Q-We`ve heard from a cousin who will soon be undergoing a marrow transplant. As a member of the family, is it possible that my marrow would be useful? How is the marrow obtained, and what is the process used for transplantation? Is this safe for the donor and the patient?
A-Although you did not mention your exact relationship with the patient, nor his disease, I think it`s pretty safe to state that you would not be any more likely to be a potential donor than someone not related to him. The marrow, which contains all of the primary cells that divide and produce all the cellular elements of the blood, and the immune cells as well, must be carefully matched to the patient`s immunologic type.
An identical twin would be best, but a brother or sister might serve, or any individual who is tissue-type compatible. In some cases, marrow can be removed from the patient before treatment by irradiation or high-intensity chemotherapy and replanted after the therapy is completed.
The marrow is obtained from the donor, under strict sterile conditions, after the donor has been placed under a general anesthesia. The marrow is sucked from the pelvic bones, placed in a tissue culture media and treated to prevent coagulation. It is then given to the patient through an intravenous infusion.
The few risks for the donor primarily involve the anesthesia. Recipients must be treated in advance to reduce their immune system, which could reject the transplant and render the whole procedure useless. It takes time for the transplant to grow and produce enough cells to take over all the needed functions. Patients may have to remain hospitalized for 3 to 12 months after transplantation, guarded closely against infections.
The technique, known and used for about 30 years, is not without difficulties, and it is expensive, but it may provide the only hope in some otherwise fatal diseases.
Across My Desk: What makes a person middle-aged? I still believe Dad`s admonition, that you`re only as old as you think you are. He should know, since he just celebrated his 90th birthday, with Mom still by his side. But according to a recent survey conducted by New World Decisions for the American Board of Family Practice (the certifying board that tests family physicians every six to seven years to make sure they are keeping up), middle age is when you think more about the past than the future, or when you become a grandparent.
Of the 1,200 people 18 to 76 years old participating in the survey, 42 percent said they think middle age occurs when you see your last child move out, and 47 percent said middle age arrives when you need a day or two to recover from demanding exercise. Eighty-four percent of participants 46 to 55 years old considered themselves middle-aged, as did 58 percent of those 36 to 45.
It`s interesting to read all these definitions of middle age, but with Dad still alive, I have no idea where the end is, and so I probably won`t have any opinion about middle age until I reach it.
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Dr. Allan Bruckheim welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to him c/o the Chicago Tribune, P.O. Box 119, Orlando, Fla. 32802-0119.
