Dr. Shilpa Bhartia

MRCP, FRCPath (UK)
Consultant Haemato-Oncologist & BMT Specialist

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Bone Marrow Transplantation



What is a bone marrow transplant


Healthy marrow and blood cells are needed to live. Disease can affect the marrow’s ability to function. When this happens a bone marrow or cord blood transplant could be the best treatment option. For some diseases, transplant offers the only potential cure.

A bone marrow or cord blood transplant replaces unhealthy blood-forming cells with healthy ones. Blood-forming cells are also called blood stem cells. Blood stem cells are immature cells that can grow into red blood cells, white blood cells and platelets.

There are two types of transplant. An autologous transplant uses your own cells which are collected from the bloodstream and stored for your transplant. An allogeneic transplant uses cells from a family member, unrelated donor or umbilical cord blood unit.

There are three sources of blood-forming cells used in transplants:
• bone marrow
• peripheral (circulating) blood (also called peripheral blood stem cell or PBSC)
• umbilical cord blood collected after a baby is born

If you need a transplant, you will be referred to a doctor who specializes in bone marrow transplants. Your transplant doctor will talk to you about the type of transplant and cell source that is most likely to work best for you based on your disease and other health factors.



How a transplant works


An autologous transplant is a way to treat cancer using very high doses of chemotherapy that destroy the bone marrow as a side effect. The autologous blood cells replace the damaged marrow. This is how autologous transplants are used to fight certain types of cancers such as lymphoma. 

An allogeneic transplant also treats cancers of the blood, and offers the added benefit of using the donor’s immune system to recognize and destroy cancer cells. Allogeneic transplant is also used to treat some non-cancerous diseases such as sickle cell anemia. In non-cancerous diseases, the transplant replaces defective marrow cells with the donor’s healthy cells.



Risks


A bone marrow transplant may cause the following symptoms:
• Chest pain
• Chills
• Drop in blood pressure
• Fever
• Flushing
• Funny taste in the mouth
• Headache
• Hives
• Nausea
• Pain
• Shortness of breath

Possible complications of a bone marrow transplant depend on many things, including:

• The disease you are being treated for
• Whether you had chemotherapy or radiation before the bone marrow transplant and the dosages of such treatments
• Your age
• Your overall health
• How good of a match your donor was
• The type of bone marrow transplant you received (autologous, allogeneic, or umbilical cord blood)


Complications can include:

• Anemia
• Cataracts
• Clotting in the small veins of the liver
• Damage to the kidneys, liver, lungs, and heart
• Delayed growth in children who receive a bone marrow transplant
• Early menopause
• Graft failure, which means that the new cells do not settle into the body and start producing stem cells
• Graft-versus-host disease, a condition in which the donor cells attack your own body
• Infections, which can be very serious
• Inflammation and sorenes in the mouth, throat, esophagus, and stomach, called mucositis
• Pain
• Stomach problems, including diarrhea, nausea, and vomiting




Bone Marrow Transplantation



Before the Procedure


Before transplant, you will have one or two tubes, called catheters, inserted into a blood vessel in your neck or arms. This tube allows you to receive treatments, fluids, and sometimes nutrition.

Your doctor or nurse will likely discuss the emotional stress of having a bone marrow transplant. You may want to meet with a mental health counselor. It is important to talk to your family and children to help them understand what to expect.

You will need to make plans to help you prepare for the procedure and handle tasks after your transplant:

• Complete an advance care directive
• Arrange medical leave from work
• Take care of bank or financial statements
• Arrange care of pets
• Arrange for someone to help with household chores
• Confirm health insurance coverage
• Pay bills
• Arrange for care of your children
• Find housing for yourself or your family near the hospital, if needed




After the Procedure


A bone marrow transplant is usually done in a hospital or medical center that specializes in such treatment. Most of the time, you will stay in a special bone marrow transplant unit in the center. This is to limit your chance of getting an infection.

Depending on the treatment and where it is done, all or part of an autologous or allogeneic transplant may be done as an outpatient. This means you do not have to stay in the hospital.

How long you stay in the hospital depends on how much chemotherapy or radiation you received, the type of transplant, and your medical center's procedures. While you are in the hospital, you will be isolated because of the increased risk of infection. The health care team will closely monitor your blood count and vital signs.

While you are in the hospital you may:

• Receive medications to prevent or treat infections, including antibiotics, antifungals, and antiviral drugs
• Need many blood transfusions
• Be fed through a vein (IV) until you can eat by mouth and stomach side effects and mouth sores have gone away
• Be given medications to prevent graft-versus-host disease

 



 

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