The first attempts to transplant bone marrow—tribute to Jan Raszek-Rosenbusch and Franciszek Groër.

Bone marrow transplantation is now a mature therapeutic method, but it was developed over many years and started from the idea that bone marrow may contain some factors of curative potential and thus could be used as a medicine for blood disorders. The first attempts to administer bone marrow in a manner allowing (at least theoretically) its engraftment are usually assigned to Edwin E. Osgood and collaborators from Oregon University [ 1 ], who reported in 1939 that they had transfused intravenously bone marrow to a patient with aplastic anemia who died five days later. Little attention is being paid to the attempts described in 1949 (but carried out in the years 1938–1941) by Jan Raszek-Rosenbusch (later using Raszek as the only surname) and Franciszek Groër to administer bone marrow intramedullary in King John Casimir University in Lwow, Poland (now Lviv, Ukraine) [ 2 ]. While performed in the years when knowledge of hematology and the physiological role of the bone marrow was still in its infancy, these attempts had the objective of transfusing with the bone marrow “‘unknown, but necessary biological factors. responsible for the normal structure and functioning of the hematopoietic system.” Donors and recipients were matched for ABO blood groups and were unrelated. Donors were usually adults, and recipients were children. Several milliliters of bone marrow were aspirated from the sternum of the donor and immediately injected into the sternum of the recipient. Procedures were repeated on the same recipients several times. No immediate or delayed toxicity with this procedure was observed, while some improvements in general condition were reported. These improvements are difficult to comment on because of uncertainties in matching the diagnoses reported (unspecified anemia with jaundice and “lymphadenosis aleukemica”) with contemporary nomenclature. Of course, there was no HLA match, no conditioning, no chimerism studies performed, and the description of the effects did not conform to today's standards. So this was only an attempt to transplant, and not yet a transplantation. Interestingly, the reported clinical attempts by Raszek-Rosenbusch were apparently preceded by experiments on rabbits, but the only document to confirm this is a photo (Fig. 1 ) from 1938 showing four doctors and two anesthetized rabbits. According to late Irena Raszek (sister of Jan) they drilled a hole using dentist drill in the head of femoral bone of one rabbit, collected bone marrow and injected it into femoral bone of another rabbit. After finding that rabbits easily survive this procedure, they have started clinical trials. Besides original publication by Raszek-Rosenbusch [ 2 ], more recently a movie was found [ 3 ] prepared by Soviet authorities most likely in 1940 when they transiently occupied Lwow at the beginning of WWII. Excerpts from this movie are shown as Fig. 2 . As shown, Professor Groër is first pointing to two people lying side by side: a child (recipient on the right) and an adult (donor on the left). Then Dr. Raszek is inserting a sternal needle into a child and is checking that the needle is really in the marrow cavity. Then one can see a needle in the sternum of the donor. Subsequently, Dr. Raszek is aspirating marrow from the donor and then injecting this marrow into the recipient. Finally, Professor Groër, Dr. Raszek, and the third doctor of unknown identity congratulate the recipient. As shown on the timer at the bottom of the screen, the entire procedure took approximately one minute and was very different from the contemporary technique. The intramedullary route was chosen because it was not known at the time that marrow components from the donor might reach the recipient’s marrow when infused intravenously. Fig. 1: Preclinical attempts to transfer bone marrow intramedullary were done on anesthetized rabbits. Full size image Raszek-Rosenbusch, the third from the left. The identity of the other doctors in the photo is unknown. Fig. 2: Excerpts from the Soviet movie from 1940 in occupied Lwow. Full size image The order of photographs is determined by the timer at their bottoms: First prof. Groër is pointing to the recipient (on the right) and the donor (on the left). Then Dr. Raszek-Rosenbusch is checking that the needle is properly inserted into the sternum of the recipient. Subsequently, a needle in the sternum of the donor is shown, and as the next step, Dr. Raszek-Rosenbusch is collecting marrow from the donor. Finally, Dr. Raszek-Rosenbusch is injecting donor marrow into the recipient's intramedullary space. In the last photograph, Professor Groër, Dr. Raszek-Rosenbusch, and the third doctor of unknown identity congratulate the recipient.