Marrow Transplants Used on Leukemia, Anemia Patients, Often With Success

Bone marrow transplants, which are now being done by American doctors on some of Chernobyl’s victims, typically are performed on patients with leukemia or aplastic anemia, with generally good results. But whether such procedures will benefit Soviet citizens exposed to radiation from the April 26 nuclear accident remains to be seen.

A bone marrow transplant is a two- to three-hour procedure that closely resembles a blood transfusion, although giving marrow requires anesthesia and hospitalization. A donor may lose three or four days of work and have discomfort from the punctures for about a week.

In the procedure, about 1 or 1 1/2 pints of soft, red marrow are removed from the donor by making numerous needle punctures in the hip bones, which have large reservoirs of marrow. The marrow is then slowly infused into a recipient’s vein after having first been carefully filtered to remove unwanted components. A donation consists of 5% to 10% of an individual’s total bone marrow.

Ordinarily Lethal Dose

Before the transplant, the patient is given a dose of whole body radiation that would normally be lethal but for the fresh marrow that is then infused. The radiation is given to rid the patient of the disease-damaged cells in his or her own marrow.

If the donor marrow has been properly matched and is not rejected, the two- to four-week period following the transplant are critical for the patient. It is during this time that the recipient is liable to die from infections and bleeding problems that can occur because the new marrow has not yet formed enough cells to become protective.

According to experts at UCLA and the Fred Hutchinson Cancer Center in Seattle, the weeks after a marrow transplant make substantial demands on hospital resources. In addition to extensive antibiotic therapy, patients can require as many as 80 blood transfusions, sterile food and considerable psychological support. A typical transplant at UCLA costs about $120,000.

Relatives Donate

Nearly all marrow donors in this country are relatives of the patient.

One study, according to a UCLA researcher, showed that the risk of serious side effects to the donor, chiefly from the anesthetic or infection, are about 3 in 1,000.

The cure rate for marrow transplants ranges as high as 80% for aplastic anemia, a disease caused by defective functioning of the blood-forming organs such as bone marrow, and 50% to 60% for some kinds of leukemia.

About a week after the April 26 nuclear accident, a team of U.S. experts began performing an undisclosed number of bone marrow transplants on seriously irradiated Soviet citizens.