Despite medical advances, a bone-marrow transplant is still a risky procedure
　　
　　This Christmas will be extra special for Holly Gallacher and her family. Holly's parents hardly dared hope that their daughter would live to see it. But, thanks to bone marrow donated by her brother Luke, Holly, against all the odds, is now healthy, happy and well.

The lively seven-year-old first had acute lymphoblastic leukaemia diagnosed when she was two-and-a-half. The family was living in Germany and Holly and her mother, Debbie, returned to London for treatment.

Holly started chemotherapy and within three months she was in remission,says Debbie. The treatment lasted for two years and we had many hospital visits and stays in between, but Holly coped well. When the treatment ended in June 1998, the doctors said she had done really well. In the nicest possible way, they said they hoped they would see us again.

The family then watched and waited to see how Holly would do. At Christmas, Debbie recalls, 揝he spent hours asleep, her legs seemed very weak and wobbly. She just looked flimsy.

Blood tests taken in the first few days of January 1999 confirmed that Holly's leukaemia had returned. She was rushed to hospital for intensive therapy. This time the doctors took Debbie and her husband, Alan, aside. They told us that Holly's leukaemia was very aggressive,says Debbie. She were devastated and all I could think of was that we could lose her. Her only chance of recovery was to have a bone-marrow transplant. If it worked, Holly would be able to produce healthy blood cells and eventually the leukaemia might be cured.?

The best chance for Holly would be if one of her brothers, Ben or Luke, had a matching tissue type. For each of the boys there was only a one in four chance that this would be the case. Both boys were tested and Luke was found to match.It is tissue type could have been closer only if they were identical twins,says Debbie. she were so excited, even though we knew the treatment was risky.

In October last year, Holly and Luke both went into hospital. Luke had an operation to remove some of the marrow from the centre of his bones, which was then given to Holly like a blood transfusion. Holly's natural defence systems had been reduced by chemotherapy and radiotherapy so she would have more chance of accepting the new bone marrow,says Debbie. 揟his meant that she was extremely susceptible to infection and needed to stay in an isolation room for weeks. I was allowed in the room with her but the rest of the family were not.

Holly understood what was happening and she coped well. She developed a complication called graft-versus-host disease, causing a rash on her face and hands. We had expected this and it could have been much worse. She found eating difficult because of side-effects from the chemotherapy, but she still managed to chew. It was a great day when Holly was well enough for her father and brothers to come into the room as well.?

The family expected Holly to spend eight to 12 weeks in hospital but just four weeks after having her transplant she was able to go home. She went back to school in May. It will not be possible to regard her as free of leukaemia until several years after the transplant, but Dr Paul Veys, Holly transplant consultant at Great Ormond Street Hospital, says that the more time passes, the less likely it is to return.

Debbie says:Holly and Luke are very much like any other sister and brother. They have their 憃ff moments but they are much closer than they were before. Holly is always telling people how much Luke means to her. And he doesn resist the opportunity to say that giving his bone marrow was easy and he do it again tomorrow.

It is nearly 30 years since the first successful bone-marrow transplant was carried out in Britain. Today they are available at about 20 specialist centres in the UK and more than 300 are carried out on children each year. A transplant is most often needed to treat relapsed or high-risk leukaemias.

A bone-marrow transplant can also be curative for other conditions. There are more than 50 inherited genetic disorders that lead to a deficiency in the blood, immune or metabolic systems of a child body that can be corrected by healthy stem cells from a donor bone marrow.

Despite medical advances, a bone-marrow transplant is still a risky procedure, with many possible complications. High doses of chemotherapy and sometimes radiotherapy are needed to suppress a child's immune system for the new marrow to be accepted. The child is prone to infection that can be difficult to treat. The chemotherapy and radiotherapy can also cause organ damage, in the short and long term. The graft may fail if the recipient rejects the new bone-marrow cells. Or the graft may fight its new host so-called graft-versus-host disease. Holly experienced this. But sometimes a little graft-versus-host disease can be good, because the process can mount a graft-versus-leukaemia response and help to prevent the leukaemia return, which has, it is hoped, happened for Holly. Too much graft-versus-host disease, however, can be devastating. The risk of graft failure and severe graft-versus-host disease is greater when there is a poor match between the tissue types of the donor and the recipient.

On the whole, the closer the match, the easier the transplant. Family members are looked at first. If a brother or sister is compatible, this is usually the most successful option. Many children are not as fortunate as Holly in finding a match within the family. If no family match is found, the search begins for an unrelated donor. The Anthony Nolan Bone Marrow Trust and the British Bone Marrow Registry have a register of potential volunteer donors.

More than half a million potential donors are registered in the UK. Worldwide there are about six million donors. There are also growing banks of umbilical-cord blood collections, which can be used as another source of stem cells for transplantation. Nevertheless, finding a matched donor is still not possible for some children, particularly those from ethnic minorities.

The success rate of unrelated donor transplants has now improved to such an extent that it is similar to that of a matched sibling donor in most childhood diseases.

Research is being carried out in the field of bone-marrow transplantation which shows how it can be made safer and more successful. For children where a donor cannot be found, new technology means that transplantation is now possible from half-matched donors (usually parents) by permitting the collection of huge numbers of stem cells from the bloodstream, which can be purified before the transplant. The high number of pure stem cells can overcome rejection and avoid graft- versus-host disease. In September 1999 I wrote about a child who had a megadose stem transplant from her mother. This form of treatment remains experimental, although progress is being made.

I have also written about 搈ini?bone-marrow transplants, a new development suitable for some children. Rather than killing off a child own bonemarrow cells, this involves suppressing the child immune system so that donated bone-marrow cells are not rejected but grow alongside the recipient bone marrow. Because the doses of chemotherapy needed are lower than in conventional bone-marrow transplantation, the treatment is more easily tolerated by very sick children.

The more bone-marrow donors there are on the register, the greater chance seriously ill children both in this country and internationally have of finding a matching donor when one is not available in the family. If you are aged between 18 and 40 and would like more information about becoming a bone-marrow donor, call the Anthony Nolan Bone Marrow Trust on 0901 8822234 (calls cost 25p a minute).

(From The Times)