Acute Myeloid Leukemia (AML) is a cancer of the bone marrow.

What does that mean?? What is bone marrow?

Bone marrow is the soft tissue on the inside of bones. It produces new blood cells, basically of 3 different types:

1. Red blood cells: these cells carry oxygen in the blood, circulating around and taking oxygen to all the tissues in the body.
2. Platelets: these help form clots and stop bleeding.
3. White blood cells: these cells make up the immune system. They are the cells that fight infections and help the body get rid of bacteria and viruses and other bad things.

AML is a cancer in which white blood cells are over-produced in the bone marrow extremely rapidly without enough time for them to mature. These early white blood cells are called blasts. Blasts normally are produced slowly and develop into mature white blood cells that fight infection. In AML, the blasts are produced too rapidly, not allowing maturation, and these immature cells are not able to properly fight infection. These are the leukemia cells. Since the bone marrow is busy producing immature, non-functional leukemia cells, it does not make enough red blood cells or platelets.

So patients with AML have trouble fighting infections because they have few functional white blood cells. They also have trouble with forming clots and bleed very easily because they also have a low number of normal platelets. This is often manifested by little bruises under the skin called petechiae. These patients also can have anemia, or low red blood cells. This can make people feel short of breath, feel tired or weak, or look pale.

This is the type of cancer that Vinay has. His white blood cells are cancer cells that are not functioning properly and crowding out all the other cells in his bone marrow. The first option for treatment of AML is chemotherapy. That is why Vinay did his chemotherapy first; this was supposed to kill all his rapidly dividing and growing bone marrow cells, thereby killing the cancer cells. Once he had chemo and all the cancer cells in his bone marrow were gone, he was at risk for lots of infections because he didn’t have enough normal white blood cells to fight infection and have a functioning immune system. So he got sick for a while, but as his bone marrow began producing normal white blood cells again, he was able to fight infections more successfully, and started to feel better.

After his induction chemotherapy and 3 rounds of consolidation chemotherapy, his doctors thought that his leukemia was in remission, meaning that his body was no longer producing the cancer cells, the leukemic blasts.

Unfortunately, his bone marrow started producing the blasts again. Since the chemotherapy was not enough to put him into long term remission, his next option for treatment, the one which we are exploring now, is bone marrow transplant. This involves more chemo, to completely destroy his own bone marrow. Then the bone marrow cells, called stem cells, which have been harvested from a matching donor can be given to him, to replace his own cancer-producing bone marrow. The donor cells are given to him through an IV, just into his veins. They go to the bone marrow and reproduce, building him up an entirely new set of cells in his bone marrow. That way, he can have a functional immune system that does not produce cancer cells. So then his body can fight infections, produce enough red blood cells to oxygenate all his tissues, and make enough platelets to form clots.

A bone marrow transplant is needed to save his life. The only way he can get one is to find a matching donor, one whose cell surfaces have similar proteins to his own, so that his body does not reject the graft, and the graft does not reject his body. Matching donors are found by testing potential donor’s cells for these proteins, and matching them against Vinay’s own proteins. The easiest and most important way to identify potential matching donors is for people to register on the bone marrow registry.

Registering for the bone marrow registry is so easy! All it takes is a swab of the cheek to collect cells to analyze for the proteins to match up against Vinay’s. Or it could be a small vial of blood. (The cheek swab is the most common way of collecting cells.) It is very simple to do.

Once the potential donor’s cells are typed and compared to Vinay’s, matching donors can be identified. These matching donors are contacted and can undergo more extensive testing, to ensure the best possible match for Vinay. The person identified as the best match will then be asked to donate their bone marrow to help Vinay.

It used to be that the only way to donate bone marrow was to have a needle put into the donor’s hip bone, to withdraw the marrow directly from the bone.

Now two procedures are available for stem cell collection/bone marrow donation.

1. Peripheral blood stem cell collection (MOST current and common method)…..You are given small injections of Neupogen/Filgrastin for 3 to 5 days to force your marrow to overproduce marrow or stem cells which are then released into your circulating blood. The stem cells are collected by removing blood from a vein in your arm, passing it through a filter system, which collects the stem cells and returns the remaining blood to you.. This is a 2 to 3 hour procedure.

2. Marrow harvest….You are given light general anesthesia so that you feel nothing during the procedure. Only 2% to 3% of your marrow is withdrawn from the large crest of your hipbone through special sterile needles.This is a 60 minute procedure. You may go home the same day.

Both methods are relatively short in terms of a time commitment. And basically this means a potential donor could donate stem cells for Vinay and possibly save his life with just a simple blood draw. When you register for the bone marrow registry, the NMDP, they hold on to your bone marrow typing profile, and match you against anyone who may be in need of a donor. That gives you the opportunity to save not just Vinay but many other people’s lives. If you register for a drive under Vinay’s name, the NMDP will expedite the typing of your sample, so they can compare your sample to Vinay’s in a more timely manner.