Bone Marrow Transplant

Overview

A stem cell transplant, or more specifically, a hematopoietic stem cell transplant, is another name for a bone marrow transplant. Transplantation can be used to treat leukemia, myeloma, and lymphoma, as well as other blood and immune system diseases that affect the bone marrow.

What are Stem Cells?

Stem cells are unique cells that can replicate themselves and transform into the various types of cells that your body requires. There are various types of stem cells, and they can be found in various parts of the body at different times.

Cancer and cancer treatment can cause hematopoietic stem cell damage. Hematopoietic stem cells are blood-forming stem cells. The soft, spongy tissue in the body known as bone marrow contains hematopoietic stem cells. It is found in the center of the majority of bones. Hematopoietic stem cells can also be found in your blood, which circulates throughout your body.
Hematopoietic stem cells that are damaged may not develop into red blood cells, white blood cells, or platelets. These blood cells are vital, and each one serves a specific purpose:

Red blood cells transport oxygen throughout the body. They also transport carbon dioxide to your lungs, where it is exhaled.
Your immune system includes white blood cells. They combat pathogens, which are viruses and bacteria that can cause illness.
Platelets form clots to stop bleeding.

A bone marrow/stem cell transplant is a medical procedure that involves the transplantation of healthy stem cells into your bone marrow or blood. This improves your body's ability to produce red blood cells, white blood cells, and platelets.

What is Bone Marrow Transplant?

A bone marrow transplant is a treatment that replaces the diseased or damaged bone marrow with healthy blood manufacturing stem cells. A bone marrow transplant is also known as a stem cell transplant.

Bone marrow refers to the spongy and soft tissue in some of the bones, such as those in the thighs and hips. A transplant to replace the damaged cells with the healthy ones, probably from a donor, is beneficial to people with some blood-related diseases. For instance, bone marrow transplants can save a person's life if they have lymphoma or leukemia or if their blood cells have been destroyed by cancer treatment.

Types of Bone Marrow Transplant

A bone marrow transplant can be divided into two categories. The underlying reason for your need will determine the form of transplant you undergo.

Autologous transplants

This is a type of transplant that uses the patient's stem cells. It usually entails extracting your cells prior to starting a cell-damaging therapy like chemotherapy and radiation treatment. The patient’s cells are restored to the body once the treatment is complete.

Autologous transplant is not frequently available and can only be utilized whenever your bone marrow is in good shape. It does, however, lower the chance of some major problems, such as GVHD.

Allogeneic transplant

Allogeneic transplant uses the stem cells obtained from the donor. A close genetic match between the donor and the recipient is required. A suitable relative is often the greatest option, but a donor registry can also help you find genetic matches.

If you have a disorder that has damaged the bone marrow cells, you will need an allogeneic transplant. They do, however, have a high risk of problems, including GVHD. You will very certainly need to take medications to restrain the immune system, so the body does not react and attack the new cells. You may become susceptible to sickness as a result of this. An allogeneic bone marrow transplant success rate is determined by how well the donor cells match with your own.

If your health care team cannot find a donor match, there are other options.

Umbilical cord blood transplant.

Stem cells from umbilical cord blood are used in this type of transplant. Before birth, the umbilical cord connects a fetus to its mother. The baby does not require it after birth. Cord blood is used in cancer treatment centers all over the world.

Parent-child transplant and haplotype mismatched transplant.

Cells from a parent, child, brother, or sister are usually a 50% match for a patient's HLA type. Doctors are increasingly using these types of transplants to broaden the use of transplantation as an effective cancer treatment.

Why Bone Marrow Transplant is Done?

A bone marrow transplant is usually recommended if a person's bone marrow is not healthy enough to work normally. This might occur as a result of long-term diseases, infections, and cancer treatments.

The following are some of the common reasons for performing a bone marrow transplant:

Aplastic anemia; this is a condition in which the bone marrow ceases producing new blood cells.
Malignancies that attack the bone marrow, including lymphoma, leukemia, and multiple myeloma
Congenital neutropenia, a genetic condition that leads to recurrent infections.
Bone marrow damage following a chemotherapy transplant
The genetic blood condition sickle cell anemia which creates malformed red blood cells.
Thalassemia, an inheritable blood illness in which the body produces an aberrant type of hemoglobin. This is an essential component of red blood cells.

How to Prepare for a Bone Marrow Transplant?

The physician will conduct some testing to evaluate the optimum form of the procedure before performing a bone marrow transplant. If necessary, they can as well seek out a suitable bone marrow transplant donor. But if the patient's cells are to be used, the doctor will obtain the cells in advance and properly keep them in a freezer till the scheduled day.

Following that, the patient will receive additional treatment, which could include radiation therapy, chemotherapy, or sometimes a combination. These modes of treatment help kill the bone marrow cells and the cancerous cells. Furthermore, chemotherapy and radiation restrain the body's immune system. This helps to avoid a bone marrow transplant rejection.

The patient might have to remain in the hospital setting for one to two weeks as they prepare for the transplant. A healthcare expert will implant a tiny tube into one of the major veins of the patient during this period.

