What is Bone Marrow - Part 1 Video

What is Bone Marrow - Part 1

Male1: What is a bone marrow? Male2: The bone marrow is the factory in which the blood cells are made, and so if you look at the circulating blood in your veins and arteries, a product of what goes on in the bone marrow. Male1: And where is it found? Male2: In all of the--well, as you get older, it becomes more central, but in a new born, it is found in all of the bones. As you get older, it is restricted to the pelvis and hip bones, mostly. Male1: And how long are bone marrows been done? Male2: Bone marrow transplants? Male1: Yes. Male2: The first transplants were reported in about 1957 or 1958. Done on five patients with leukemia. None of them were successful, but the proof of principle was demonstrated and the patients with leukemia received bone marrow grafts from unrelated individuals and in fact, were not grafted. Male1: But the first successful bone marrow transplant was done when? Male2: The first successful transplants were done in 1968 in two children at separate institutions with immune difficiencies. Male1: And the patients are still alive today? Male2: That is right. Male1: If we were to come to you and searching about bone marrow transplant, what kind of patients would be considered for a bone marrow transplant? Male2: There are a few categories of disease that are amenable right now for bone marrow transplant. Most of our transplants are done for relapsed or refractory leukemia. Leukemia being a highly curable disease in pediatrics, but in fact, one knows that diseases are not cured, a bone marrow transplant offers an opportunity for salvage of those patients who prior to bone marrow transplant cannot be cured. Male1: There are two types of situations when you look for a donor that you never knew about to find a bone marrow, it is not that you get lucky, if they could be identical twins, is that true? Male2: Well, interestingly enough, if you have an identical twin that might be a good donor for a malignant disease, but it might not. The confidence ring--the rate of leukemia in identical twins under the age of five is high enough that one would be taking a fairly high risk using an identical twin. In genetic diseases, the identical twin would be likewise affected. With the same genetic twins, the-- Male1: Because they have identical potential problems, how do you track? Male2: Well they have the same if they were genetically identical as identical twins are, they would have the same genetic disease, so they would not serve as a donor, so the best donor is a tissue compatible sibling, a brother or sister who shares the tissue antigens that are required to match for transplantation. It is called HLA. Male1: In other words, having the same blood type is not enough. There are other things that you would look for and that would be what? Male2: Having the same blood type is not necessary. As we sit here today, we are transplanting a little girl with aplastic anemia, bone marrow failure and her sister is a donor, they have different blood types, but they have the same HLA type. Male1: What does HLA mean? Male2: Human Leukocyte Antigen and these are the tissue antigens that permit recognition of the bone marrow by the host and recognition of the host by the bone marrow, if they are not compatible, then you can have graft rejection or something called graft versus host disesase where the actual marrow graft rejects the host. A very serious and often fatal condition. So we test only for HLA and the blood groups are not important. Male1: And I got a list of situations, I hear that there are only about 70% of people who can find a match, is that true? Male2: Well, it depends where you are looking. If you are looking at siblings based on the size of families and the knowledge that you have a one in four chance of having an HLA match with a sibling, it gives you about a 20% to 25% likelihood of having a sibling donor. So 75% of individuals have to go outside of their family to find donors and because of that, what has been established is the national marrow donor program and more blood programs--the national marrow donor program consists of over six or seven million individuals who have been HLA-typed and if in a computer search, they show up as compatible donors, they are willing to donate their marrow to an individual who need to transplant, and with that I would say you have probably 70% or 80% likelihood of finding a donor depending upon your ethnic group. Certain ethnic groups are more diverse and rare in our population and are difficult to find donors for and certainly, more common ethnic groups are easier to find donors for. That is why the cord blood system arose, and the cord blood system is really umbilical cord blood collected at the time of birth, the blood is the blood of the baby, not of the mother. It is frozen and serendepitously, it happens to have a large number of stem cells, or cells capable of repopulating an adult marrow, so anybody under about 40 or 50 kilos in weight or about 80 to 100 pounds can avail themselves of a cord blood donor.

