Bone Marrow transplant questions

I recently saw an episode of House MD, in which a teenage boy with leukemia was about to receive a marrow transplant from his brother. He’d already been irradiated - and the younger brother started sneezing. This of course kicked off a long, overly dramatic, convoluted search for the cause of the sneezing (and subsequent symptoms) because otherwise the marrow woulda killed the leukemia-stricken brother. And they only had a few days to do it because hey, they’d already nuked the patient’s own marrow.

OK - why do they do the nuking PRIOR to harvesting the marrow. I mean, what if the donor gets hit by a car on the way to do the donation. Couldn’t they harvest the marrow, freeze it for a couple of days, then do the transfusion?

Secondly: in this particular situation, couldn’t they buy the patient some time - at least a few days - by doing a lot of blood transfusions?

I don’t watch House, nor am I a bone marrow transplant expert, but I’m gonna guess that they don’t actually destroy the patient’s bone marrow before they have the harvested bone marrow in hand for exactly this kind of reason.

Hmmm… How long does it take to be sure the old marrow is fully nuked? otherwise the two marrows get into a rejection fight?

I like the episode if L&O where the guy was eliminated as a suspect due DNA mismatch against a blood sample, only to find later his blood DNA was different from his skin/semen DNA due to a bone marrow transplant.

Back when I watched House, I would go to this site after each episode. They have a detailed rundown of the medical information, and how closely it reflects reality.

I think you’re looking for the episode called Family.

I’m not sure if your exact question is addressed there - I didn’t read through all the comments and responses.

Thanks - no, they didn’t answer the question about why nuke before having the marrow already extracted. The site did talk about how bad the medicine was in the episode (a common problem with House). One that always amuses me: when someone needs a transplant, they seem to always obtain one AWFULLY quickly (like in this episode, the partial-match marrow from the registry). The boy would have been dead before they were able to track down the anonymous donor.

My friend is a haemotology/transplant nurse and I asked her about this. Basically the issue is timing. For an unrelated donor the ideal situation is to get the marrow out of the donor and into the patient within about 24 hours so harvesting early and putting it on ice isn’t possible. The cells don’t freeze as well and the transplant is more likely to fail. The patient, however needs to be prepped to receive the marrow by wiping out their immune system and killing all the existing marrow. This is a 7 day drug protocol and once the process has begun it cannot be stopped without pretty much killing the patient. If the donor has a mild cold they can give antibiotics with the other drugs and hope the patient doesn’t develop an infection or worse; a cold doesn’t automatically mean the transplant doesn’t go through.

My friend then proceeded to tell me stories of patients and their infections and deaths. It’s a sad, sad reality. My friend is amazing for doing this job but it’s a tough one with fewer happy endings than House.