Bone Marrow Transplantation

OR
Stem Cells Transplantation

A bone marrow transplant, also called a stem cell transplant, is a treatment

for some types of cancer. For example, you might have one if you have
leukemia, multiple myeloma, or some types of lymphoma. Doctors also
treat some blood diseases with stem cell transplants.

In the past, a stem cell transplant was more commonly called a bone
marrow transplant because the stem cells were collected from the bone
marrow. Today, stem cells are usually collected from the blood, instead of
 the bone marrow. For this reason, they are now often called stem cell
transplant.

Why are bone marrow and stem cells important?

A part of your bones called “bone marrow” makes blood cells. Marrow is
the soft, spongy tissue inside bones. It contains cells called “hematopoietic”
stem cells (pronounced he-mah-tuh-poy-ET-ick). These cells can turn into
several other types of cells. They can turn into more bone marrow cells. Or
they can turn into any type of blood cell.

Certain cancers and other diseases keep hematopoietic stem cells from
developing normally. If they are not normal, neither are the blood cells that
they make. A stem cell transplant gives you new stem cells. The new stem
cells can make new, healthy blood cells.

 Types Of Stem Cells Transplant:

The main types of stem cell transplants and other options are discussed
below.

 Autologous transplant:

 This is also called an AUTO transplant or high-dose chemotherapy with

autologous stem cell rescue.
In an AUTO transplant, you get your own stem cells after doctors treat the
cancer. First, your health care team collects stem cells from your blood and
freezes them. Next, you have powerful chemotherapy, and
rarely, radiation therapy. Then, your health care team thaws your frozen
stem cells. They put them back in your blood through a tube placed in a
vein (IV).
 It takes about 24 hours for your stem cells to reach the bone marrow. Then
they start to grow, multiply, and help the marrow make healthy blood cells
again.

 Allogeneic transplantation:

 This is also called an ALLO transplant. In an ALLO transplant, you get

another person’s stem cells. It is important to find someone whose bone
marrow matches yours. This is because you have certain proteins on your
white blood cells called human leukocyte antigens (HLA). The best donor
has HLA proteins as much like yours as possible.
Matching proteins make a serious condition called graft-versus-host
disease (GVHD) less likely. In GVHD, healthy cells from the transplant
attack your cells. A brother or sister may be the best match. But another
family member or volunteer may also work.

Donor:
Once you find a donor, you receive chemotherapy with or without radiation
therapy. Next, you get the other person’s stem cells through a tube placed
in a vein (IV). The cells in an ALLO transplant are not typically frozen. This
way, your doctor can give you the cells as soon as possible after
chemotherapy or radiation therapy.

There are 2 types of ALLO transplants. The best type for each person
depends on his or her age, health, and the type of disease being treated.

 Ablative, which uses high-dose chemotherapy

 Reduced intensity, which uses milder doses of chemotherapy

If your health care team cannot find a matched adult donor, there are other
options. Research is ongoing to determine which type of transplant will
work best for different people.

 Umbilical cord blood transplant. 

 This may be an option if you cannot find a donor match. Cancer
centers around the world use cord blood.
 Parent-child transplant and haplotype mismatched transplant.

These types of transplants are being used more often. The match is
50%, instead of near 100%. Your donor might be a parent, child,
brother, or sister.

 How a Bone Marrow Transplant Is

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

If you’re having an allogeneic transplant, bone marrow cells will be harvested from
your donor a day or two before your procedure. If your own cells are being
used, they’ll be retrieved from the stem cell bank.

Cells are collected in two ways.

During a bone marrow harvest, cells are collected from both hipbones
through a needle. You’re under anesthesia for this procedure, meaning
you’ll be asleep and free of any pain.

Leukapheresis:

During leukapheresis, a donor is given five shots to help the stem cells
move from the bone marrow and into the bloodstream. Blood is then drawn
through an intravenous (IV) line, and a machine separates out the white
blood cells that contain stem cells.
A needle called a central venous catheter, or a port, will be installed on the
upper right portion of your chest. This allows the fluid containing the new
stem cells to flow directly into your heart. The stem cells then disperse
throughout your body. They flow through your blood and into the bone
marrow. They’ll become established there and begin to grow.

The port is left in place because the bone marrow transplant is done over
several sessions for a few days. Multiple sessions give the new stem cells
the best chance to integrate themselves into your body. That process is
known as engraftment.

Through this port, you’ll also receive blood transfusions, liquids, and
possibly nutrients. You may need medications to fight off infections and
help the new marrow grow. This depends on how well you handle the
treatments.

During this time, you’ll be closely monitored for any complications.

 What to Expect After a Bone Marrow

Transplant?
The success of a bone marrow transplant is primarily dependent on how
closely the donor and recipient genetically match. Sometimes, it can be
very difficult to find a good match among unrelated donors.

The state of your engraftment will be regularly monitored. It’s generally

complete between 10 and 28 days after the initial transplant. The first sign
of engraftment is a rising white blood cell count. This shows that the
transplant is starting to make new blood cells.
Typical recovery time for a bone marrow transplant is about three months.
However, it may take up to a year for you to recover fully. Recovery
depends on numerous factors, including:

 the condition being treated

 chemotherapy
 radiation
 donor match
 where the transplant is performed

There’s a possibility that some of the symptoms you experience after the
transplant will remain with you for the rest of your life.