"A bone marrow transplant is a medical procedure performed to replace bone marrow that has been damaged or destroyed by disease, infection, or chemotherapy. This procedure involves transplanting blood stem cells, which travel to the bone marrow where they produce new blood cells and promote growth of new marrow. "
Bone marrow is the spongy, fatty tissue inside your bones. It creates the following parts of the blood:
- red blood cells, which carry oxygen and nutrients throughout the body
- white blood cells, which fight infection
- platelets, which are responsible for the formation of clots
Bone marrow also contains immature blood-forming stem cells known as hematopoietic stem cells, or HSCs. Most cells are already differentiated and can only make copies of themselves. However, these stem cells are unspecialized, meaning they have the potential to multiply through cell division and either remain stem cells or differentiate and mature into many different kinds of blood cells. The HSC found in the bone marrow will make new blood cells throughout your lifespan.
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.
Healthy stem cells can come from a donor, or they can come from your own body. In such cases, stem cells can be harvested, or grown, before you start chemotherapy or radiation treatment. Those healthy cells are then stored and used in transplantation.
When are bone marrow transplants used?
If you have a bone marrow transplant, your unhealthy bone marrow will be replaced with healthy stem cells. You may need a bone marrow transplant because you have a condition that affects your bone marrow or your red blood cells. These include the following.
- Cancers that affect your bone marrow, such as leukaemia, lymphoma and myeloma.
- Conditions affecting your blood cells, such as sickle cell anaemia and thalassaemia.
- Conditions that affect your immune system.
The stem cells can come from another person (a donor) – this is called an allogeneic transplant. For example, you may have a related donor such as a brother or sister, or a matched unrelated donor. If the stem cells come from your identical twin, this is called a syngeneic transplant. The cells can also come from your own bone marrow, which is called an autologous transplant. But this can only happen if your stem cells are removed when they are healthy.
Having a stem cell transplant means you may be able to have higher doses of chemotherapy treatment. Treating cancer with high-dose chemotherapy and a bone marrow transplant may cure your cancer, keep it under control or stop it coming back. Examples of conditions treated by an autologous stem cell transplant include myeloma and lymphoma.
Types of Bone Marrow Transplant
There are two major types of bone marrow transplants. The type used will depend on the reason you need a transplant.
Autologous Transplants
Autologous transplants involve the use of a person’s own stem cells. They typically involve harvesting your cells before beginning a damaging therapy to cells like chemotherapy or radiation. After the treatment is done, your own cells are returned to your body.
This type of transplant isn’t always available. It can only be used if you have a healthy bone marrow. However, it reduces the risk of some serious complications, including GVHD.
Allogeneic Transplants
Allogeneic transplants involve the use of cells from a donor. The donor must be a close genetic match. Often, a compatible relative is the best choice, but genetic matches can also be found from a donor registry.
Allogeneic transplants are necessary if you have a condition that has damaged your bone marrow cells. However, they have a higher risk of certain complications, such as GVHD. You’ll also probably need to be put on medications to suppress your immune system so that your body doesn’t attack the new cells. This can leave you susceptible to illness.
The success of an allogeneic transplant depends on how closely the donor cells match your own.
Preparing for a bone marrow transplant
Once you’ve decided to have a bone marrow transplant, your doctor or nurse will explain how to prepare for it. They will start looking for a suitable stem cell donor if your stem cells are coming from another person. Your donor will ideally be a close relative (usually a brother or sister). This is because their blood cells are likely to be similar to yours. If your doctor can’t find a relative who is a close match, they will look for someone who isn’t related to you.
You and any possible donors will need to have some blood tests. Your doctor will compare your blood cells with those of the donor to see whether the donor is a good match for you. Your doctor will ask the donors about their medical and family history too.
If your own stem cells are being used, you may need to have a general anaesthetic beforehand. This means you’ll be asleep during the procedure. You’ll also be asked to follow fasting instructions. This means not eating or drinking anything, usually for about six hours, before your surgery. It’s important to follow your anaesthetist’s advice. This method of collecting stem cells is now used less commonly. Instead, stem cells are more commonly collected from the blood stream.
After you have a bone marrow transplant, you’ll need to stay in a hospital room on your own for a while. This could be for about four weeks. It will reduce your chances of catching an infection while your immune system recovers. When you’re packing your hospital bag, take some personal things with you, such as photographs, books and magazines, to make your room more homely. Taking a mobile phone, electronic tablet or laptop might help you to pass the time and keep in touch with relatives and friends.
Your nurse or doctor will discuss with you what will happen before, during and after your procedure, including any pain you might have. If you’re unsure about anything, don’t be afraid to ask. No question is too small. It’s important that you feel fully informed so you feel happy to give your consent for the procedure to go ahead. You’ll be asked to do this by signing a consent form.
Alternatives to a bone marrow transplant
Doctors are now using bone marrow transplants to treat a wide range of conditions. But these transplants aren’t suitable for everyone. Your doctor will take your age and general health into account when they decide whether the procedure is right for you. For example, if you’re having a stem cell transplant from a donor, you generally need to be under 70 years old. Your doctor will need to find a compatible stem cell donor if your own cells aren’t suitable.
Stem cells can also come from blood found in babies’ umbilical cords. Previously, this treatment was only considered suitable for children and small adults. This is because umbilical cord blood contains only small amounts of stem cells. But new research is exploring whether cord blood can be used in all adults.
What happens during a bone marrow transplant?
