Evgeniy Danilovich Pashanov, physician, Doctor of Medical Sciences, tells:

  "Two medical centers in Russia work on the problems of marrow transplantation - one in St. Petersburg and the MT section of the Russian Children's Clinical Hospital (RCCH). It is here where the majority of the most complicated transplantations are carried out - the allogenic ones, meaning from a donor to a patient. The MT section has been operational for 7 years already. The first transplantation was in January 1993. It was successful and the patient is still alive. More than 50 transplantations have been carried out during the time of the section's operation.
 
  An ill marrow produces anomalous blood cells and thereby causes deadly illnesses. The point of a marrow transplantation is to replace the sick marrow with the healthy marrow of a donor. A transplantation is done in cases of different blood sicknesses (different kinds of leucosis, aplastic anemia), some cancers, immunity deficiencies and the variety of congenital inherent sicknesses. It is necessary to take into account that a marrow transplantation is done only for deadly ill children when no other therapy can help. Chemotherapy cannot help these children, only transplantation can save them, this is their last chance. The donor for an allogenic transplantation is, in most cases, a relative of the sick person - his or her brother or sister. Ideally the donor should be compatible with the patient. The compatibility of the donor's and the patient's marrow is tested by the special type-determination - a complicated kind of analysis, taking into account many parameters. In some cases, an incompatible marrow is transplanted; in those cases, it should be cleared from the cells which can cause different complications during the post operational period. In most cases, a compatible marrow of a brother or a sister is used. The donor recuperates quickly, in about a week. MTs became available for the masses in the 80s. Since then, donors have been monitored and no complications after a marrow take have been observed by the specialists. The marrow is taken in a surgery unit by means of a surgery from the back podvzdoshnie bones of the donor and then intravenously injected, as any other medicine or blood product. The transplantation procedure itself, from the technical or the surgical point of view, is not complicated. The main problem is treating the patient directly before the transplantation, when he or she gets an intense chemotherapy as a result of which the space for the new marrow is cleared. It is necessary lest the transplant is rejected. Also, it is rather difficult to follow up with the patient in the early post transplantation period, until the moment the marrow is accepted. During this period, the children get additional therapy causing temporary immunity defects and the danger of the development of lethal infection complications, viral as well as bacterial, which don't pose any danger for a healthy child.
 
  In addition, doctors have to take into account the toxicity of the drugs, because all the chemicals that children get are toxic for different organs. As a rule, the liver, kidneys, lungs, nerve system and heart suffer. In order to prevent these complications, a certain approach to a child's additional therapy is also necessary. Basically, the job of a physician in the MT section is in this complex of treating a patient. During the process of transplanting a marrow, there are two essential dangers to the patient's life. The first one is the transplant seizure; when the patient rejects the marrow. The second one is the reaction of the transplant against the host (RTAH); when the marrow is accepted but starts to act aggressively against different organs and tissues of the patient. A light form of RTAH is favorable, because it shows the additional effect of the healthy marrow against the remainder of the sickness. One can speak about the positive result of the marrow transplantation about 2-4 weeks after the operation. During this time, the acceptance of the donor marrow should happen (or not happen), which is tested by means of different biological investigation techniques. When the acceptance takes place, the patient gradually recovers. During many months, using high-tech methods, doctors of the section control to what degree the marrow is accepted, what percentage of the cells in the marrow and in the peripheral blood is donor's and what percentage of the host's cells is left. If the acceptance of the transplant doesn't happen, most often there is an opportunity to re-transplant, i.e. make, if the condition of the child allows, a second marrow transplantation." 

 

  Elena Vladimirovna Skorobogatova, the head of the MT section, Doctor of Medical Sciences tells:

  "Here, in RCCH, 64 marrow transplantations have been made. The approximate cost of a transplantation for one child is $ 50,000 (fifty thousand US dollars). The cost includes medications, materials used and disinfectants. More than 50% of medications and other materials are bought from the budget money but it is very hard to cover a transplantation in full. In order to cover all the expenditures, out-of-budget sources of financing are necessary: humanitarian aid and the support from the regions. Naturally, we can only start the transplantation when we are confident that the transplantation will not be aborted in two-three weeks because of the shortage of medications. 
 