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Male1: What is a bone marrow? Male2: The bone marrow is the factory in which the blood cells are made, and so if you look at the circulating blood in your veins and arteries, a product of what goes on in the bone marrow. Male1: And where is it found? Male2: In all of the--well, as you get older, it becomes more central, but in a new born, it is found in all of the bones. As you get older, it is restricted to the pelvis and hip bones, mostly. Male1: And how long are bone marrows been done? Male2: Bone marrow transplants? Male1: Yes. Male2: The first transplants were reported in about 1957 or 1958. Done on five patients with leukemia. None of them were successful, but the proof of principle was demonstrated and the patients with leukemia received bone marrow grafts from unrelated individuals and in fact, were not grafted. Male1: But the first successful bone marrow transplant was done when? Male2: The first successful transplants were done in 1968 in two children at separate institutions with immune difficiencies. Male1: And the patients are still alive today? Male2: That is right. Male1: If we were to come to you and searching about bone marrow transplant, what kind of patients would be considered for a bone marrow transplant? Male2: There are a few categories of disease that are amenable right now for bone marrow transplant. Most of our transplants are done for relapsed or refractory leukemia. Leukemia being a highly curable disease in pediatrics, but in fact, one knows that diseases are not cured, a bone marrow transplant offers an opportunity for salvage of those patients who prior to bone marrow transplant cannot be cured. Male1: There are two types of situations when you look for a donor that you never knew about to find a bone marrow, it is not that you get lucky, if they could be identical twins, is that true? Male2: Well, interestingly enough, if you have an identical twin that might be a good donor for a malignant disease, but it might not. The confidence ring--the rate of leukemia in identical twins under the age of five is high enough that one would be taking a fairly high risk using an identical twin. In genetic diseases, the identical twin would be likewise affected. With the same genetic twins, the-- Male1: Because they have identical potential problems, how do you track? Male2: Well they have the same if they were genetically identical as identical twins are, they would have the same genetic disease, so they would not serve as a donor, so the best donor is a tissue compatible sibling, a brother or sister who shares the tissue antigens that are required to match for transplantation. It is called HLA. Male1: In other words, having the same blood type is not enough. There are other things that you would look for and that would be what? Male2: Having the same blood type is not necessary. As we sit here today, we are transplanting a little girl with aplastic anemia, bone marrow failure and her sister is a donor, they have different blood types, but they have the same HLA type. Male1: What does HLA mean? Male2: Human Leukocyte Antigen and these are the tissue antigens that permit recognition of the bone marrow by the host and recognition of the host by the bone marrow, if they are not compatible, then you can have graft rejection or something called graft versus host disesase where the actual marrow graft rejects the host. A very serious and often fatal condition. So we test only for HLA and the blood groups are not important. Male1: And I got a list of situations, I hear that there are only about 70% of people who can find a match, is that true? Male2: Well, it depends where you are looking. If you are looking at siblings based on the size of families and the knowledge that you have a one in four chance of having an HLA match with a sibling, it gives you about a 20% to 25% likelihood of having a sibling donor. So 75% of individuals have to go outside of their family to find donors and because of that, what has been established is the national marrow donor program and more blood programs--the national marrow donor program consists of over six or seven million individuals who have been HLA-typed and if in a computer search, they show up as compatible donors, they are willing to donate their marrow to an individual who need to transplant, and with that I would say you have probably 70% or 80% likelihood of finding a donor depending upon your ethnic group. Certain ethnic groups are more diverse and rare in our population and are difficult to find donors for and certainly, more common ethnic groups are easier to find donors for. That is why the cord blood system arose, and the cord blood system is really umbilical cord blood collected at the time of birth, the blood is the blood of the baby, not of the mother. It is frozen and serendepitously, it happens to have a large number of stem cells, or cells capable of repopulating an adult marrow, so anybody under about 40 or 50 kilos in weight or about 80 to 100 pounds can avail themselves of a cord blood donor.

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