When Andrea Brault was diagnosed with acute myeloid leukemia in September 2025, her family in Farmington began a search that has consumed the better part of a year and exposed a gap in the American bone marrow donor system that few people outside oncology fully understand. Her three daughters, Eliza Martin, Olyvia Gibbs, and Aleigha Brault, organized a community swab drive in March, brought roughly 40 people through a fieldhouse in Farmington in a single afternoon, and helped push their mother’s odds in a process where odds matter enormously. In late April, after months of waiting, Andrea found a match through a national donor registry. She is now preparing to receive the bone marrow transplant that her doctors say offers the best chance of long-term remission. Her story, as told this week by New Hampshire Public Radio, is on its surface a hopeful one. Underneath that story is a much harder fact: for Black patients and other patients of color, the math of finding a match is fundamentally different from the math facing white patients, and that difference is killing people.
What acute myeloid leukemia is and why a transplant matters
Acute myeloid leukemia, commonly abbreviated AML, is a fast-moving cancer of the blood and bone marrow. It begins when a single hematopoietic stem cell, the kind of cell responsible for producing blood, mutates and starts producing abnormal white blood cells that crowd out the healthy blood-forming cells the body needs. Without treatment, the disease progresses within weeks rather than months. Even with aggressive chemotherapy, AML has a notoriously high relapse rate, which is why doctors typically push patients toward an allogeneic bone marrow transplant when one is feasible. The transplant essentially resets the patient’s blood-forming system by replacing it with healthy stem cells from a compatible donor.
Compatibility is where the system gets unforgiving. Doctors look for matches based on human leukocyte antigens, or HLAs, a set of proteins on the surface of most cells in the body that the immune system uses to distinguish self from not-self. The closer the donor’s HLAs match the patient’s, the lower the chance that the patient’s body will identify the transplanted cells as foreign and attack them, a complication called graft-versus-host disease. The standard right now is a so-called eight-out-of-eight match, meaning the donor matches the patient at all eight of the most clinically relevant HLA loci.
“We try to provide a perfect match if we can, meaning that the donor is matched at eight out of eight different locations in the gene to be a good donor for a person with leukemia,” Dr. Alison Loren, who directs the University of Pennsylvania’s bone marrow transplant program, told NHPR. A perfect match, Loren said, means the patient’s body is less likely to reject the transplant.
The donor-pool gap that hurts patients of color
This is where the system breaks down for many patients. HLA types vary by ancestry, often substantially. The national bone marrow registry, run by the nonprofit NMDP (formerly Be The Match), is overwhelmingly composed of donors of European ancestry, a reflection of who has historically been recruited and who has historically signed up. That demographic skew has direct consequences for patients.
According to Loren, roughly 80 percent of patients with European ancestry can find a perfect match through the registry. For patients with African ancestry, the figure is closer to 30 percent. The gap is not theoretical. It translates into longer waits, less optimal matches, more graft-versus-host disease, and more deaths among patients who otherwise might have lived. Patients with mixed ancestry, including many of New Hampshire’s growing population of multiracial families, face additional difficulty because the rare combinations of HLA markers that result from mixed ancestry are even less represented in the registry pool.
That is the math that made Andrea Brault’s diagnosis so much harder to navigate than a casual reader might assume. The fact that she eventually found a match through the registry is, in the context of those numbers, both a relief and a reminder of how many patients in similar situations do not.
How the Brault family responded
Eliza Martin, Andrea’s daughter, did what families in this situation increasingly do: she went looking for ways to widen the pool. Working with her sisters, she organized a bone marrow registration drive at a fieldhouse in Farmington on March 14, 2026. The event was equal parts community gathering and clinical recruitment. Pizza, balloons, streamers, and music filled the fieldhouse. Prizes were raffled off to people who agreed to swab their cheeks and submit their samples to the national registry. Roughly 40 people came through and registered. The drive did not directly produce Andrea’s match. Most marrow donors who eventually help a patient are matched months or years after they sign up, with someone they will never meet. But every additional registered donor changes the odds for someone, and that was the point of the afternoon.