The patient will also get some drugs through the tube that eliminates any present abnormal stem cells. It can as well trigger the immune system to stop the new healthy transplanted cells from rejection.

It's a good initiative to make the following arrangements before going to the hospital:

Take leave from work or school for such medical reasons
Provide the necessary care if there are any children or pets to look after
Transportation to and from the hospital
Clothing and other essentials
If necessary, find a family member who will stay with you while in the hospital

How a Bone Marrow Transplant is done?

Typically, a bone marrow transplant isn't a surgical procedure. It's comparable to receiving a blood transfusion. If the transplant involves the use of donor stem cells, they will be obtained before the procedure. If the patient’s own cells are to be used in the transplant, the medical facility will store the cells.

The transplant is usually done in a series of procedures for a few days. This method of staggering cell entry offers them the highest opportunity of merging with the body.

The doctor can use the tube to infuse liquids like nutrients, blood, and drugs to help in fighting infection or promote bone marrow growth. The exact combination is determined by the body's reaction to the treatment.

The operation will temporarily weaken the patient's immune system, leaving them vulnerable to infection. To assist limit this danger of infection, most medical facilities maintain a separate, isolation area for persons undergoing a bone marrow transplant.

How does an AUTO transplant work?

Collecting your stem cells

This procedure takes several days. To begin, you will be given injections (shots) of a medication to boost your stem cell count. The stem cells are then collected by your medical team via a vein in your arm or chest. The cells will be kept in reserve until they are required.

2. Pre-transplant treatment

This procedure takes 5 to 10 days. You will be given a large dose of chemotherapy. Patients may also receive radiation therapy on occasion.

3. Step 3: Getting your stem cells back

This is the day of your transplant. Each dose of stem cells takes about 30 minutes. This is known as an infusion. The stem cells are reintroduced into your bloodstream via the catheter by your medical team. You may have received more than one infusion.

4. Step 4: Recovery

Your doctor will closely monitor the recovery and growth of your cells, and you will be given antibiotics to prevent infection. Any side effects will also be treated by your medical team. More information about recovering from a bone marrow transplant can be found below.

How does an ALLO transplant work?

1. Donor identification

Before the ALLO transplant procedure can begin, a matched donor must be identified. Blood tests will determine your HLA type. Then, your health care team will work with you to perform HLA testing on potential donors in your family and, if necessary, search a volunteer registry of unrelated donors.

2. Collecting stem cells from your donor

Your medical team will take cells from your donor's blood or bone marrow. If the cells are collected from the bloodstream, your donor will receive daily injections (shots) of a medication to increase the number of white blood cells in their blood for a few days before the collection. The stem cells are then extracted from their bloodstream. If the cells are from bone marrow, your donor will undergo a bone marrow harvest in a hospital operating room.

3. Pre-transplant treatment

This procedure takes 5 to 7 days. You will receive chemotherapy, either alone or in combination with radiation therapy, to prepare your body to receive the donor's cells.

4. Getting the donor cells

This is the day of your transplant. Through the catheter, your medical team injects the donor's stem cells into your bloodstream. Obtaining donor cells typically takes less than an hour.

5. Recovery

During your initial recovery, you will be given antibiotics to reduce your risk of infection, as well as other medications, such as those to prevent and/or manage GVHD. Your medical team will also treat any transplant-related side effects. More information about bone marrow transplant recovery can be found below.

Bone Marrow Transplant Recovery

The genetic compatibility of the donor and recipient is crucial to the success and recovery of a bone marrow transplant. However, finding a suitable match among the available unrelated donors might be difficult at times.

The engraftment will be checked on a regular basis. It usually takes between 10 and 28 days to complete following the first transplant. An increase in the white blood cell count is the first indicator of engraftment. This indicates that the transplant is producing new blood cells.

A bone marrow transplant usually takes three months to recover from. It might, however, take up to one year for one to completely recover. Some of the factors that can influence recovery include;

The underlying health condition
Chemotherapy
Radiation therapy
A match of donors
The area in which the transplant will take place

There is a chance that some of the side effects you'll have following the transplant will last for your entire life.

Medications

The doctor can recommend some drugs to help avoid graft-versus-host disease and minimize the immune system's reactivity (immunosuppressive medications). This is usually if your bone marrow transplant uses stem cells obtained from the donor (allogeneic transplant).

It generally takes some time before the immune system recovers after a transplant. Therefore, medications to help prevent infections may be necessary to you at this period.

Bone Marrow Transplant Results

Physicians can treat some health conditions using a bone marrow transplant, where others can go into remission. A bone marrow transplant goal varies depending on your situation. However, they commonly involve controlling or treating the disease, prolonging your life, and enhancing your general quality of life.

Some patients are able to complete their bone marrow transplant procedure with few difficulties and side effects. On the other hand, others face a variety of challenges, both short-term and long-term. The seriousness of adverse effects and the transplant's success varies from one patient to another. It’s sometimes hard to predict prior to the procedure.

How do You Know if the Transplant Worked?

