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It all started one spring afternoon about 10 years ago. David Cavell, then a student at Tufts University, strolled past what looked like a campus blood drive. He saw a friend, stopped, agreed to run a Q-tip across the inside of his cheek, and moved on.
That "blood drive" was a bone marrow donor drive. You may have seen the appeals: "Swab a cheek, save a life." Perhaps you've wondered what comes next?
Well, seven years after that cheek swab, the bone marrow registry Gift of Life telephoned Cavell. They said he might be a match for a patient with a life-threatening disease, but they needed a blood sample that would provide more details about the proteins in Cavell’s cells. Cavell gave the blood, but he didn’t hear anything for another three years.
“Then, all of a sudden, out of the blue, I got a call from the organization to say that I was a perfect match."
Meaning that 10 markers on Cavell’s cells are the same as 10 markers on those of a patient somewhere with leukemia, a few other types of cancer or a blood disease.
But for whom? Cavell, now 30 and an attorney at a Boston law firm, doesn’t know. He will not get any information about the person who needs to replace their own stem cells with those from Cavell’s bone marrow until one year after the exchange. And then, only if the recipient is willing.
“I don’t know, it’s weird,” Cavell tells his colleague Drew Goodwin, while recording an audio diary of his donor experience — one filled with excitement, anxiety, pain and elation. “I do wonder whether we’ll have like, an ancestor in common on something. I mean, for us to match this closely?”
The recipient is likely Jewish and someone who, like Cavell, had ancestors in eastern Europe. He or she could be anywhere in the world now. They are probably not related, unless you string together many multiples of "great."
"So what do you think about the guy who you’re helping," Cavell's colleague asks him on the recording. "I mean, you haven’t met him but you’re pretty much saving someone’s life. Do you think about that?"
"I, well, not really. I guess only in the sense of, like, that’s why I didn’t feel like I could say no," he concludes with a candid laugh.
Cavell is nervous. He’s never been in a hospital overnight and never had general anesthesia, which doctors are recommending in his case.
Cavell and his fiance Kate Drizos fly to Washington, D.C. after being told Boston hospitals that do the procedure could not get him in on short notice.
In a hotel room, Drizos reads one of the messages she solicited from Cavell's friend in case he needed some support the night before doctors “harvest” — the medical term — bone marrow from Cavell’s hips.
"Hey Davey," writes one of Cavell's oldest friends, "not only have you done something incredibly brave and generous for another person, but with any luck you’ve also sent along some of your prodigious wit, drive and ability to quote nearly any movie in history."
Cavell is touched. "It's odd," Cavell tells Drizos on the audio diary. "You don't just pull your friends aside every week and say, 'You're a great person.' That would be a really weird thing to do. But it's been really incredible to hear people say nice things and encourage me."
Early the next morning, Cavell changes into a one-size-fits-all hospital gown with little teal sailing flags and matching socks. He climbs onto a gurney at Georgetown University Medical Center and the dreaded nurse with needles approaches.
"The pain is always considered to be a very minimal inconvenience compared to the good feeling they got from donating."Dr. Joseph Antin, Dana Farber Cancer Institute
"I’m going to look at you," Cavell tells his fiance.
To distract him, Drizos asks him to list his top 10 favorite movies of all time.
"I think this might take you a while," Drizos says laughing.
The tactic works. Is "Chinatown" or "North by Northwest" number one? He can't decide.
Enter Dr. Corina Gonzalez, one of two oncologists who will perform the procedure. One of them will draw marrow from Cavell's left hip, the other from his right, to balance the pain and reduce the time needed for recovery. He'll be in the operating room for 40 minutes to an hour.
During surgery, doctors pump two units of blood Cavell had given days before the surgery back into his body to help restore blood lost during the procedure.
Three hours later, Dr. Gonzalez tells Cavell his stem cell count was “very good.”
"I’ve always thought that was one of my best features,” Cavell quips on the audio diary.
Dr. Gonzalez explains that because Cavell's count was so good, she didn't have to take as much as she expected. In all, Dr. Gonzalez extracted a little more than 10 ounces of bone marrow, which would typically mean 40 to 60 tiny holes in Cavell’s hips.
