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"A sibling who has inherited the same tissue traits from both parents can become a donor. In most cases, however, it is necessary to look for a donor outside the family, one whose immune system most closely resembles the recipient. " he said prof. MUDr. Petr Sedlacek, CSc., chief physician Transplant units of the Department of Hematology and Pediatric Oncology, Motol University Hospital in Prague. Unlike blood donation, in bone marrow transplants, blood group agreement is not important, but the suitability of the donor is assessed by the ten tissue features of white blood cells. These vary globally and regionally.

Two national registries

There are two national registries in the Czech Republic. Czech Registry of Hematopoietic Cell Donors in Prague was established in 1991 at the Prague Institute of Clinical and Experimental Medicine (IKEM). It registers 34 donors (September 015). Czech National Register of Bone Marrow Donors (CNMDR) was established in 1992 and registered as of 30 June 6 a total of 2020 donors. "Since its inception, it has enabled transplant to 1 patients, of whom about 784 percent were pediatric patients." stated by MUDr. Pavel Jindra, chief physician of the Czech National Marrow Donor Registry and head of the hematology and oncology department at the University Hospital in Pilsen. "Since the beginning of the registry's activities at IKEM in Prague, we have been looking for donors for more than 700 pediatric patients from the Motol University Hospital, for whom we have arranged over 400 transplants, both with adult donors and with umbilical cord blood grafts. Our register registers them in its database from the very beginning. Umbilical cord blood grafts can be used for transplantation in a similar way as adult donor cells, “says Mgr. Marie Kuříková. Both workplaces cooperate with each other and also with other registries around the world, in which there are a total of 37 donors. Nevertheless, every fourth to fifth patient, including children, will not find a suitable donor in time or at all.

Applicants can enter both registers at one of the donor or recruitment centers across the country. If you want to donate bone marrow, you must be in good health, do not take any drugs permanently and weigh at least 50 kg. You can enter the register at IKEM in Prague if you are between 18 and 40 years old. "Despite the fact that we try to register the youngest possible donors in the registers, a few years ago we decided to allow the registration of a large group of healthy applicants aged 35 to 40, who are still promising donors," says Mgr. Marie Kuříková. The border in CNMDR is between 18 and 35 years old. The age of the donor is very important from a professional point of view. "Five years ago, the average age of newly enrolled donors was close to 30 years. Today we are five years lower. The younger the donor we can find for the patient, the higher the success of the transplant. In addition, every 10 years of age, the donor worsens the chances of transplant success by 3 percent. " stated by MUDr. Pavel Jindra.

You will be able to enroll in bone marrow donation registries at Children's Oncology Days 2020, which will take place on September 19 on Malostranské Square in Prague.

Children for transplant

The most common reason for transplantation of bone marrow hematopoietic stem cells in childhood is an unfavorable form of acute leukemia. Acute leukemia represents 30 percent of cancers diagnosed in childhood and is the most common malignancy in children aged 1 to 15 years.

The most common type of leukemia in childhood is acute lymphoblastic leukemia (80%, about 65 children are diagnosed annually. Other types are acute myeloid leukemia (15%, 12 children per year), myelodysplastic syndrome (5%, 3 children per year) and chronic myeloid leukemia 2- 3%, 2 children per year) leukemia. The overall incidence of leukemia in our population is 5 new cases per 100 children aged 000-0.

"Hematopoietic stem cell transplantation, ie bone marrow, is the only way for many of them to defeat hematopoietic cancer. These are mainly various forms of leukemias and lymphomas, where standard chemotherapy treatment fails or is unable to destroy tumor cells without serious damage to healthy hematopoiesis and the immune system. " states prof. Petr Sedlacek. According to him, in pediatrics, transplantation is often used in the treatment of acquired and congenital non-cancerous hematopoietic diseases - for example, severe immune system disorders or some inherited metabolic disorders.

How it's actually done

The transplant itself differs from the common ideas of many people. This is not a surgical procedure, as the name itself suggests, it does not take long and does not hurt. "The very process of bone marrow transplantation is painless, it is performed directly into the vein. In our country, the transplant itself took about half an hour, because Kryštůfek was a small ten-kilo baby. " says Michaela Hájková, mother of a four-year-old boy. He was barely a year old when he contracted Juvenile Myelomonocytic Leukemia. These are rare hematopoietic disorders that cannot be treated other than by transplantation.

Thus, the transplant itself is performed by intravenous infusion. "Cells travel through the recipient's blood. When they reach the bone marrow, they are trapped in its structure, where they begin to multiply and mature. Therefore, the transplant itself must be preceded by careful preparation, after which the recipient's own hematopoiesis is greatly suppressed or even completely destroyed. " explains prof. Petr Sedlacek and continues: "The whole process is supported by the administration of immunosuppressants to reduce the risk that the transplanted cells would be rejected by the child's own immune system and / or the donor's immune system would damage the recipient's organs.

Thus, technically, the transplant process itself is not complicated. For a small patient and his family, in addition to serious health problems, forced isolation is more of a burden - in strict conditions, the transplant unit usually has to spend a number of weeks. "The child's health condition must be such that he or she can handle the transplant. In our case, the preparation was more complicated because Kryštůfek had to have his spleen surgically removed fourteen days before the transplant. Without this intervention, the entire transplant would be jeopardized, “ specifies Michaela Hájková. Lucie Hrubá, the mother of Nikolka, now XNUMX, also says that the transplant itself is the easiest thing to do in the whole process. Her daughter developed lymphoma at the age of five, later the tumor metastasized to the brain. "Much more demanding than the transplant itself, the previous stay in the ICU was. Every night, I believed that the next day would be better and that we would soon be ready for the necessary bone marrow transplant. " claims Lucie Hrubá. "We were in the hospital for nine months, but it passed very quickly, you perceive that time completely differently."

If, after bone marrow transplantation, the donor hematopoietic germ cells in the bone marrow are sufficiently attached, the cells begin to multiply and mature, and after about two to three weeks, mature blood cells begin to appear in the blood. Prof. Petr Sedláček explains: "The risk period is the next many months, during which the body has to get used to the foreign immune system that the transplant has acquired. It must not harm him, but on the contrary help him to suppress common infections and, in the initial phase, also to suppress or eliminate leukemic or tumor cells that have survived. " Both children received bone marrow from voluntary donors from German registries.

Successes that save lives

Bone marrow transplantation currently cures 70 percent of children with malignancies, up to 85 percent for non-cancerous diseases. At the Department of Pediatric Hematology and Oncology in Prague, the University Hospital in Motol, doctors annually perform 30-40 transplants with grafts from family or unrelated donors. Motol University Hospital is the only workplace in the Czech Republic where unrelated transplants are performed. The first patient in 1989 was a five-year-old boy with acute leukemia. He was at the birth of the transplant program Professor Jan Starý, the current head of the Motol Department of Pediatric Hematology and Oncology.