PBSC or Marrow? Recent Study May Determine Which Type of Donation You’re Asked to Make

Posted November 5th, 2012 by Be The Match and filed in Donor Stories, News
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In a recent study published in the New England Journal of Medicine, the outcomes of patients receiving transplants by either of the two methods of donation, peripheral blood stem cells (PBSC) or bone marrow, from unrelated donors was compared.  While the study found no difference in patient survival rates between these two donation types, the complications experienced by the patient differs between the two.  For example, bone marrow reduces risk of the patient experiencing chronic graft-versus-host disease (cGVHD) compared to PBSC. Because cGVHD causes significant disability in the post-transplant period, these findings may fuel a resurgence of interest in bone marrow as the favored donation method requested by transplant physicians. Currently, 76% of donations are done by PBSC and 24% by bone marrow. Registry members need to be ready to donate by either method.

“This new research confirms much of what we had suspected previously, but now gives patients, donors and physicians more concrete evidence to consider when deciding on a course of treatment,” said Dr. Dennis Confer, chief medical officer for the National Marrow Donor Program®, co-author of the study.

Read more and view full study>

39 Responses to “PBSC or Marrow? Recent Study May Determine Which Type of Donation You’re Asked to Make”

  1. Guy Pascale says:

    Does this pbsc donation carry the same restrictions as bone marrow? I am writing about the weight restrictions.

    • admin says:

      Hi Guy, you can find our medical guidelines for PBSC and marrow donation here: http://marrow.org/Join/Medical_Guidelines/Medical_Guidelines_for_Joining_the_Registry.aspx If you have any additional questions please give us a call at 1-800-MARROW2 and we could be happy to speak with you. Thanks!

  2. Ken says:

    That’s interesting. I’m curious are there any advantages to using PBSC from a medical standpoint? I mean other than convienance for all involved is there any benefit with this procedure vice a straight marrow transplant?

  3. Edward Meyer says:

    Is there any data re: if mega-dosing of Filgrastim can cause MDS? I would prefer to donate PBSC, however I am concerned re: the experimental nature of Filgrastim esp. since my dose would 960 mcg/day. Thanks!

  4. Stu says:

    Following up on Edward Meyer’s comment, that was one thing for which I’d like to know what are the most recent clinical data. Does anyone really know Filgrastim’s impact over the long term (i.e., decades after PBSC stimulation) on the donor, not only from the standpoint of MDS but also other hematologic malignancies? Given that marrow donation is pretty convincingly better for the recipient in terms of cGVHD, might it also be better for the donor in terms of potentially removing such risks, or even psychologically removing any stress from lingering questions about a perceived (if not real) long-term risk? I know there are risks associated with marrow donation as opposed to PBSC donation and that it’s a procedure requiring anaesthesia, but not having a large bolus dose of hematopoietic growth factor (Filgrastim) cranking up and stimulating growth of a huge number of a healthy person’s stem cells seems like it would be a good thing.

  5. Peter Andrews says:

    I am glad to hear this. I, for one, am not willing to do PBSC because I do not wish to take Filgrastim.

    Let’s put it another way: is there ever a reason to REQUIRE a donor to do PBSC if they are willing to donate bone marrow?

  6. Jeff says:

    “Registry members need to be ready to donate by either method.” I find this statement pretentious. Like it or not the PBSC method where a serious drug is required and a protracted invasive extraction method is used, is no-go for me. If I’m willing to give via the bone marrow method, and studies show that it is a better method anyway, I see no reason to entertain the PBSC method at all. Maybe someone can enlighten me as to what would make it imperative for the donor to consent to PBSC over bone marrow.

    • Brandy says:

      I, too, thought the statement was presumptuous. Except I read it the other way around: My preferred choice of donation was PBSC. I’m more reluctant to undergo a surgical procedure requiring anesthesia. That’s more “off the table” for me as someone thinking about starting a family soon. I think the Registry needs to make it even clearer that donors do not get a choice and will likely be asked to do the bone marrow method. At the very least, the newsletter wording should have been more along the lines of “Here’s what you’ll likely be asked for…..we hope this new finding doesn’t make you change your mind about donating…please re-visit our FAQ page about the two different processes…”

    • Martha says:

      Not pretentious, but perhaps not well phrased. I think the point was that donors should no longer assumed that they will be asked to donate via PBSC as has been the preferred method in recent years.

      Donors do not get to choose which method is use; that decision is made by the medical team on behalf of the recipient.

      When I donated via marrow extraction in 2000, the PBSC method was the new thing in development that could/would replace the more invasive procedure someday. But as I read the comments about the possible long-term effects, it seems a bit scarier to me than the marrow procedure.

  7. rohb says:

    Doesn’t matter which to me as long as it is effective and works!