"So is there like a courier racing with part of me to the airport right now?" Cavell asks. "Maybe getting an all expenses paid vacation to Europe or South America or wherever this guy is or this woman is?"
Yes, Cavell is told.
"Well that sounds good cause the rest of me is feeling like you punched me in the lower back," he says with a heavy sigh.
Most bone marrow donors leave the hospital the same day, but Cavell spends the night, and then part of the following day.
"It’s 10:30 on Friday, the day after the surgery," Cavell records. "I thought that I might be getting out around now, but unfortunately I just don’t feel very well."
He’s nauseous, dizzy and having trouble standing. Cavell leaves the hospital later that day in a wheelchair. He must avoid any stress to the hips that might create fracture lines between the small holes.
The Good News
Cavell spends two nights in a hotel because he doesn’t feel well enough to fly back to Boston. In all, he's out of work for eight days. Some of the continued weakness and nausea, he says, was a reaction to pain medications which he wished he'd stopped earlier than he did.
Then, one month after the surgery, while sitting at his desk at work, Cavell gets a call. His stem cells are alive and well in the body of a man or woman somewhere. There is no sign of rejection or the return of his recipient’s original disease.
7 Interesting Facts About Bone Marrow Donation
From Dr. Joseph Antin, chief of stem cell transplantation at Dana Farber Cancer Institute
- Half of all bone marrow transplants are autologous, meaning the marrow comes from the patient himself or herself.
- Thirty percent of patients who need a bone marrow transplant have a donor in their family.
- There are roughly 22 million registered bone marrow donors worldwide. They “age out” at 60. Many registries don’t recruit donors who are older than 45.
- About 93 percent of Caucasians have a donor in the registry. For Latinos, it’s 72 percent, for Asians it's 73 percent, and for African-Americans it's 66 percent.
- Doctors are having more success in the last few years with family members who are haploidentical, or half matches, where five of the 10 cell markers match. Given all these possibilities, the chance of finding a transplant option is 95 percent worldwide.
- Antin sees patients who are cancer or disease free 25 to 30 years after a bone marrow transplant.
- Stem cells originate in bone marrow, but can be collected from a blood donation. Patients who choose, or who are asked to donate in this manner, are given a drug called Neupogen, which causes cells to be released from the marrow into the blood.
"I am sort of speechless," Cavell says, faltering. "I’d started to get a little nervous because I hadn’t heard anything and I feel as if an enormous weight has been lifted off my shoulders."
For Cavell, the joy in that call trumped any pain or problems caused by the procedure.
Cavell’s reaction is typical, says Dr. Joseph Antin, chief of stem cell transplantation at Dana Farber Cancer Institute.
"When we query people, it is uniformly positive," Antin says. "The pain is always considered to be a very minimal inconvenience compared to the good feeling they got from donating."
Which is reinforced, Antin says, by success rates. The range is 20 to 95 percent, based on age, the disease and how far it has progressed.
Contrary to popular belief, a bone marrow transplant is no longer the last treatment option.
"As we’ve gotten better and better at it, it’s now primary for some therapy for a number of different diseases because it is curative," Antin says. "Whereas, many of the therapies that we give, while effective at temporarily controlling a disease, do not cure it."
Cavell won’t know if that’s the case for his recipient for at least a year, but wants to celebrate now. What’s appropriate, should he pop champagne?
"To know that somewhere in the world, this person is recovering and their family has gotten good news for the first time in however long, is just so deeply meaningful and moving to me," Cavell says slowly.
With help from the registry, Cavell sends a letter to his recipient. It’s edited to remove any identifying information. He’s hoping for a response.
He still feels a twinge in his back when he reaches down to touch his toes. He might wince and smile. It's a nice reminder of the adventure that started with that Q-tip 10 years ago.
Correction: An earlier version of this post's sidebar used incorrect figures for the likelihood of various races and ethnicities finding a donor in the registry. We regret the error.
This article was originally published on May 13, 2014.
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