Bone Marrow Transplant
A bone marrow transplant is a procedure to replace damaged or destroyed bone marrow with healthy bone marrow stem cells.
Bone marrow is the soft, fatty tissue inside your bones. Stem cells are immature cells in the bone marrow that give rise to all of your blood cells.
There are three kinds of bone marrow transplants:
- Autologous bone marrow transplant: The term auto means self. Stem cells are removed from you before you receive high-dose chemotherapy or radiation treatment. The stem cells are stored in a freezer (cryopreservation). After high-dose chemotherapy or radiation treatments, your stems cells are put back in your body to make (regenerate) normal blood cells. This is called a rescue transplant.
- Allogeneic bone marrow transplant: The term allo means other. Stem cells are removed from another person, called a donor. Most times, the donor's genes must at least partly match your genes. Special blood tests are done to see if a donor is a good match for you. A brother or sister is most likely to be a good match. Sometimes parents, children, and other relatives are good matches. Donors who are not related to you may be found through national bone marrow registries.
- Umbilical cord blood transplant: This is a type of allogeneic transplant. Stem cells are removed from a newborn baby's umbilical cord right after birth. The stem cells are frozen and stored until they are needed for a transplant. Umbilical cord blood cells are very immature so there is less of a need for matching.
Before the transplant, chemotherapy, radiation, or both may be given. This may be done in two ways:
- Ablative (myeloablative) treatment: High-dose chemotherapy, radiation, or both are given to kill any cancer cells. This also kills all healthy bone marrow that remains, and allows new stem cells to grow in the bone marrow.
- Reduced intensity treatment, also called a mini transplant: Patients receive lower doses of chemotherapy and radiation before a transplant. This allows older patients, and those with other health problems to have a transplant.
- A stem cell transplant is done after chemotherapy and radiation is complete. The stem cells are delivered into your bloodstream usually through a tube called a central venous catheter. The process is similar to getting a blood transfusion. The stem cells travel through the blood into the bone marrow. Most times, no surgery is needed.Donor stem cells can be collected in two ways:
- Bone marrow harvest. This minor surgery is done under general anesthesia. This means the donor will be asleep and pain-free during the procedure. The bone marrow is removed from the back of both hip bones. The amount of marrow removed depends on the weight of the person who is receiving it.
- Leukapheresis. First, the donor is given 5 days of shots to help stem cells move from the bone marrow into the blood. During leukapheresis, blood is removed from the donor through an IV line in a vein. The part of white blood cells that contains stem cells is then separated in a machine and removed to be later given to the recipient. The red blood cells are returned to the donor.
Who Performs Bone Marrow Transplants
Bone marrow transplants should be performed by oncologists or specialists in autologous or allergenic bone marrow transplant procedures. Oncologists join with a bone marrow transplant team, all of whom should be certified in their field in their country of origin. When searching for bone marrow transplant procedures, check to make sure facilities as well as staff are accredited and certified by international or country accrediting organizations, universities, and oncology and transplant boards and organizations.
Procedure is Performed
A bone marrow transplant replaces bone marrow that either is not working properly or has been destroyed (ablated) by chemotherapy or radiation.
Your doctor may recommend a bone marrow transplant if you have:
- Certain cancers, such as leukemia, lymphoma, and multiple myeloma
- A disease that affects the production of bone marrow cells, such as aplastic anemia, congenital neutropenia, severe immunodeficiency syndromes, sickle cell anemia, thalassemia
- Had chemotherapy that destroyed your bone marrow
A bone marrow transplant may cause the following symptoms:
- Chest pain
- Drop in blood pressure
- Funny taste in the mouth
- Shortness of breath
Possible complications of a bone marrow transplant depend on many things, including:
- The disease you are being treated for
- Whether you had chemotherapy or radiation before the bone marrow transplant and the dosages of such treatments
- Your age
- Your overall health
- How good of a match your donor was
- The type of bone marrow transplant you received (autologous, allogeneic, or umbilical cord blood)
Complications can include:
- Bleeding in the lungs, intestines, brain, and other areas of the body
- Clotting in the small veins of the liver
- Damage to the kidneys, liver, lungs, and heart
- Delayed growth in children who receive a bone marrow transplant
- Early menopause
- Graft failure, which means that the new cells do not settle into the body and start producing stem cells
- Graft-versus-host disease, a condition in which the donor cells attack your own body
- Infections, which can be very serious
- Inflammation and sorenes in the mouth, throat, esophagus, and stomach, called mucositis
- Stomach problems, including diarrhea, nausea, and vomiting
Before the Procedure
Your health care provider will ask about your medical history and do a physical exam. You will have many tests before treatment begins.