  Before the MT, we place a child in a sterile box, having mounted onto him or her the central venous catheter beforehand, and begin to treat him or her with anti-fungus, antibacterial and antiviral drugs. Then, the chemotherapy is given for about a week. In order for the donor marrow to get accepted, it is necessary to almost completely destroy the marrow of the patient. The chemotherapy given is so aggressive that if you don't implant the marrow after that, the blood creating mechanism will not recover and the patient will die. All of the rooms in our section are equipped with anti- microbe filters and the air which, under pressure, comes into the rooms is purified from any microbe particles. The patient breaths absolutely pure air and all of the surfaces inside the box are washed with disinfectants daily. Everything that the patient touches must be sterile, because his immunity after the chemotherapy and the transplantation is so weakened that his susceptibility to any infection is very high compared to a normal person. That's why all the doctors, medical staff and the parents prior to entering the box must put on a mask, a hat, a sterile robe, gloves and special shoes. The transplantation day here is day 0, before the transplantation - this is the day "minus", -1 day, -2 day, -14 day, and after the zero day goes the day "plus", +1, +10. After the marrow is transplanted (2-3 weeks pass until the donor marrow starts functioning, or his own transplanted auto marrow, the patient is most vulnerable and defenseless facing the infection. Besides that, at this moment, the toxic complications are developed because of the chemotherapy, and the patient suffers the strongest pain because of the damage to the mucous membranes. The children do not eat but are fed through a vein until they can eat themselves and the food is again assimilated. On average, they are fed artificially for a month. When the first leucocytes appear, the patient starts eating sterile and specially prepared food. (The parents cook all this food; they are continuously near the child, day and night, taking care of him or her and supporting him or her morally.)" 

 

  Mother of a 10 year old girl from the MT section tells:

   "The person must not be left alone with her pain, she must share it with somebody: the child must not be alone day or night, nor for a little period of time. If the child feels pain she must always know that there is somebody near and that somebody is talking to her. You should talk to her like to an absolutely healthy normal person, you should not treat her like a crystal vase - talk less about the pain, tell her what is going on around her as if she is like everyone else.
 
  When you spend less time with the child, you begin to fear the sickness more, but you must not fear or the child will feel it. Your confidence is the confidence of the child. If you come to her and say that it's all right, it already happened to somebody else, and now what is happening to you can be forecasted, it's bad two or three days but then it's going to get better... My child started a little journal and marked the days: "very bad", "completely bad", "somewhat better". And when she felt the worst she took a pencil, made some movements, marked, and she got a little distracted. So, she kind of did her book keeping. "Today you feel as bad as yesterday?", "Today is a little bit better". "You see, better, told you!" She is a such person that she must know everything in advance. If something must happen it's better to tell her in advance to prepare her. Then she gets mobilized somehow and is ready. Emotional comfort is much more important then anything else I think. Everything that is required of doctors they'll do, but the child must also have the right mood: the child should not get absorbed by her illness, become alone, withdraw into herself, think about the disease or think about the pain. On the contrary, she must disengage herself from all of that and try to get through it as quickly as possible. One must find something good to focus on like:" Anyway, you are beautiful, cute, etc." When her skin began to shed we told her: "You are like a pupa now, you were a little caterpillar but soon you'll be a butterfly". Then when she was looking at herself she said:" Well, my skin is whiter now". And when her face began to show, we said: " You see, Nasten'ka, you look much more like a little person now". She says: " Yes, of course, and soon I will become a butterfly". 
 
  This game was also well assumed by the doctors and nurses. Even when we were doing very poor and we had to sit there with her till the morning with the doctors, everybody came, played with her like with a healthy normal child."