  8. Michele says:

    I’m with Peter. I was a potential donor a few months ago, and read the side effects of Filgrastim. I told them I’d rather donate bone marrow, even though it is more invasive, and I risk being sore for a few days. Better sore than dead or with serious side effects. I’m one of those people who rarely take drugs of ANY type, preferring to handle any medical issues with diet and herbs.

  9. laura says:

    either method, i do not care! i want to help save a life

  10. Tabitha Hall says:

    I have to say that either is fine with me. To help someone else is an honor. These are seriously sick people. However, despite the number of years that I have been on the registry, I am about to be deemed too old which I find frustrating since I am a healthy, active athletic adult.

  11. Trish Moore says:

    I agree exactly with Tabitha Hall. I would be honored to be able to help someone in this way and would donate either way. I only hope that I’ll be able to donate before I’m deemed too old, though I’m not sure when that will be.

  12. James says:

    I’ve donated by both methods for the same patient. I was relieved when I donated marrow the first time because I was nervous about taking Filgrastim, but when I was asked to do a PBSC donation later on, I knew that there was no way I could not do it knowing what the repercussions would be for my patient if I refused based on the idea that I could possibly, one day, suffer negative side effects from the drug. My patient’s need was immediate and real; my fears are distant and abstract.

  13. Ralph S. says:

    I’ve been in the registry since the Eighties and never been asked to donate either way. I’m 50 years old now and was wondering after reading these comments at what age do they consider you to old?

    • admin says:

      Hi Ralph, Registry members may be called to donate at any time between the ages of 18-60 and should stand ready. However, transplant doctors request donors between the ages of 18-44 more than 90 percent of the time.

  14. Craig B. says:

    I donated PBSC about a year and a half ago and took Filgrastin and have had no ill effects.

  15. April says:

    I am donating marrow on the 28th and Be The Match program asked me which way I prefer to donate. I was willing to do which ever was best for the patient, which is why I am donating my marrow and said I would be willing to donate PBSC if the patient needs that in the future.

  16. Herbert Lintelman says:

    I will be willing to donate by any methods needed.

  17. Jerome says:

    As a parent whose son received a transplant three years ago, please know that when you donate you give the gift of life. Your recipient and their family will be eternally grateful beyond what can be expressed by words. Thank you for being on the registry whether you are called to donate or not.

  18. Linda Manning says:

    I will be willing to donate any method.

  19. Linda Manning says:

    i am willing to donate any method

  20. Linda Manning says:

    I’m willing to donate by any method

  21. Kenlyn Hobley says:

    I have been on the Registry for about 20years now and never been called,
    I think I still have about 15 years until I’m “too old”. I would donate by either method.

    • admin says:

      Hi Kenlyn, Registry members may be called to donate at any time between the ages of 18-60 and should stand ready. However, transplant doctors request donors between the ages of 18-44 more than 90 percent of the time.

  22. Sean Marlow says:

    I have sleep apnea so I have been told recently that I cannot give marrow and can only do the PBSC.
    It is ALWAYS a matter of personal choice. You have to decide whether to even be in The Registry and you are given the choice of whether or not to approve the method chosen for you. You absolutley have to weigh the risks to yourself first and foremost. If you already know that there is a method which you will not consider then you have to be up front about that. We all know what can happen to a patient when the donor backs out at the last minute. Don’t take anything for granted. Read, read and read some more about both methods so that you understand completely what is at stake and what will be asked of you. It is no shame to feel it is too large a risk for you but you owe it to future matches to know that before you are asked to help.
    I was asked to donate a couple of years ago and I got all the way through the final process right up until I was to head down to the hospital to begin. The night before, I was called and informed that my match had passed away that very day. He was a 16 year old boy whom I had (obviously) never met but nonetheless I was devastated. I was so close to possibly saving this young man’s life. For me, that was enough of an experience that I knew that I HAD to be in this as long as I was healthy. This was all before I was called a second time and then told I was only able to do the PBSC. I read up on it as much as I could and realized that there are some real health concerns. But, for me, it seemed as long as I paid attention to my body and stayed on contact with the doctors during the process my risks were minimized. That does not take into consideration the long term risks because there has not been enough of these done to have any data for that. So, to echo James’s earlier sentiments I just decided to put the immediate concerns of the patient ahead of my possible long term issues.

  23. Michelle says:

    This is probably not the correct forum for this, but I was reading all of these comments and get the destinct impression that I am significantly less educated than the average donor. Today is the first day I even heard of PBSC. I registered as a donor over 15 years ago, and since no one ever contacted me, I was waiting to get more educated on the subject when my name came up. Which it never does. Am I just incredibly naive? I see comments from people who clearly have not been asked to donate yet, and I wonder if I should be educating myself more, or if it is such a huge concern given that I am never called upon. This is actually something I sincerely want to do, so am I just being lazy?

