Bone Marrow Transplant
What is Bone Marrow Transplant?
Transplantation is a tool that replaces damaged or diseased bone marrow in healthy blood for marrow. Bone marrow transplantation is required when the marrow does not work or sufficient healthy blood cannot be grown.
Bone marrow transplants are of two types, autologous and allogeneic. Transplants using cells from the human body are called autologous, and transplants from a donor are called allogeneic transplants.
Autologous Stem Cell Transplant
Autologous stem cell transplant uses healthy blood stem cells in the body to replace diseased or damaged bone marrow. During a stem cell transplant, using cells from one’s own body has some advantages over using stem cells from someone else. In autologous stem cell transplants, there is no incompatibility problem between the transplanted cells and the body’s own cells.
Autologous bone marrow transplant may be an option only if the body is producing enough healthy bone marrow cells. These cells can be harvested, frozen and stored for later use. Autologous stem cell transplants are often used in people who need high doses of chemotherapy and radiation. Autologous stem cell transplant helps replace damaged bone marrow.
Autologous stem cell transplants are mostly used to treat the following conditions:
- Hodgkin lymphoma
- Myeloma
- Non-Hodgkin lymphoma
- Plasma cell disorders
Allogeneic Stem Cell Transplant
Allogeneic stem cell transplant uses healthy “blood stem cells” from a donor to replace diseased or damaged bone marrow. Allogeneic stem cell transplant is also called allogeneic bone marrow transplant.
Donor; It could be a family member, acquaintance or stranger. Cells used in allogeneic stem cell transplantation can be collected from different sites such as:
- from the donor’s blood
- from the bone marrow in the donor’s hip bone
- from donated umbilical cord blood
Before an allogeneic stem cell transplant, high doses of chemotherapy or radiation therapy are taken to destroy diseased cells and prepare the body for donor cells. An allogeneic stem cell transplant may be an option for people with a variety of diseases, including:
- Acute Leukemia
- Adrenoleukodystrophy
- Extreme anemia
- Bone marrow failure syndromes
- Chronic leukemia
- Hemoglobinopathies
- Hodgkin lymphoma
- Immune deficiencies
- Inborn errors of metabolism
- Multiple myeloma
- Myelodysplastic syndromes
- Neuroblastoma
- Non-hodgkin lymphoma
- Plasma cell disorders
- Poems syndrome
- Primary amyloidosis
How is a Bone Marrow Transplant Done?
PRE-TRANSPLANT TESTS AND PROCEDURES
Before undergoing a bone marrow transplant, a series of tests and procedures are performed to assess the patient’s general health and ensure that he or she is physically ready for the transplant. Evaluation may take several days or longer. Otherwise, a surgeon or radiologist inserts a long, thin tube (intravenous catheter) into a large vein in the chest or neck. The catheter usually remains in place for the duration of the treatment. The transplant team will use this catheter to deliver the transplanted stem cells, drugs, and blood products to the body.
STEM CELL COLLECTION FOR AUTOLOGICAL TRANSPLANT
If a transplant using one’s own cells (autologous transplant) is planned, a procedure called apheresis is used to collect blood stem cells. Before apheresis, daily injections of growth factor are administered to increase stem cell production and to transport stem cells into the circulating blood so that they can be harvested.
During apheresis, blood is taken from a vein and circulated in a special machine. The machine separates the blood into different parts, including stem cells. Stem cells are collected and frozen for use during transplantation. The remaining blood is returned to the body.
COLLECTION OF STEM CELLS FOR ALLOGENIC TRANSPLANT
In a transplant using stem cells from a donor (allogeneic transplant), a suitable donor is searched and, when found, procedures for stem cell harvesting are performed. Stem cells can come from the donor’s blood or bone marrow. The transplant team decides which is better according to the patient’s condition.
Another type of allogeneic transplant uses stem cells from umbilical cords (cord blood transplant). Mothers can choose to donate their umbilical cord after the birth of their baby. The blood from these cords is frozen and stored in a cord blood bank until a bone marrow transplant is needed.
PREPARATION OR CONDITIONING PROCESS
After the pre-transplant tests and procedures are completed, a process known as the conditioning regimen begins. During conditioning, chemotherapy or radiation is administered to provide the following conditions:
- Destroying cancer cells
- Suppress the immune system
- Preparing the bone marrow for new stem cells
The conditioning regimen to be taken; It depends on a number of factors, such as disease, general health, and the type of transplant planned.
What Happens During a Bone Marrow Transplant?
On the day of transplantation, stem cells are given to the body through the catheter. The transplant is painless and the patient is not asleep during the procedure.
What Happens After Bone Marrow Transplant?
When new stem cells enter the body, they travel from the blood to the bone marrow. Over time, they multiply and begin to make new, healthy blood cells. While it usually takes a few weeks for the number of blood cells in the body to return to normal, it may take longer for some people.
It is important to closely monitor the patient’s condition in the days and weeks after a bone marrow transplant. For this, a number of blood and similar tests can be applied to the patient. Complications such as nausea and diarrhea may be observed and medication may be required to cure them.
After a bone marrow transplant, close medical care is required. If infection or other complications occur, it may be necessary to stay in the hospital for several days or sometimes longer.
The patient may need periodic transfusions of red blood cells and platelets until the bone marrow begins to produce enough of the healthy cells on its own.
Even months or years after transplant, patients may be at higher risk for infection or other complications. Periodic lifelong follow-up appointments should be made to monitor for late complications.
Things to Consider After Bone Marrow Transplantation?
If the bone marrow transplant uses stem cells from a donor (allogeneic transplant), doctors may prescribe drugs that reduce the immune system’s reaction (immunosuppressive drugs) to prevent Graft-versus-Host Disease (GVHD). It takes time for the immune system to recover after a transplant. During this time, medications may also be given to prevent infections.
After a bone marrow transplant, dietary adjustments may be necessary to stay healthy and prevent excessive weight gain. The nutritionist (dietician) and other members of the transplant team work with the patient to create a healthy eating plan that meets their needs and complements their lifestyle. Some of the recommendations may include:
- Following food safety instructions to prevent foodborne infections
- Eating a wide variety of healthy foods, including vegetables; fruits; whole grains; lean meat, poultry and fish; legumes; and healthy fats such as olive oil
- Limiting salt intake
- Limiting alcohol
- Avoiding grapefruit and grapefruit juice because of their effects on a group of immunosuppressive drugs (calcineurin inhibitors)
- Regular physical activity after bone marrow transplant; It helps control weight, strengthen bones, increase endurance, strengthen muscles and keep the heart healthy.
It is even more important to take steps to prevent cancer after a transplant. It is necessary not to smoke, to use sunscreen when outside and to have cancer screenings recommended by the doctor.
What are the Bone Marrow Transplant Results?
A bone marrow transplant can cure some diseases and put others in remission. Some people complete a bone marrow transplant with few side effects and complications. Others face a multitude of challenging problems both in the short and long term. The severity of side effects and the success of the transplant vary from person to person and can sometimes be difficult to predict before transplant.
It can be discouraging when significant difficulties arise in the transplant process. However, it may be helpful to remember that sometimes there are many people who have had a very difficult time in the transplant process but ultimately have successful transplants and return to normal activities with a good quality of life.