Bone Marrow Donation is Not Without Risk
Researchers affiliated with the National Marrow Donor Program® have reported that serious complications occur in 1.35% of marrow harvest procedures. They reported these findings at the tandem BMT meetings in Orlando, Florida February 13-17, 2004. This was a joint meeting between the International Bone Marrow Transplant Registry and the American Society for Blood and Marrow Transplantation (IBMTR/ASBMT).
Allogeneic stem cell transplantion has become an integral part of treatment of some hematologic and non-hematologic malignancies as well as some non-malignant diseases. Bone marrow stem cells are usually obtained by using a large needle to draw cells from the bone marrow in the iliac crests, the hip bone. General or local anesthesia is used. Bone marrow harvesting was originally performed only from family members who were willing to take risks for their loved ones. However, over the past 2 decades there have been increasing numbers of allogeneic stem cell transplants performed from volunteer donors. Before a normal person volunteers to donate marrow the procedure is explained to him or her in great detail. However, it takes large numbers of marrow donations to clearly define the statistical risk of this procedure.
This analysis included 9,282 bone marrow harvests carried out between 1987 and 1999. These researchers identified 345 cases that were considered potentially serious and included: excessive pain, adverse acute anesthesia reactions, delayed return to normal activities, or the need for additional medical intervention. Of these 345 cases the researchers identified 125, 1.35% of the total population, that were considered “serious”. Sixty-nine of these cases were mechanical injury to tissue, bone or nerve, 45 were anesthesia related events, one was an infection, and there were 9 events unrelated to donation. Thus, 116 donors had serious complications directly related to donation. Sixty-seven donors had problems that lasted months or years. The factors associated with more complications were use of regional anesthesia, longer duration of harvesting, female gender, and older age. It is important for donors to understand that marrow donation is not without risk and all potential donors should be given information contained in this report before they sign an informed consent.
At the present time the overwhelming number of related donors are undergoing peripheral blood stem cell harvesting rather than marrow collection and more and more unrelated donors are choosing this option. Peripheral blood is harvested from a vein and is performed over a 1-3 day period following daily administration of Neupogen®. Currently, there have been no good comparisons of complications between the two procedures, but most donors who have undergone both procedures prefer the harvesting of peripheral blood stem cells. In this procedure there are no risks of mechanical trauma or risks of anesthesia. However, there is some concern about the long-term effects of Neupogen® although no adverse effects have been documented.
Reference: Confer DL, Leitman SF, Papadopoulos EB, et al. Serious Complications Following Unrelated Donor Marrow Collection: Experiences of the National Marrow Donor Program®.
Biology of Blood and Marrow Transplantation 2004;10:13, supplement 1, Abstract #19.