There are usually three steps involved in having a bone marrow transplant:
- collecting the stem cells from you or a donor
- having high-dose chemotherapy and/or radiotherapy
- transplanting the new stem cells
Collecting the stem cells
The first step is to collect, or ‘harvest’, the stem cells from you or your donor. There are two main ways to do this. The first way is to collect the stem cells from you or your donor’s blood. This is called a peripheral blood stem cell harvest (PBSCH). The other way is to collect the stem cells directly from you or your donor’s bone marrow.
If you have a PBSCH, you’ll first be given injections of a growth factor. Most of your body’s stem cells are found in your bone marrow. The growth factor triggers your stem cells to mature more quickly so that they leave your bone marrow and move into your bloodstream. Then your nurse will put two drips into your arms and use a machine to collect these cells from your blood.
If your stem cells are collected from your bone marrow, you’ll usually have a general anaesthetic, which means you’ll be asleep during the procedure. Alternatively, you may be able to have an epidural. This completely blocks pain from your lower body, but you’ll stay awake during the procedure. Your doctor will then insert a needle into your pelvic bone, or sometimes breast bone, to take stem calls out of your bone marrow.
The collected stem cells will be given back to you through a drip in your arm. You may need to have other treatments first, such as high-dose chemotherapy.
High-dose chemotherapy
Next, you’ll be treated with high-dose chemotherapy, sometimes with high-dose radiotherapy (called total body irradiation) as well. This completely destroys your own bone marrow, creating room for the new bone marrow cells. If you’re being treated for cancer, this step may also aim to destroy any remaining cancer cells in your body. This treatment usually takes about four to seven days. It can make you feel sick or vomit and feel generally unwell. Your doctor or nurse will give you medicines to help relieve this.
The transplant
After you’ve finished chemotherapy, the new stem cells will be fed through a drip into your bloodstream. During this simple procedure, you usually lie in bed for a few hours with the drip in your arm. The stem cells will find their way to your bone marrow where they will begin to make new cells. It will take between two and four weeks before there are enough new stem cells in your bone marrow to start making new blood cells.
What to expect afterwards?
After a bone marrow transplant, you’re likely to have low levels of blood cells in your body. You may need to have a blood and platelet transfusion to correct this. You’ll also need to take antibiotics to protect you from infections. Your immune system won’t be working properly because your body will contain only low levels of white blood cells. You may need to stay in a room on your own in hospital until your blood cells have gone back up to a safe level.
A transplant using your own stem cells usually causes fewer side-effects than a transplant using stem cells from a donor. This is because your body is less likely to reject stem cells that have come from its own bone marrow or blood.
Immediately after a bone marrow transplant, your mouth may feel sore and you may find it difficult to swallow. Your doctor may suggest that you’re fed through a tube placed in one of your veins or directly into your stomach until your mouth recovers.
The overall success of a bone marrow transplant depends on many factors. These include what condition you have, how far it’s progressed, your age, and how good a match your donors are. If you’d like more information, speak to your nurse or doctor. Donor stem cell transplants are physically and emotionally demanding so it’s important that you prepare yourself and have the support of friends and family. If you’re worried about any aspect of your transplant, speak to your doctor or nurse.
Recovering from a bone marrow transplant
How long it takes to recover fully from your bone marrow transplant will depend on whether or not your stem cells were from a donor. This can vary from person to person, so it’s important to follow your doctor’s advice. It can take months or sometimes even years to recover properly as your body gets used to the newly transplanted cells.
Once the number of blood cells in your body has returned to a safe level, you’ll be able to leave the hospital. You may be advised to avoid eating certain foods, which could be contaminated with bacteria or fungi. These foods include raw or lightly cooked shellfish, blue cheese and raw or undercooked eggs. You’ll also need to be very careful with food hygiene, for example when you prepare, cook, eat out or store food. You should continue to follow this food safety advice for at least six months after being discharged from hospital.
After a bone marrow transplant, you lose your immunity to common childhood infections. You’ll need to be vaccinated again to protect you against conditions such as tetanus and diphtheria. You’ll usually have these vaccinations about 12 months after your transplant. Your doctor will suggest that you are re-immunised against the flu as well.
Complications Associated with a Bone Marrow Transplant
A bone marrow transplant is considered a major medical procedure and increases your risk of experiencing:
- a drop in blood pressure
- a headache
- nausea
- pain
- shortness of breath
- chills
- a fever
The above symptoms are typically short-lived, but a bone marrow transplant can cause complications. Your chances of developing these complications depend on several factors, including:
- your age
- your overall health
- the disease you’re being treated for
- the type of transplant you’ve received
Complications can be mild or very serious, and they can include:
- graft-versus-host disease (GVHD), which is a condition in which donor cells attack your body
- graft failure, which occurs when transplanted cells don’t begin producing new cells as planned
- bleeding in the lungs, brain, and other parts of the body
- cataracts, which is characterized by 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
- mucositis, which is a condition that causes inflammation and soreness in the mouth, throat, and stomach
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.
Side-effects of a bone marrow transplant
After your bone marrow transplant, you may have some side-effects, such as diarrhoea, which should be mostly temporary.
Straight after your transplant, the levels of blood cells in your body will be very low. This may cause the following.
- Having a low immunity to infections, due to a lack of white blood cells.
- Anaemia – a condition in which you have too few red blood cells or not enough haemoglobin in your blood. Haemoglobin is a protein found in red blood cells that carries oxygen and carbon dioxide around your body in your bloodstream.
- Bleeding because of a lack of platelets in your blood – these normally help your blood to clot.
- Problems eating as a result of feeling sick, not feeling hungry or having a sore mouth after treatment.
You may need to have a blood transfusion to increase your levels of platelets and red blood cells.
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