HACKENSACK, N.J. — The sister who saved Yarelis Bonilla's life almost wasn't allowed into the United States.
Last December, Yarelis, 5, had high-risk acute lymphocytic leukemia and needed a bone-marrow transplant. But the donor who was a perfect match was a girl she had never met, a sister who lived in El Salvador. Twice, the sister — Gisselle Bonilla, 7 — was denied a visa to visit the United States.
When she finally was allowed to visit on humanitarian grounds — after the intervention of a U.S. senator — Gisselle gave Yarelis part of her healthy bone marrow and a new chance at life.
On Monday, Yarelis left Hackensack University Medical Center 27 days after that transplant, happy and — her family and medical team hope — healthy. The disease she was diagnosed with last summer was in remission.
"There's a very good chance that she's cured of this disease," said Dr. Alfred Gillio, who performed the transplant on Jan. 24. "We'll watch her very carefully. The highest risk of relapse is in the first year."
The girls' grandfather, Gertrudis Ramirez, said the two sisters were very happy, but "the sad part is, she 1/8Gisselle3/8 knows she has to go back." She is scheduled to return to El Salvador on March 21.
Gisselle and every member of Yarelis' family were tested as possible donors when Yarelis was diagnosed with leukemia. Only Gisselle, who lived thousands of miles away, matched perfectly.
Without a transplant, the extremely acute form of leukemia is treated with three years of chemotherapy, Gillio said. The chance of survival is about 30 percent.
With a transplant, the chance of survival is 70 to 75 percent, he said.
The challenge was to get Gisselle to the United States. She lived with her maternal grandmother in Ilobasco, about 30 miles northeast of San Salvador. Her parents had left for the United States when she was a baby. Yarelis was born two years later in the United States, making her a U.S. citizen.
It was a race against time, as Yarelis underwent chemotherapy treatments with limited success. Through the intervention of Sen. Robert Menendez, D-N.J., and the efforts of lawyers with the American Friends Service Committee in Newark, a humanitarian exception was granted so Gisselle could travel to the United States for the sole purpose of donating her bone marrow.
"For week and weeks, we were not able to get her donor here from El Salvador," Gillio said.
The Hackensack program is the only pediatric bone-marrow transplant program in the state and performs about 25 transplants a year. Yarelis had been referred from Newark Beth Israel Medical Center, part of Barnabas Health, where her leukemia was diagnosed.
When Gisselle arrived in December, it was the first time the girls had met.
To Gillio's relief, Gisselle was healthy enough to be a donor.
He prepared Yarelis for the transplant with total body radiation and heavy chemotherapy to kill all her white blood cells.
On Jan. 24, with Gisselle under general anesthesia, he removed some of her bone-marrow cells from her hip bones. A few hours later, he transfused them to Yarelis.
"She did extremely well," he said Monday. With her immune system eradicated by radiation and chemotherapy, she was isolated in a room to avoid infection. She was not permitted to leave the room, and visitors were required to wear masks and gloves.
Hospital specialists brought music, dance and art activities to her, Gillio said.
Gisselle, meanwhile, had left the hospital the day of the donation. She was given pain medication the first day home, Gillio said.
The transplant team will see Yarelis weekly for the next three months, he said. She is taking oral medication.
Her sister's cells have taken hold in her bone marrow and begun to produce healthy blood cells. "When we examine the blood, all her blood cells are donor cells," he said.
Most important, Gillio said, there is "no evidence of leukemia."
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