  24. Sean Marlow says:

    There is a less than 0.2% chance of being called to donate. But ,since that is not zero it is worth making sure you are informed. I joined in 1998 and was not called until early 2010. I have been called twice in the past two years.
    Also found in http://www.marrow.org, 90% of all donors are younger than 45 so it does become increasingly near a zero possibility after age 45 but, again, it isn’t zero and the more people in the pool from which to choose the better chance the patient has of being treated.

  25. Shelly White says:

    Wow…I’ve been excited that after 17 years on the registry I’ve finally been identified as a potential match. But now I’m reading that because I am 48 (although VERY healthy) I’m still unlikely to be be selected because of being 3 years over the preferred age of 45? I know that they will pick the absolute best match for the patient, but it saddens me to think that I will have come this close and not be selected simply because of age…

  26. Dr. Dennis Confer, CMO, NMDP says:

    Follow up to “PBSC or Marrow? Recent Study May Determine Which Type of Donation You’re Asked to Make”
    From Dr. Dennis Confer, Chief Medical Officer, National Marrow Donor Program

    Thank you to the blog community for your comments and interest in the “Peripheral-Blood Stem Cells versus Bone Marrow from Unrelated Donors” article in the New England Journal of Medicine.
    We received many great questions that I would like to answer below.

    • Are potential donors required to donate marrow or PBSC? We do ask those who join the Be The Match Registry to consider donating by whichever method is needed, depending on what is best for the patient. No donor is ever required to donate by a certain method – the donor always has the final say about which method they want to use to donate or whether to donate at all.
    • Why would a physician consider PBSC for their patient? The study shows that bone marrow donation results in less graft v. host disease. For some patients, however, PBSC provides advantages that may be important for some patients. For this reason, physicians may still prefer PBSC in these patients.
    • Are there any risks to receiving filgrastim injections? We began using filgrastim to aid in transplants in the 1990s. The doses given for PBSC donation are higher than most people will ever experience naturally, but there is no evidence that these doses cause any marrow damage or damage in any other organ system. Filgrastim is a protein – a string of aminoacids, like insulin – that is virtually identical to a normal human protein called Granulocyte-Colony Stimulating Factor, G-CSF. G-CSF is present in every person and increases during times of challenge, such as an infection. Filgrastim differs from authentic G-CSF by having the one additional aminoacid, methionine, stuck on one end. This methionine is necessary to manufacture filgrastim and doesn’t change the function of the protein.
    • Do donors ever get leukemia or myelodsyplastic syndrome (MDS)? Unfortunately, yes, but not due to donation and not a rate any different from the people who have never donated. Risk factors for leukemia and MDS can include a brother, sister or parent with leukemia (slight increase); increasing age, particularly after 60 years old; long-term exposure to certain chemicals, most notably, benzene; and large exposure to ionizing radiation (x-rays). Regarding radiation, it is virtually impossible nowadays to receive a leukemia-causing dose of radiation. In the early and mid-20th century, before the leukemogenic effects of radiation were fully appreciated, it was often administered in uncontrolled and indiscriminate ways. For example(and I am showing my age here), many shoe stores once had x-ray machines called fluoroscopes. As a child, I tried on new shoes and stuck my feet in an x-ray machine. There was a port for me to look, one for my mom, and one for the shoe salesman. The salesman used a pointer to show how the shoes fit. It was really pretty cool… and stupid.

    NMDP conducts long-term donor follow-up on both bone marrow and PBSC donors. We have no evidence that either donation leads to late health complications.

    Again, thank you for all of your questions and comments.

  27. Kurtis McFarland says:

    Is this obsurd to ask if there is a Bone Marrow Bank ? also I feel that the medical departments in penal system should be required to ask inmates if they would like to be donors because of the systems organization and the many healthy men and women available.

    • admin says:

      Hi Kurtis, those between the ages of 18 and 60 that meet health guidelines and are willing to donate to any patient in need, can join the Be The Match bone marrow registry. We do not have a bone marrow bank, but if you are on the registry you are active in searches for patients in need of a marrow transplant.

  28. Andy McGowan says:

    I am frustrated about searching for information about the details of each procedure. I would luv to help someone and I don’t really care about which meathod the patient needs BUT I have two procedural issues that would be show stoppers for me, and I can’t find the answers to either anywhere. Maybe I can ask here…

    1) If marrow transplant is selected, can I choose the anesthesia meathod? I would only agree to regional w/ no sedation. I had a terrible reaction to sedation and I won’t go there.

    2) If PBSC is choosen, how do I urinate? It says 75% of sessions are done in 1 8 hour session, and I would imagine I will have to go. A cathiter (sp?) is NOT an option, so how is this done?? Bedpan??

    • admin says:

      Hi Andy, thank you for your interest in getting involved. You can learn more on the ways to donate here: http://marrow.org/Registry_Members/Donation/Donation.aspx But to answer your specific questions, I would like to direct you to a medical professional that can help give you some more information. Please call us at 1-800-MARROW2 Thanks!

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