What Is Bone Marrow Transplant?

A bone marrow or stem cell transplant is a medical procedure done to replace bone marrow that has been damaged or destroyed. It can be used to treat conditions affecting the blood cells, such as leukemia and lymphoma.

How Is Bone Marrow Transplant Done: Types, Recovery, Life Expectancy

What Is a Bone Marrow Transplant?

A bone marrow or stem cell transplant is a medical procedure done to replace bone marrow that has been damaged or destroyed. It can be used to treat conditions affecting the blood cells, such as leukemia and lymphoma.

A bone marrow transplant is done by transplanting blood stem cells, which are responsible for producing new blood cells and promoting the growth of new marrow.

Stem cells are special cells produced by bone marrow (a spongy fatty tissue found in the center of some bones) that can turn into different types of blood cells including:

  • Red Blood Cells – Which Carry Oxygen And Nutrients Around The Body
  • White Blood Cells – Which Help Fight Infection
  • Platelets – Which Are Responsible For The Formation Of Clots And Help Stop Bleeding

A bone marrow transplant replaces your damaged stem cells with healthy cells. This helps your body make enough white blood cells, platelets, or red blood cells to avoid infections, bleeding disorders, or anemia.

You may need a stem cell transplant if your bone marrow stops working and does not produce enough healthy blood cells.

Healthy stem cells can either be harvested from a donor (allogeneic transplant), or they can be grown and come from your own body (autologous transplant)

Why Is A Bone Marrow Transplant Done?

Bone marrow transplants can be performed for a variety of reasons. Generally, they are performed to treat conditions in which a person’s bone marrow is damaged and is no longer able to function properly and produce new healthy blood cells.

These procedures can also be done to replace blood cells that are damaged or destroyed due to chronic infections,  cancer treatment or chemotherapy, and other diseases.

Bone marrow transplants can be performed to benefit patients with both cancerous (malignant) and noncancerous (benign) conditions, including:

  • Aplastic Anemia: which is a disorder where the bone marrow fails to make new blood cells (bone marrow failure)
  • Thalassemia:  which is an inherited blood disorder where the body makes an abnormal form of hemoglobin, an integral part of red blood cells
  • Damaged Bone Marrow:  as a result of chemotherapy
  • Sickle Cell Anemia: which is an inherited blood disorder that causes misshapen red blood cells
  • Different types of Cancers That Affect The Marrow: such as acute/chronic leukemia, Hodgkin’s/non-Hodgkin’s lymphoma, multiple myeloma, and neuroblastoma
  • Congenital Neutropenia: which is an inherited disorder that causes recurring infections

Types of Bone Marrow Transplant

As mentioned before, stem cell transplants can be divided into two major types.

1) Allogenic Transplants

The donor must be a close genetic match. Usually, the primary choices for donors would be compatible with family members or relatives, but genetic matches can also be found from a donor registry.

The blood stem cells used in an allogeneic stem cell transplant can be collected from:

  • The donor’s blood
  • The bone marrow within a donor’s hipbone
  • The blood of a donated umbilical cord

Allogeneic transplants are necessary if you have a condition that has damaged your bone marrow cells. The outcome of an allogeneic stem cell transplant highly depends on how closely the donor cells match your own.

2) Autologous Transplants

An autologous stem cell transplant uses healthy blood stem cells from your own body to replace your damaged bone marrow.

This type of procedure offers you advantages over using stem cells from a donor since you don’t need to worry whether the donor cells will be genetic matches to your own cells.

The procedure normally involves harvesting your cells and then performing chemotherapy or radiation to remove any diseased or damaged cells. After the treatment is done, your own healthy cells will be returned to your body.

Keep in mind that this type of bone marrow transplant can only be used if you still have healthy bone marrow that moving forward can produce enough healthy blood cells.

How Is A Bone Marrow Transplant Performed?

A stem cell transplant will usually only be carried out if:

  • Other treatments have failed to help with your condition
  • The potential benefits of a transplant outweigh the risks
  • Your doctor has determined you are in relatively good health, despite your underlying condition

When your doctor thinks you’re ready, you’ll have the transplant. The procedure is similar to a blood transfusion.

A bone marrow transplant typically consists of these 5 main steps:

  1. Tests and examinations before the procedure
  2. Harvesting 
  3. Conditioning 
  4. Transplanting the stem cells
  5. Recovery

1) Tests and examinations 

Before your transplant, you’ll undergo several tests to access your general level of health and the status of your condition to discover what type of bone marrow cells you need and also to ensure you are physically prepared for the procedure.

2) Harvesting 

Harvesting is the process of obtaining the stem cells to be used in the transplant, which can either come from you or a genetically matched donor.

If the stem cells are coming from yourself (autologous transplant), you’ll undergo a procedure called apheresis to collect the needed cells.

Before apheresis, you’ll receive injection shots containing growth factors to help with stem cell production and move the cells into your circulating blood for collection later.