Drives like the one in Farmington have become one of the more important supply-side responses to the donor-pool gap. National organizations have spent years trying to close the disparity through targeted recruitment at historically Black colleges, Hispanic community organizations, AAPI cultural centers, and tribal health programs. Local drives organized by patients’ families add a layer of community urgency that registry recruiters cannot replicate. A swab in Farmington feels different when the person asking you to do it is the daughter of the woman whose life depends on it.
The drive also illustrates something about how cancer care actually happens in northern New England. Patients in places like Farmington often travel to Boston, Lebanon, or Burlington for high-acuity treatment. The volunteer infrastructure that supports them, the meal trains, the fundraisers, the bone marrow drives, is built in the towns they came from. New Hampshire’s small-town density makes that infrastructure unusually visible. It also makes the gaps in the donor pool unusually visible when families like the Braults run into them.
What donating bone marrow actually looks like
One of the most persistent obstacles to bone marrow donation is fear. Many people imagine an extraction procedure that involves a long needle, deep anesthesia, and substantial recovery time. The reality, for the vast majority of donors today, is much less dramatic.
Loren described the process for NHPR. Donors typically take an injectable medication for about five days. The medication mobilizes stem cells out of the bone marrow and into the bloodstream, which means the actual donation can be done by a process called peripheral blood stem cell collection rather than by surgical extraction from the hip bone. Donors then go to a collection center near their home and have an IV placed in each arm. They sit, awake, for several hours while a machine separates their blood into platelets, plasma, and white blood cells. The unneeded components are returned. The whole process is more like a long blood donation than a surgery.
“Sitting for a few hours with an IV in your arm isn’t usually particularly enjoyable, but it’s not terrible, especially if you think that you’re saving a life by doing this,” Loren told NHPR.
A small percentage of donors are still asked to do a traditional surgical bone marrow harvest, typically when the recipient is a young child or when peripheral collection is medically inadvisable. For those donors, the procedure is done under general anesthesia, takes one to two hours, and produces some hip soreness for a few days. By any clinical standard, both procedures are remarkably safe.
What recovery looks like for Andrea Brault
Andrea’s recovery so far has been a cycle of hope and setback that will be familiar to anyone who has watched a family member through aggressive cancer treatment. A routine lung biopsy and the chemotherapy that followed weakened her immune system and left her unable to talk for a stretch. Her family describes her booming laugh as a whisper now. As her recovery has progressed, she has been able to speak, in a soft voice, about what she wants to do once the transplant is done. She wants to finish her bachelor’s degree. She wants to eventually earn a master’s in social work. She wants to return to her work as a substance use counselor in her community.
Eliza Martin says her family is leaning on their faith to see her mother through. She told NHPR that her family really believes that God has a hand in this and will work it all out for his greater good. The next several weeks will determine how the transplant takes and how soon Andrea can come home. Her family describes her as the best mimi in the world. They are all focused on getting her back.
How New Hampshire residents can help
For New Hampshire residents who want to help close the donor-pool gap, the most direct action is to register as a potential bone marrow donor through the NMDP. The process starts with a cheek swab kit that the registry will mail at no cost. Donors aged 18 to 40 are most often called on because younger donors typically produce better outcomes for recipients. People of African, Hispanic, Asian, Pacific Islander, Middle Eastern, and Indigenous ancestry, as well as people with mixed-ancestry backgrounds, can have an outsized impact on closing the gap by registering.
For families currently navigating a serious diagnosis, the experience of the Brault family also points to a broader truth about the New Hampshire health system. Local volunteer infrastructure, including swab drives, meal trains, and fundraisers, often makes the difference between a patient who can focus on getting well and a patient who has to spend energy holding her household together. Our recent reporting on access and quality of care has covered both the impact of the Exeter Hospital merger on patient experience and the difficult choices facing rural health programs after Medicaid changes. For families dealing with mental health and substance use intersections in cancer care, our coverage of Gov. Ayotte’s wraparound mental health services debate is also relevant.
Andrea Brault is, in a real sense, one of the lucky ones. She found a match. The transplant is scheduled. Her family is ready. The harder question, the one her story leaves the rest of us with, is what happens to the patients in similar situations who do not.
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