When and where did the first stem cell collection of a DKMS donor take place?
The first stem cell donation of a DKMS donor took place in March 1992 at the Eberhard Karls University in Tübingen. In total, there were 7 DKMS stem cell donations in that year. By comparison, today there are 21 DKMS donations per day worldwide. This really is a tremendous development, for which we are very grateful to our donors. Because every single donation is a second chance at life for a patient somewhere in the world.
How did it work back then, were the collection procedures different compared to today?
Initially, there was only one procedure: the bone marrow collection. This still works today in exactly the same way as it did back then. It involves a minor surgical procedure during which a bone marrow-blood mixture is taken from the donor's iliac crest; the stem cells are then extracted. In the second half of the 1990s, the peripheral collection was added. This is an outpatient procedure: The physician places a venous access into the veins of both arms and the stem cells are filtered out of the blood with an apheresis device. Normally, this takes three to five hours. Today, peripheral stem cell collection is the most commonly used method, accounting for 90 percent of collections. In 1996, this figure was only six percent; four years later, 24 percent of all collections were made using this method. At that time, the trend towards peripheral collection originated in USA but this quickly had widespread use internationally. DKMS made a concentrated effort to promote and supported its establishment in Germany initially. It is a very simple and fast method. Immediately after the collection, the donor can leave the clinic and it does not normally involve an overnight stay.
Has anything changed in the pre- and post-donation care for our donors since the first donation?
Essentially, nothing has changed. The health of our donors was our top priority then - and it still is and will be in the future. As far as preparation is concerned, the drug G-CSF, which our donors administer five days before the peripheral donation, is still the same as for the first peripheral stem cell collection. It is used to mobilize stem cells so that sufficient cells can be obtained from the blood. Even then, the drug was already established and safe, as it had been used for many years in autologous stem cell donation and family donation. Today, we can also rely on our 26 years of experience using G-CSF. Our systematic follow-up surveys of our donors, which we already performed for decades, have shown no evidence of late effects or long-term side effects, neither from the temporary loss of stem cells, nor from the use of G-CSF.
How perfect was the "perfect match" back then - in contrast to a match today?
There has indeed been a tremendous development concerning the typing profile. One crucial factor in the success of a blood stem cell transplantation is the degree of match between the tissue characteristics of donor and patient. This was already known at that time. However, the number of known HLA markers has multiplied: today, more than 33,000 are known. Our scientists at DKMS have also contributed to this, as they continue to discover numerous previously unknown HLA characteristics. In addition, over the years, further markers have been continuously added that are relevant for the success of a stem cell transplantation, for example the CMV status. Important milestones were also the advances in sequencing technology that enable high-resolution, high-throughput typing. As a result, it is now possible to determine the donor profile in much greater detail than in the past. The search for suitable donors is therefore much more precise - and so are the chances of survival and recovery for the transplanted patients.
Whoever registers with DKMS today receives a registration set with so-called "buccal swabs". Did the very first DKMS stem cell donors register in the same way?
Initially, registration was much more challenging, because a blood sample was required. This could be taken either at a public donor drive or at the family doctor's office. Today it is much easier: You order a set of "buccal swabs", as we call them, at dkms.de. You use them to take a simple cheek swab. Then you send the swabs in the provided envelope to our laboratory in Dresden for typing. You can also swab directly on site at one of our events. We first used the swabs to register new donors in 2007 - initially as a supplement to the blood collection procedure and for online registration, but since October 2017 we have been using them exclusively. They are high-quality medical products made of synthetic fibers. With these, the cells of the oral mucosa can be picked up particularly well during cheek swabbing. In order to improve the process, we have conducted extensive tests and continuously optimized the material. Another important achievement was made in 2017/18: our laboratory has developed a method for determining CMV status from cheek swabs. Since then, our donors receive three instead of two swabs for registration.