Bone marrow transplants are medical procedures in which healthy blood-forming stem cells replace damaged or diseased bone marrow. Blood cells are produced by bone marrow, which is the soft tissue inside your bones. Blood cells carry oxygen, fight infections, and stop bleeding.
There are two main types of bone marrow transplant:
In an autologous transplant, your own stem cells are collected and stored before receiving high-dose chemotherapy or radiation therapy. The stem cells are then returned to your body through a vein after the treatment. As a result, the bone marrow recovers and makes new blood cells.
Allogeneic transplant uses stem cells from a donor with a tissue type similar to yours. The donor can be a family member, an unrelated volunteer, or a cord blood unit. After a baby is born, cord blood remains in the placenta and umbilical cord. In the first stage of the transplant, you are given chemotherapy or radiation therapy to destroy your bone marrow before receiving donor stem cells through the vein. Your bone marrow uses the donor stem cells to make new blood cells.
You may need a bone marrow transplant if your bone marrow is not working properly or has been damaged by a disease or treatment. Some of the conditions that may require a bone marrow transplant are:
Leukemia: A type of blood cancer that affects the white blood cells, which help fight infections.
Lymphoma: A type of blood cancer that affects the lymphatic system, which is part of the immune system.
Multiple myeloma: A type of blood cancer that affects the plasma cells, which make antibodies to fight infections.
Myelodysplastic syndrome: A group of disorders that affect the blood cells and bone marrow.
Aplastic anemia: A condition that occurs when the bone marrow does not make enough blood cells.
Sickle cell anemia: A genetic disorder that causes the red blood cells to have an abnormal shape and function.
Thalassemia: A genetic disorder that affects the production of hemoglobin, the protein that carries oxygen in the red blood cells.
Immune deficiency disorders: A group of disorders that affect the immune system, which protects the body from infections and diseases.
Inherited metabolic disorders: A group of disorders that affect the metabolism, which is the process of converting food into energy and other substances.
The symptoms of bone marrow transplant depend on the type of transplant, the condition being treated, and the complications that may arise. Some of the common symptoms are:
Fatigue: Feeling tired or weak due to low red blood cell count or anemia.
Infections: Having frequent or severe infections due to low white blood cell count or neutropenia.
Bleeding: Having easy bruising or bleeding due to low platelet count or thrombocytopenia.
Graft-versus-host disease: Having skin rash, diarrhea, liver problems, or other symptoms due to the donor stem cells attacking the recipient’s tissues and organs. This is a possible complication of allogeneic transplant.
Graft failure: Having persistent low blood cell counts due to the donor stem cells not engrafting or growing in the recipient’s bone marrow. This is a possible complication of both autologous and allogeneic transplant.
Organ damage: Having problems with the heart, lungs, kidneys, liver, or other organs due to the chemotherapy or radiation therapy used before the transplant or the complications of the transplant.
Cataracts: Having cloudy vision due to the damage to the lens of the eye caused by the radiation therapy used before the transplant.
Infertility: Having difficulty conceiving or fathering a child due to the damage to the reproductive organs caused by the chemotherapy or radiation therapy used before the transplant.
In order to determine your eligibility for a bone marrow transplant and to prepare you for the transplant, you will need to undergo several tests and procedures.
Blood tests: To check your blood type, blood count, blood chemistry, and immune system markers. You will also be tested for infections such as hepatitis, HIV, and cytomegalovirus (CMV).
Bone marrow biopsy: To take a small sample of your bone marrow from your hip bone using a needle. The sample will be examined under a microscope to look for abnormal cells or signs of disease.
Tissue typing: To match your tissue type with a potential donor. You and the donor will have blood tests to check the compatibility of your human leukocyte antigens (HLA), which are proteins on the surface of your cells. The more closely your HLA match, the less likely you will have graft-versus-host disease or graft failure.
Lumbar puncture: To take a sample of your cerebrospinal fluid (CSF), which is the fluid that surrounds your brain and spinal cord. The sample will be tested for infections or cancer cells that may have spread to your central nervous system.
Chest X-ray: To take a picture of your chest to check for any problems with your lungs or heart.
Electrocardiogram (EKG or ECG): To measure the electrical activity of your heart to check for any irregularities or damage.
Echocardiogram: To use sound waves to create an image of your heart to check for any problems with its structure or function.
Pulmonary function tests: To measure how well your lungs work by having you breathe into a device that records the amount and speed of air you inhale and exhale.
CT scan: To use X-rays to create detailed images of your organs and tissues to check for any abnormalities or signs of disease.
PET scan: To use a radioactive substance that is injected into your vein and travels to the areas of your body that use glucose (sugar) for energy. A special camera then takes pictures of these areas to check for any cancer cells or infections.
MRI scan: To use a strong magnetic field and radio waves to create detailed images of your organs and tissues to check for any abnormalities or signs of disease.
The treatment of bone marrow transplant involves several steps, which may vary depending on the type of transplant, the condition being treated, and the complications that may occur. The main steps are:
Preparation: This is when you receive chemotherapy or radiation therapy to destroy your bone marrow and any cancer cells or diseased cells. During this period, you may also receive medication to prevent infections or other complications. You will stay in the hospital or a special transplant unit during this time. This also prevents your immune system from rejecting the donor stem cells.
The stem cells are sent through a vein, usually in the chest, to your bone marrow, where they can make new blood cells. This process may take several weeks or months. You will be closely monitored for any signs of infection, bleeding, graft-versus-host disease, or graft failure. As needed, you will receive blood transfusions, fluids, nutrition, and medications. The hospital or special transplant unit will keep you until your blood counts are stable and you are well enough to go home.
You will need to get regular blood tests and check-ups to monitor your blood count, organ function, and potential complications during recovery. This is when you continue to recover at home or in an outpatient clinic. You will need to take medications to prevent infections, graft-versus-host disease, or graft rejection. Avoid germs, crowds, and people who are ill. In order to prevent complications and help your body heal, you will need to follow a healthy diet, exercise, and lifestyle. If you develop any late effects from the transplant, such as cataracts, infertility, cancer, or chronic health problems, you will need to undergo lifelong follow-up care.
There is no sure way to prevent bone marrow transplant, as it is often the last resort for treating life-threatening diseases or conditions. However, you can take some steps to reduce your risk of needing a bone marrow transplant, such as:
Avoiding exposure to chemicals, radiation, or infections that can damage your bone marrow or cause cancer.
Getting regular check-ups and screenings for any diseases or conditions that can affect your bone marrow or blood cells.
Following your doctor’s advice and treatment plan if you have a disease or condition that can affect your bone marrow or blood cells.
Seeking medical attention promptly if you have any symptoms of bone marrow failure, such as fatigue, infections, bleeding, or bruising.
Joining a bone marrow registry or donating cord blood if you are healthy and eligible. This can help save the lives of people who need a bone marrow transplant.
