Woman meets the stranger who saved her life

By Sabrina Rubin Erdely

updated 9:58 a.m. ET Nov. 23, 2009

Anna Robinson's first clue that something was terribly wrong came just after she had flown home for summer vacation in 2006. She'd finished her junior year at Smith College in Northampton, Massachusetts, and was looking forward to a relaxing summer in Seattle, working at a neighborhood convenience store and hanging out with her boyfriend—a welcome change of pace from the pressures of her engineering major. For Robinson's flight westward, she'd stuffed her things into a rolling duffel bag, which had gently nudged the back of her legs as she walked through the airport. By the time she got home, her thighs and calves were mottled with bruises.

"You should go to the doctor," her father suggested, but Robinson, a slight, freckle-faced 21-year-old, demurred; she was a low-key person who didn't like to make a fuss. "It will go away," she assured her dad. Instead, in the coming weeks, purplish-green bruises bloomed all over her body, standing out against her fair skin. Soon her vision was marred by spots, and the two-block walk to her job became exhausting. She tried not to worry. "I figured there was some simple explanation, like I wasn't getting enough vitamins or I needed to exercise more," she remembers. Finally, by late August, when she couldn't climb stairs without getting dizzy, she agreed to see her family practitioner. That's how Anna Robinson discovered she had leukemia.

Within days, a bone marrow biopsy revealed the grim details. Robinson had an aggressive cancer called acute myeloid leukemia (AML). Normally, the stem cells inside the marrow of our bones produce immature blood cells, which differentiate into red cells, white cells and platelets. But an alarming number of Robinson's immature cells weren't developing properly—they were cancerous and accumulating at a frightening rate. Cancer cells crowded her bloodstream, leaving her with too few red cells to carry oxygen, white cells that were unable to patrol for foreign invaders and not enough platelets to clot injuries. And there was one last cruel complication: Robinson's cancer sported a mutation called FLT3, a sign it was extra resistant to standard treatment. Her oncology team at the Fred Hutchinson/University of Washington Cancer Consortium in Seattle concluded that chemotherapy alone wouldn't be enough to save her.

For Robinson—lying in a hospital bed with an IV port implanted in her chest to deliver medications and transfusions, her parents and younger sister standing in a worried knot by her bedside—the whole situation felt unreal. "I thought I'd wake up and it would all be a dream," Robinson remembers. Days earlier, she'd been packing to start her senior year of college. Now she was in a fog of chemotherapy, receiving repeated blood transfusions—and facing her own mortality. There was but one ray of hope, she was told: a bone marrow transplant.

Say the words bone marrow transplant to anyone and the first reaction is probably a wince. "People imagine drilling through bone and pain and a long recovery," says Katharina Harf, executive vice president and cofounder of the donor-recruitment organization DKMS Americas in New York City. In fact, nearly three quarters of so-called bone marrow donations involve no removal whatsoever of bone marrow—they're done by extracting blood stem cells intravenously from the arm, like giving plasma. (Some doctors now prefer the term "stem cell transplant," because both marrow and blood house these vital cells.) If the transplant takes, with the help of antirejection meds, the recipient's blood-making stem cells are replaced with the donor's, which become new, healthy blood cells for the rest of the patient's life. Meanwhile, the donor's body immediately begins making more cells; within a month or so, her supply is entirely replenished. "You go on with your life as if nothing happened—except you've saved someone else's life," Harf says.

The donation may be relatively simple, but the science behind a bone marrow transplant is rigorous. For the procedure to succeed, donor and recipient each must possess a specific pattern of proteins called HLA (human leukocyte antigens). It's a needle-in-a-haystack sort of search, because the proteins have 10 billion possible combinations—"more than there are people on earth," notes Jeffrey Chell, M.D., the CEO of the National Marrow Donor Program (NMDP) in Minneapolis, which runs the nation's centralized registry. Even with 7 million people on the registry, only 3 out of 10 patients needing a transplant receive one.

Recruitment organizations have sprung into action by holding drives for specific patients—especially for African-American and Hispanic patients, whose need for donors is particularly urgent. However, recruitment efforts face major hurdles: not only a lack of public awareness but also a chronic lack of money. The genetic testing is so complex, recruitment groups spend $100 to process each potential donor; the 450,000 donors who registered in 2008 bore a price tag of $45 million.

Umbilical cord blood donations—which contain stem cells that are less mature and thus more adaptable and easier to match—cost even more. Because the registry must spend $1,500 to process and freeze each donation, most new moms aren't even given the option to help. (A list of the 200 participating U.S. hospitals is available at www.bethematch.org/cord.) In 2005, Congress pledged $79 million to increase cord-blood donations by 2010, but it has provided only about half the promised money.

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To make up for the shortfall, the NMDP and other organizations raise money in communities and are appealing to Congress to make good on its pledge. In the meantime, the lives of an untold number of people are left to the charity of anonymous strangers.

Katie Quinn was feeling dejected as she headed out of the annual Greek Week blood drive at the University of Missouri at Columbia in the spring of 2007. She had been all set to represent her sorority, Kappa Alpha Theta, by giving a pint. But a finger prick revealed that her iron was too low to qualify. The red-haired 20-year-old nursing student was genuinely disappointed as she slung her book bag over her shoulder and started off to class. So when she heard a young woman at a booth call out, "Hi, would you like to sign up?" she stopped walking.

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