of the salary. Like a common disease. The rest, 25%, is paid by the Association of Stem Cell Donors. Also, the donor receives from the same association 100 lei per day allowance for food, during the procedure”.
