The call from the National Marrow Donor Program (NMDP) seemed to come from out of nowhere, but it bore some hopeful news: Dana-Farber senior project manager Alexandria Monteiro’s stem cells were a match for a stranger with leukemia who needed a stem cell transplant.
“I don’t remember signing up,” Monteiro admits, “but based on who I know myself to be,” she continues, “it does sound like something I would have done.”
According to the NMDP, she had done so 12 years ago in college when her career in health care was just a dream.
An unlikely match
Despite the surprise, Monteiro came to her decision quickly. She could not pass up an opportunity to potentially help cure someone’s leukemia.
A stem cell transplant can be a lifesaving treatment. Some blood disorders, including cancers like leukemia and lymphoma, originate from a malfunction in the stem cells which produce either dysfunctional blood cells, too many cells, or too little.
In some cases, through a process called an autologous transplant, physicians are able to essentially restart the immune system by reinfusing the patient’s own stem cells after treatment that eradicates dysfunctional and cancerous cells. For most leukemia patients and some lymphoma cases, however, oncologists rely on allogeneic transplants, meaning a donation of someone else’s stem cells.
In this process, chemotherapy is used to purposely suppress the immune system so that it does not fight the new donor cells as the new stem cells settle, allowing them to produce new white blood cells that will hopefully fight the cancer.
Donor stem cells need to be a close genetic match. Otherwise, the recipient’s immune system may reject them regardless of immunosuppressing treatment, or the patient could develop an inflammatory condition called graft versus host disease. Sometimes, a relative can donate their stem cells, but in around 70 percent of cases no one in the family is a match. In those cases, physicians turn to the NMDP, a worldwide database of potential donors like Monteiro. Still, there aren’t always matches in the registry.
“Some patients have thousands of matches out there, but some patients have none,” says Robert Soiffer, MD, codirector of the Adult Stem Cell Transplantation Program. “That’s because they may have hard-to-find HLA types. It’s much harder to find a match for someone who isn’t from a white, northern European background.”
“That’s why it’s a no-brainer for me,” says Monteiro, who will take any opportunity to help someone in need. “That’s how I was raised.”
The daughter of immigrants from Cape Verde who built their lives in Dorchester, Mass., Monteiro saw early on how community support can change lives.
“Other people did a lot to carve out the path that I’m walking on,” she explains. She has since led a life centered on paying that work forward.
Destined donation
Monteiro’s choice to donate through Dana-Farber Donor Services was also an easy one. A senior project manager in the Business Operations and Provider Services Department at Dana-Farber, Monteiro has found her dream role supporting a mission that is fundamentally about helping people.
“This has come full circle,” she observes. “What I signed up for 12 years ago is directly connected to what we do here day-to-day at Dana-Farber.”
The Dana-Farber Donor Services Program takes a comprehensive approach to managing and collecting stem cell donations with dedicated advocates and clinical teams to ensure a donor’s health and safety. They provide education for, and facilitation of, donations via bone marrow or through the blood circulating in the donor’s body.
Sometimes a cell donation will require an operation under anesthesia to harvest stem cells from the bone marrow, but Monteiro was able to donate through a process using her peripheral blood. Before donating, she was given shots to raise the number of stem cells circulating in her blood. Then, a machine collected her blood, separated the stem cells (a process called apheresis), and returned the rest of her blood cells to her.
Monteiro needed to sit for around seven hours, but she shrugged that off. “Just another workday,” she jokes.
The donation process may be long, and some donors can experience side effects like fatigue, but it is harmless, and the body will regenerate the appropriate stem cells. For Monteiro, it was nothing compared to the feeling that she has potentially changed someone’s life.
“Being a donor, you are providing the gift of life to a patient,” says Soiffer. “But it’s also a gift to be able to give. Most of us never have an opportunity to save a life, but this is what bone marrow and stem cell donors do.”
“It’s an honor,” Monteiro says, reflecting on the experience. “It affirms to me that our deeds – regardless of how big or small you might think they are – can make an impact.”