Melissa Macalisang

Father Donates Marrow to Save Young Daughter's Life

By Erica Holt

Photo: Tom Seawell

Today, a few scars on Melissa Macalisang's chest are the sole reminder that she was once very sick.

The 9-year-old can't remember the nightmare that began six years ago when her parents, Maria and John-John Macalisang of Daly City, Calif., decided to take her to the emergency room after months of unexplained bruises, pallid skin and cold symptoms.

"Melissa said she couldn't breathe and she was so pale," Maria remembers.

When emergency room doctors examined the toddler, they believed she had asthma, possibly an iron deficiency, and were ready to send her home. But despite doctors' orders, Maria persisted for more tests. "I know Melissa and I knew something more was wrong," Maria said. "I insisted on a blood check." And her mother's intuition proved right. Melissa's blood counts were drastically low, and she was swiftly transferred to UCSF Benioff Children's Hospital to see its experts in pediatric bone marrow transplant and blood disease.

The next day, UCSF doctors did a biopsy on Melissa's bone marrow. Maria and John-John were shocked at their daughter's diagnosis.

"They said she had severe aplastic anemia," Maria said. Aplastic anemia is a rare disease where the bone marrow fails to produce enough red cells, white cells and platelets—all needed to keep a body healthy and alive. Children with the disease may experience symptoms similar to Melissa's—pale skin and fingernails, rapid pulse, fatigue, and abnormal bleeding including multiple bruises.

"We didn't know what the disease was or what to do about it and the UCSF group really helped us out. They explained the sickness, gave us support and helped us find a doctor," Maria said.

Melissa was referred to UCSF's Pediatric Blood and Marrow Transplant Program. A transplant from a tissue-matched relative is the treatment of choice for severe aplastic anemia. Unfortunately, Melissa did not have a matched relative, so she underwent a year of drug therapy in hopes it would cure her illness. "There is about a 70% response rate with most of the responders getting at least a transient response and some actually going into a durable remission," says one of Melissa's specialists, Dr. Morton J. Cowan. But the drugs didn't work for Melissa, so Cowan and his colleague Dr. Biljana Horn determined she would need a transplant to save her life.

UCSF doctors and her parents then began the search for a donor. But even after checking with family in the Philippines and unrelated donors in the National Marrow Donor Program, no match turned up for Melissa, who stayed upbeat despite feeling sick. "She was ready for whatever happened—a true fighter. In fact, it is from her where we get our strength," says John-John.

Fortunately, UCSF is an innovator in developing ways for patients to receive bone marrow or blood stem cells from a donor who may or may not be a relative. "A matched sibling is always the best. If we can't find a matched sibling, we look for a matched unrelated donor. If we can't find that, then we use a parent or a half-matched sibling or uncle, or cousin," Cowan says. Ultimately, Melissa's father John-John was picked to be the donor because Maria was pregnant with the family's third child.

Because a parent is half-matched to his or her own child, UCSF uses a unique process to make the bone marrow safe to transplant. The process took about two weeks for John-John and his daughter, including chemotherapy and radiation treatment for Melissa. John-John remembers the entire team, which includes doctors, nurses, social workers, child life specialists, pharmacists and nutritionists, becoming like family.

"They treated us as their family, their friends, and of course, as their patients," he recalls. "During the chemo, one of the personal care attendants treated Melissa as her daughter, cleaning her up and even buying her a comb. Of course, the hair fell out eventually, but it is the care that lingers to our minds."

Then in March of 2002, Melissa, who was nearly 4 years old, had her transplant. Instead of undergoing an operation, the UCSF doctors extracted John-John's bone marrow stem cells using leukapheresis. During leukapheresis, blood is removed from the patient and passed through a special machine, which collects those white cells that contain the bone marrow stem cells that are present in the blood. The remaining blood is returned to the patient.

John-John will never forget the support of Melissa's doctors. "What Drs. Cowan and Horn said really stuck in our minds: 'One day at a time.' Those words of wisdom really did help," he recalls. "We felt at home. You can really feel the love that they have for their patients. Not only because they are just doing their jobs, but along the way you can feel the warmth of their care. We really felt that Melissa was in good hands. That is why we never did change our hospital."

Following six weeks of recovery at the hospital before returning home, Melissa got stronger and stronger every day.

And now, the playful 9-year-old looks as healthy as ever, without any mask of a life-threatening disease. She has a passion and talent for art and theater, has been cast as a princess in her school play and is active in her student council.

Despite all of their struggles, John-John and Maria continue to think optimistically about their daughter's ordeal. "The tendency is to forget the nightmare that she has been through," says John-John. "But it didn't affect Melissa's emotional stability. In fact, it made her a stronger person. Not to mention, a good kid and a very loving daughter."

Story written in April 2007.

Erica Holt is a freelance writer in San Francisco.

Related Information

UCSF Clinics & Centers

Blood & Marrow Transplant

Blood and Marrow Transplant Program
1975 Fourth St., Sixth Floor
San Francisco, CA 94158
Phone: (415) 476-2188
Fax: (415) 502-4867

Blood & Marrow Transplant Clinic
1825 Fourth St., Sixth Floor
San Francisco, CA 94158
Phone: (415) 353-2986
Fax: (415) 502-4867

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