During apheresis, your blood will be drawn from a vein through an IV line, and then circulated through a machine. This machine identifies and separates your stem cells from the rest of your blood, which are collected and frozen for future use in the transplant.

The remaining blood is returned to your body.

Apheresis is performed under general anesthesia, meaning you will be asleep and won’t feel any pain.

If you’re having a transplant using stem cells from a donor (allogeneic transplant), once a matching donor is found, stem cells are gathered from that person for the transplant which can be obtained either from the donor’s blood or bone marrow depending on your transplant team’s decision.  

Sometimes stem cells can be collected from the blood of donated umbilical cords. Mothers can choose to donate umbilical cords after their babies’ births. The blood from these cords is frozen and stored in a bank until the need for a transplant arises.

Radiation Therapy

3) Conditioning 

Your healthcare team will perform high doses of radiation or chemotherapy to prepare you for your new stem cells. This is called the conditioning process.

Conditioning is done to:

  • Destroy cancer cells if you are being treated for a cancerous disease
  • Suppress your immune system to reduce the risk of the transplant getting rejected
  • Prepare your bone marrow for the new stem cells by destroying existing bone marrow cells.

You may need to receive some medications during the conditioning process. These will be given to you via a central line( tube) that is connected to a vein near your neck or your heart.

The conditioning can take up to a week, so you will most probably have to stay in the hospital for that time.

4) Transplanting the stem cells

The transplant will usually be carried out a day or 2 after conditioning has been completed. This process often takes around a couple of hours.

The stem cells will be injected into your body through a central line. The procedure will be done while you are awake but you won’t feel any pain. This process is also usually called engraftment.

5) Recovery

After your transplant is completed, you will need to stay in a special germ-free hospital room during the first few weeks after the transplant.

The typical recovery time for the procedure is about three months, and usually depends on:

  • The condition being treated
  • Chemotherapy
  • Radiation
  • Donor match
  • Where the transplant is performed

After the transplant is completed, you will be regularly monitored. If it has been successful and your body has started to make new blood cells, your tests will show an elevation of white blood cell count.

This generally happens between 10 and 28 days after the initial transplant.

After going home, you’ll need to be careful about coming into contact with people with infections

What Are The Risks, And Complications Of A Bone Marrow Transplant?

Stem cell or bone marrow transplants are complex treatments that carry a significant risk of serious complications.

Consult with your doctor on any possible side effects or risks before treatment begins.

During treatment, you may experience some side effects including:

  • Headache
  • Nausea
  • Pain
  • Shortness of breath
  • Fever and chills

While these symptoms are typically short-term, however, a bone marrow transplant can carry mild or serious complications such as:

  • Graft-Versus-Host Disease (GvHD): In some cases, the transplanted cells identify the recipient’s cells as “foreign” and attack them. This is known as graft versus host disease (GvHD).

Look out for some of these GvHD symptoms:

  • An itchy rash
  • Diarrhea
  • Feeling and being sick
  • A sensitive and dry mouth
  • Dry eyes
  • Shortness of breath
  • Joint pain
  • Yellowing of the skin and whites of the eyes (jaundice)

GvHD can occur within a few months, a year, or 2 years after the transplant. The condition is usually mild, but can sometimes be life-threatening.

  • Graft failure: which occurs when transplanted cells don’t begin producing new cells as they should
  • Bleeding in the lungs, brain, and other parts of the body
  • Cataracts: which is associated with clouding in the lens of the eye
  • Damage to vital organs
  • Early menopause
  • Anemia: which occurs when the body doesn’t produce enough red blood cells
  • Infections
  • Nausea, diarrhea, or vomiting

Your chances of developing these complications depend on various factors, including your age, your overall health, the type of transplant you’ve had, and the condition you are being treated for.

Don’t forget to talk to your doctor about any concerns you may have. They can help you weigh the risks and complications against the potential benefits of this procedure.

Bone Marrow Transplant Survival Rates

According to The U.S National Library Of Medicine, “Increasing age has been reported to be a poor prognostic factor for survival after bone marrow transplantation.”

As expected, transplants for patients with nonmalignant (non-cancerous) diseases have a much better success rate with 70% to 90 % survival with a matched sibling donor and 36% to 65% with unrelated donors.

However, life expectancy in patients that have undergone an autologous transplant and used their own stem cells as donors, is higher than those who have used unrelated donors.

Results

While the goals of a bone marrow transplant include controlling or curing your disease, it can be dependant on your unique situation and/or disease. These transplants can be good cures for some conditions and put others into remission.

While it can be discouraging if significant challenges arise during the transplant process, however, it is important to remember that many survivors also experienced similar hardships during the treatments but ultimately had successful transplants and have returned to normal daily activities with a good quality of life.

Keep in mind to always discuss your situation with your care physician, and weigh the advantages against the disadvantages to get a clear mind of whether the procedure can be beneficial to your condition.

We offer free medical consultation services so you can make any inquiries concerning your situation. Our staff of experienced medical specialists, are here to guide you through any uncertainties regarding your treatments.

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