A successful transplant can mean different things to different people, including you, your family, and your medical team. Here are two ways to tell if your transplant was successful.

Your blood counts are back to safe levels

A blood count determines the concentrations of red blood cells, white blood cells, and platelets in your blood. For the first 1 to 2 weeks after the transplant, these numbers are extremely low. This weakens your immune system and puts you at risk of infections, bleeding, and exhaustion. Your medical team will reduce these risks by administering blood and platelet transfusions. Antibiotics will also be prescribed to help prevent infections.

When the new stem cells divide, they produce more blood cells. Your blood counts will then return to normal. This is one method of determining whether or not a transplant was successful.

Your cancer is controlled

A bone marrow/stem cell transplant is frequently used to cure cancer. Certain cancers, such as some types of leukemia and lymphoma, may be curable. For other diseases, cancer remission is the best possible outcome. In remission, there are no signs or symptoms of cancer.

As previously stated, you must see your doctor and undergo tests on a regular basis following a transplant. This is to monitor for any signs of cancer or transplant complications, as well as to provide care for any side effects you may experience. This follow-up care is critical to your recovery.

Risks of Bone Marrow Transplant

The transplantation of bone marrow is generally a major treatment procedure. Due to this, there is a significant risk of problems that can occur both during and after the procedure. The possibility of complications occurring is determined by a number of factors, such as;

The age of the patient
General health and well-being
The form for transplantation
The underlying reason for the treatment

The following are some of the most prevalent problems and bone marrow transplant side effects:

Infections
Nausea and vomiting, or a combination of the two
Diarrhea
Mucositis, a condition that causes inflammation and pain in the mouth, throat, and stomach.
Graft failure that occurs when the cells that were transplanted fail to create new blood cells.
Anemia
Early menopause onset
Infertility
Cataracts
Damage to the organ
Graft-versus-host disease, a condition where the donor cells attack the recipient's body
Bleeding inside the lungs, brain, or other organs.
Sometimes, the complications from the bone marrow transplant lead to death.

The patient who undergoes a bone marrow transplant might also have the usual side effects that come with any medical treatment. They include:

Breathing problems
Reduced blood pressure
Headaches
Pain
Fever and chills

Donating Stem Cells and Bone Marrow

People typically volunteer to donate stem cells for an allogeneic transplant because they have a loved one or friend who requires a match or because they want to help others. Some people donate their stem cells in order to receive them later if they require an autologous transplant.

Medical guidelines are in place to protect both potential donors' and bone marrow and stem cell transplant patients' health. Many factors can influence whether or not a person is eligible to register as a donor.

People who want to donate stem cells or join a volunteer registry, including cancer survivors, can check the registry's eligibility list. They can also speak with a medical professional or contact the National Marrow Donor Program to locate a donor center near them. Potential donors are questioned to ensure they are healthy enough to donate and will not infect the recipient.

Collecting bone marrow stem cells

This is commonly referred to as bone marrow harvesting. It is performed in an operating room while the donor is under general anesthesia (a medication that puts them into a deep sleep and prevents them from feeling pain). The marrow cells are extracted from the pelvic (hip) bone. A large needle is inserted through the skin and into the back of the donor's hip bone. The needle is pushed through the bone to the center, where the thick, liquid marrow is extracted.

This is done several times until enough marrow has been extracted (harvested). The amount taken is determined by the donor's weight. Typically, 10% of the donor's marrow, or approximately 2 pints, is collected. This takes approximately 1 to 2 hours. Within 4 to 6 weeks, the body will replace these cells. If the donor's blood was taken prior to the marrow donation, it is frequently returned to the donor at this time.

The donor is taken to the recovery room after the bone marrow is harvested to allow the anesthesia to wear off. The donor may then be taken to a hospital room and monitored until he or she is fully alert and able to eat and drink. Most donors are able to leave the hospital within a few hours or the next morning.

Donors face few risks, and serious complications are uncommon. Bone marrow donation, on the other hand, is a surgical procedure. Anesthesia reactions, infection, nerve or muscle damage, transfusion reactions (if a blood transfusion of someone else's blood is required - this does not happen if you get your own blood), or injury at the needle insertion sites are all rare complications. Anesthesia can cause problems such as a sore throat or nausea.

Donors of allogeneic stem cells are not required to pay for harvesting because the recipient's insurance company usually covers the cost. Even so, before you decide to have the bone marrow harvest, make sure to inquire about insurance coverage.

After collecting the cells, they are filtered through fine mesh screens. This prevents the recipient from receiving bone or fat particles. The cells for an allogeneic or syngeneic transplant may be given to the recipient through a vein shortly after being harvested. They are sometimes frozen, for example, if the donor lives a long distance away from the recipient.

Conclusion

A bone marrow transplant is one of the major medical treatment procedures that necessitate extensive planning. This entails deciding on the best form of transplant, locating a donor where necessary, and preparing for an extended stay in the hospital.

The length of time it takes for the body to recover from a transplant fully depends on a number of factors. They can include the patient's age, overall health, and the purpose of the transplant.