The first successful bone marrow transplant was performed in 1968. Since that time, bone marrow transplants have been used to treat thousands of patients every year. Bone marrow transplants are used to treat patients suffering from leukemia, Hodgkin’s disease, aplastic anemia, multiple myeloma, immune disorders and certain types of breast and ovarian cancers. While bone marrow transplantation is a viable treatment for many diseases, nearly 70 percent of all patients in need of a transplant do not receive one due to the lack of a workable donor.
What Is Bone Marrow?
Bone marrow is found inside of the bones. It is a soft, flexible tissue. The bone marrow in certain areas is comprised of stem cells, which produces blood cells for the body. These blood cells play an important role in the body’s functions. The white blood cells help the body to ward off infection, while the red blood cells deliver oxygen and remove waste from body organs and tissue. Another component of stem cells is platelets, which enable the blood to clot. Bone marrow from the following bones contain stem cells:
About the Three Types
There are three types of bone marrow transplants:
- Autologous, also known as a rescue transplant. “Auto” refers to the stem cells being your own and not being derived from a donor source. In this type of transplant procedure, stem cells are removed from your body and placed in a freezer for cryopreservation. The retrieval of stem cells is done before you have received any high-dose radiation treatment or chemotherapy. Once the therapy is complete, the stem cells are returned to your body as an addition to your typical blood cells.
- Allogeneic, “allo” meaning other, as in a donor. In this type of transplant procedure, a donor must be located in order to complete the process. A donor has to be a partial genetic match. Typically, brothers and sisters are a good match, but other relatives and children may also be viable donors. Additionally, donors may be found through the national bone marrow registry.
- Umbilical Cord Blood Transplant. In this type of transplant procedure, the stem cells from the umbilical cord blood of a newborn are gathered and stored directly after birth. These stem cells are then stored until they are needed. The stem cells from umbilical cord blood are very immature therefore the need for matching is much less.
What To Expect Before The Procedure
In order for a bone marrow transplant to be successful, the patient must be subjected to a variety of tests to ensure that they are healthy enough to undergo the procedure. Once the patient has been cleared for the procedure, he or she will have to undergo several days of chemotherapy, radiation treatments or both in order to prepare the body to receive new bone marrow. The radiation and/or chemotherapy kill off cancer cells and existing bone marrow to make room for the transplanted, new bone marrow. This can be performed in one of two ways:
- Ablative or myeloablative treatment. An extremely high dose of radiation or chemotherapy is administered to kill off existing bone marrow, making it possible for the transplanted stem cells to grow and flourish.
- Reduced intensity or nonmyeloablative treatment. A much lower concentration of radiation or chemotherapy is given to prepare for the transplantation of the stem cells. This type of procedure is done so that aging patients or those who have additional medical problems can safely undergo a bone marrow transplant. This procedure is sometimes referred to as a mini-transplant.
How Donor Cells Are Collected
The process of collecting donor cells can be done in one of two ways:
- Harvesting. Bone marrow is harvested from the donor under general anesthesia and in a hospital. The bone marrow of the donor will be removed from the backside of both hipbones; this area yields the most bone marrow.
- Leukapheresis. In preparation, the donor will be given a series of shots that will allow the stem cells to move from the bone marrow into the blood stream. The blood of the donor is then removed via an intravenous line. The stem cells are then extracted from the blood cells using a special machine, before the remainder of blood is returned to the donor.
How The Transplant Is Performed
No surgery is needed for the patient to receive bone marrow. The procedure is typically done in the patient’s hospital room, where the patient will be given the bone marrow intravenously. The procedure is similar to that of receiving a blood transfusion. The stem cells will course through the blood stream and into the bone marrow.
What To Expect After The Procedure
Following the procedure, the patient may have to remain in the hospital for monitoring. Your hospital stay will depend upon how much radiation or chemotherapy you received in preparation for the procedure, as well as the type of transplant you have received. Because radiation and chemotherapy can adversely affect the immune system, patients are sometimes isolated to decrease the risk of infection. You will likely be monitored closely during your hospital stay to assess your vital signs, prevent infection, ensure proper engrafting of the new bone marrow and evaluate your progress. Bone marrow transplant patients may be in the hospital for up to eight weeks. While in the hospital, bone marrow transplant patients will likely:
- Be given medications to fight infection
- Receive blood transfusions to ward off infection and prevent bleeding
- Be fed intravenously until able to handle food
- Be given medications to prevent the marrow from being rejected, graft versus host disease
Bone Marrow Transplant Risks
Recipients of a bone marrow transplant are at risk for developing symptoms and side effects including:
- Drop in blood pressure
- Chest pain
- Unusual taste in mouth
- Flushed skin
- Shortness of breath
Complication following a bone marrow transplant can occur for a variety of reasons including:
- The disease you have been treated for
- Receiving radiation or chemotherapy before the procedure.
- How precise a match the donor was
- The kind of bone marrow transplant you underwent
Complications following a bone marrow transplant may include:
- Bleeding in various areas of the body.
- Damage to the liver, kidneys, heart or lungs
- Stunted growth if the recipient is a child
- Early onset menopause.
- Graft failure, meaning the donor cells have not begun to produce new bone marrow
- Graft versus host disease, meaning the recipient’s body is attacking the donor cells
- Stomach issues
- Mucositis, meaning inflammation or soreness in the mouth, throat or stomach
Following a bone marrow transplant, it may take up to one year to fully recover. Having a bone marrow transplant may cure your disease or may help you to partially recover from it. Complications following a bone marrow transplant or the rejections of bone marrow can result in death.
A bone marrow transplant is done in the hopes of treating an underlying illness. New, healthy stem cells are given to the patient to replace damaged bone marrow. Bone marrow transplants help thousand of patients each year, but it can sometimes be difficult to find a viable donor.