BONE MARROW TRANSPLANTATION:
new needs - new horizons?

Here you can find the story with pictures about Sergey Borovik, who had a bone-marrow transplantation done in April 2000. Unfortunately, it wasn't successful...

	25 October 1999 Hematologists from Cuba visiting our clinic. Discussing a question about the possibility of taking our children to Cuba for bone-marrow transplantation. Unfortunately, now this project doesn't function.

More and more often we have in our clinic children who need an operation of bone-marrow transplantation. Former a necessity of such operations for Crimean children arose only 1-2 times a year. But since year 1999 the number increased. Probably, these are the Cherniobyl consequences. Statistics made in Japan showed the increase of oncological diseases beginning the 12th year after the bombing. Year 1999 was the 13th since the catastrophe happened in Ukraine... We cannot change the past. So we, parents and doctors, don't ask the question 'why?', but rather a traditional Russian 'what can we do?'. These children won't survive without bone-marrow transplantation. Marlen Reshatov died because of that, and he wasn't the only one…

Why bone-marrow transplantation (further abbreviated BMT) is needed? It is the last chance, the last hope for those whom all other kinds of treatment didn't help. Anti-relapse treatment is possible in cases with lymphoblast leukemia, but when a relapse comes for a person with lymphom and myeloblast leukemia, only BMT can help. Transplantation is also used for people with aplastic anemia and some other diseases.

BMT is one of the most expensive operations. This is in many ways linked to the treatment after operation.

The transplantation itself is theoretically not very complex: bone-marrow cells can be taken directly from a bone, but they are able to get through into the peripheral blood, and then they're "caught" and frozen. In such a condition, cells can be preserved for a long while. Later, when the necessity of transplantation arises again, they can be refrozen and in-planted back. It can seem easy from the first sight, but it's not exactly so.

To put it in a very simple way, during the operation, bone-marrow, blood and all the affected tissues and cells of a person are being completely removed by a powerful chemotherapy. Then donor's bone-marrow is being in-planted. If it adopts completely, person's life will be saved. But there are might arise two problems. First is that the transplanted tissue won't be adopted. To avoid it, the protective resistance of the organism is being suppressed by powerful medicaments. The second threat is that for 2-3 months following the operation the organism is almost completely devoid of the immune system. The smallest infection can become fatal. To avoid infections, patient is put into a ward with special means of protection, being completely isolated. All this - medicaments and care after the operation is very expensive.

There are two kinds of BMT: autological (when the own bone-marrow of the person is being transplanted - if it is not affected) and allogenic BMT (when bone-marrow of a donor is used).

Kiev oncological clinic, the department of children's oncology. Taking bone-marrow before the autological operation. Sergey Borovik, Crimea. Spring 2000.

Allogenic transplantation is an operation of replacing an affected bone-marrow with a healthy one taken from donor. If a blood brother or sister is a donor, there is 25% chance that a set of antigens in bone -marrow will fit the person, and that is considered to be the best possibility for transplantations of this kind. In the world there also exists a practice of transplantations between people who are not relatives. In the registers of the bank of blood data there is information received by the method of typifying, which makes possible to define the set of antigens necessary for transplantation.

It is far more difficult to find a donor of bone-marrow than the one of blood. Such a selection takes a long while and is very expensive. Besides, a register of donors is just in the process of forming in Russia (see the link on the right). In Ukraine there is still no bank of data for bone-marrow donors.

The increase of the cases when transplantation is the recommended way of treatment has, nevertheless, its positive sides. This increase brings up two issues:

- upgrading methods and practices of BMT. As a result, it is used more often, including these cases that were formerly thought incurable. For example, according to the latest programs of treatment, BMT is advised to those with Acute Myeloblastic leukemia, the group of high risk, when they have their first remission (in our clinic it is the case with Sasha Shtilik);

- an opportunity to send our children to be operated in other clinics.

The most close place where such operations are already possible is Kiev center of children's hematology. The next remote ones are in Moscow and St.-Petersburg, and further - in Israel, Germany, US… Now their clinics are theoretically available for us. But…

AT PRESENT the cost of BMT operation is:

* in USA - 100 to 200 thousand dollars (depends on conditions, kind of transportation, finding donors, etc.);

* in Israel - 100 to 120 thousand dollars (including transportation, hospital boarding and other necessary services);

* in Moscow and St.-Petersburg for foreigners (including citizens of Ukraine) - about 70-80 thousand dollars;

* that's why it is so important for us that the program of BMT is broadened and updated in Kiev. The operations have been made here already for three years. That far these were only autological transplantations. Besides, the number of children that the Kiev clinic is able to accept is limited. The approximate cost of the operation in Kiev is 7-10 thousand dollars.

Kiev oncological clinic. Near the bad of a child who needs BMT. Doctors (from the left to the right): Hematologist Julia BAZALUK; The chief of the department of BMT Oleg RYZHAK; The chief of the department of children's onko-hematology Svetlana DONSKAYA.

Besides close co-operation with Kiev hematologists (who belong to the Ukrainian Leukemia Group as well as Crimean ones), we try to find possibilities to send our children to other countries for operations. At present there is a boy from Simferopol, Eugene Mitrofanov, in the St.-Petersburg clinic. He is waiting there for a donor to be found for him. We also have contacts with Israelite and Italian doctors. In the beginning of the year 2001 one boy from Yalta, Pavel Alubaev, had a BMT done in one of the Italian clinics, city Triesta (a sponsor from Vatican helped to pay for the operation). Unfortunately, the boy died because of the hepatitis that became acute in the period that followed the operation. One of the American clinics has also agreed to accept Crimean children for operations, if funding is found (see Robert Bond's letter).

In the end of 1999 we have written in the article on the site:

"The search for the opportunities to send our children for BMT and funding for such operations that we've started recently, is probably one of the main results of the existence of our WEB-site that far. Any particular ways of solving this problem aren't found yet, though…"

To tell honestly, they are not found up to this day. We are not able to help all the children who need BMT. Parents of some children choose palliative, that is, supportive treatment that only helps to prolong child's life for a short while… Others cut off the treatment, desponding to find any means for the operation. Third ones - … just do not have enough time left to wait for the help to come.