JBSA-FORT SAM HOUSTON –
Each year, more than 12,000 people are diagnosed with diseases that require an infusion of stem cells, but more than 70 percent of patients are unable to find an appropriate match within their own family and will require an unrelated donor, according to the C.W. Bill Young Department of Defense Marrow Donor Program website at https://www.salutetolife.org/.
The San Antonio Military Medical Center is the only Department of Defense medical facility collecting autologous and allogeneic transplants for patients. Autologous cells are obtained from the same individual, while allogeneic transplants are collected from a genetically similar, but not identical donor.
Tucked away in the corner of the fourth floor of the facility is blood services' cellular therapy and apheresis section - again the only one of its kind for the DOD. With a staff of eight military and civilian employees, the section has had a direct impact on the long-term quality of health for military beneficiaries being treated at SAMMC.
"Most patients seen by the cellular therapy and apheresis team have been diagnosed with leukemia, multiple myeloma, Hodgkin's disease or non-Hodgkin lymphoma," said Linda Weigand, technical supervisor and program quality assurance manager. "We generally provide this service to patients who have tried other therapies which were not successful.
"Our nursing staff collects autologous and related (family member) allogeneic hematopoietic progenitor cells using an automated apheresis procedure," Weigand added. "The progenitor cell processing lab is responsible for processing, packaging, labeling and cryopreservation of hematopoietic progenitor cells, stem cells and sometimes bone marrow. We can also receive and ship products for transplant to and from other hospitals around the United States."
Hematopoietic progenitor cells are immature cells located in the bone marrow and, to a lesser extent, in the bloodstream. These specialized cells create more blood-forming cells or mature into the body's red blood cells, white blood cells and platelets.
For SAMMC patients, transplant or "engraftment" procedures usually happen within a couple months after their collection. The two major transplant approaches used are autologous, which uses the patient's own cells, and allogeneic, which uses cells from related or unrelated donors, peripheral stem cell collection.
For autologous transplant patients, the patient's stem cells are collected between cycles of high-dose chemotherapy given before the patient receives chemotherapy to destroy the cancerous cells. In the process, the chemotherapy also destroys the patient's bone marrow.
After chemotherapy or radiation therapy is completed, stem cells are transfused back into the patient where they travel back to the bone marrow to produce mature blood cells and platelets.
During the next several days to weeks, transplant patients are dependent on blood donors and available blood products until their bone marrow fully recovers.
Allogeneic stem cells are donated by another person - a family member or a volunteer donor identified by one of the national marrow programs.
Donors must be screened and qualified through a medical questionnaire and tissue typing. The donor's tissue typing or human leukocyte antigen type needs to closely match the patient's type to help prevent the risk of graft versus host disease, a potential major complication following the engraftment procedure. This disease occurs when a donor's cells recognize the patient's cells as foreign and attack them.
"Several months ago, the program performed an allogeneic transplant with one identical twin donating for the other - a synergistic transplant - this was rare," Weigand noted. "The product was almost the same as an autologous. There was virtually no chance for a graft versus host reaction for the patient."
Once the stem cells have been collected, the progenitor cell processing lab removes any excess plasma and prepares it for a cryopreservation procedure. Cryopreservation is essential to improve cell storage and ensure the quality of the product for later infusion. Preparation removes excess plasma and adds a cryoprotectant to the product.
The staff then uses a control rate freezer to freeze the product steadily, but quickly, down to minus 150 degrees Celsius. Once frozen, the products are transferred into storage vats using either liquid nitrogen or liquid nitrogen vapor and can be stored up to 10 years.
The bone marrow transplant program at the Brooke Army Medical Center and the then-Wilford Hall Medical Center - a joint program at the time - was first accredited in 1988 by the Foundation for the Accreditation of Cellular Therapy. FACT is the only accrediting organization that addresses all quality aspects of cellular therapy treatments to include clinical care, donor management, cell collection, cell processing, cell storage and banking, cell transportation, cell administration, cell selection and cell release.
"The lab undergoes an inspection for re-accreditation every three years. For the years it's not inspected, staff members are required to submit documentation on procedures, registration, labeling, staff qualifications and training," Weigand said.
Additionally, the lab must also meet regulatory and accrediting requirements of the Food and Drug Administration, the College of American Pathologists, the American Association of Blood Banks and the Joint Commissioning requirements, making it one of the most regulated sections within the SAMMC.
For more information or questions about how to sign up to be a blood donor or a potential bone marrow/stem cell donor, call the Akeroyd Blood Donor Center blood donor recruiter at 295-4655 or 295-4989.
The center is open from 7:30 a.m. to noon, Monday through Friday. The center is located at B1240 Harney Road, behind Budge Dental Clinic on Joint Base San Antonio-Fort Sam Houston.
To find out how to can help the Armed Services Blood Program or to schedule an appointment to donate, visit http://www.militaryblood.dod.mil. To see photos or get the latest news, visit http://www.facebook.com/militaryblood
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