Before transplant, you will have one or two tubes, called catheters, inserted into a blood vessel in your neck or arms. This tube allows you to receive treatments, fluids, and sometimes nutrition.
Your doctor or nurse will likely discuss the emotional stress of having a bone marrow transplant. You may want to meet with a mental health counselor. It is important to talk to your family and children to help them understand what to expect.
After the Procedure
A bone marrow transplant is usually done in a hospital or medical center that specializes in such treatment. Most of the time, you will stay in a special bone marrow transplant unit in the center. This is to limit your chance of getting an infection.
Depending on the treatment and where it is done, all or part of an autologous or allogeneic transplant may be done as an outpatient. This means you do not have to stay in the hospital.
How long you stay in the hospital depends on how much chemotherapy or radiation you received, the type of transplant, and your medical center's procedures. While you are in the hospital, you will be isolated because of the increased risk of infection. The health care team will closely monitor your blood count and vital signs.
While you are in the hospital you may:
- Receive medications to prevent or treat infections, including antibiotics, antifungals, and antiviral drugs
- Need many blood transfusions
- Be fed through a vein (IV) until you can eat by mouth and stomach side effects and mouth sores have gone away
- Be given medications to prevent graft-versus-host disease
How well you do after transplant depends on:
- The type of bone marrow transplant
- How well the donor's cells match yours
- What type of cancer or illness you have
- Your age and overall health
- The type and dosage of chemotherapy or radiation therapy you had before your transplant
- Any complications
- Your genes
A bone marrow transplant may completely or partially cure your illness. If the transplant is a success, you can go back to most of your normal activities as soon as you feel well enough. Usually it takes up to 1 year to recover fully.
Complications or failure of the bone marrow transplant can lead to death.
Common Bone Marrow Transplant Procedures
There are three basic types of bone marrow transplants:
- Autologous bone marrow transplant
- Allergenic bone marrow transplant
- Umbilical cord blood transplant
A bone marrow transplant enables an individual to receive healthy stem cells in the event that a person's own bone marrow has been compromised or destroyed, as is the case with many diseases and cancers such as leukemia.
An autologous bone marrow transplant defines a procedure in which a patient's own cells or tissues are cultivated from the body prior to a procedure or surgery. In the case of a bone marrow transplant, a person's own bone morrow is cultivated from his or her body prior to chemotherapy or radiation treatments and then injected back into that patient's body following cancer treatments. This procedure is called a 'rescue' transplant.
An allergenic bone marrow transplant utilizes stem cells that come from someone else, also known as a donor. Donors who contribute bone marrow or blood must match genetic typing between patients, or the body will reject the contribution. Blood tests will determine whether or not donors are a good match for a recipient patient, but in most cases, siblings are the most common donors for any type of tissue or organ transplant success.
Umbilical cord blood transplants are becoming more popular as a result of extended research and development in stem cell technology. Umbilical cord blood is collected from the umbilical cord following the birth of an infant and does not harm either baby or mother. Taken from typically discarded after birth, umbilical cord blood contains stem cells that may be genetically tested and then frozen until needed for transplant. In most cases, this technology is best used for family members of a person needing a bone marrow transplant.
In the 'old days' individuals suffering from leukemia or other autoimmune disease processes were given bone marrow transplants, which can be an expensive and painful process. Today, bone marrow transplants are commonly achieved through stem cells cultivated from samples of bone marrow from an individual, and enjoys the added benefit of reduced chances of rejection or reactions between recipients and donors.
Bone marrow transplant procedures often take place in facilities that specialize in such treatments and may require an individual to stay in the hospital for several weeks during the healing process to reduce chances of infection, but depending on situation and whether or not the transplant is allergenic or autologous, the procedure may sometimes be completed on an outpatient basis.
Any type of organ transplant is expensive, and while medical insurance for bone marrow transplants in the United States cover some costs, others are not. An autologous bone marrow transplant can cost between $50,000 and $100,000, while an allergenic bone marrow transplant may cost between $150,000 and $200,000. That does not include donor search fees, which for uninsured individuals may run between $2,000 and $5000. Individuals who know potential non-relative donors may pay between 15,000 and $50,000 for match testing, while testing relatives in a donor search may cost between $3,500 and $5,000.
While an autologous bone marrow transplant in the United States costs an average of $75,000 or more, the same procedure performed in Asia and Europe costs about $30,000. The lower cost does not at all reflect on training, expertise, or quality of service, as India, like many other foreign destinations, offers superlative, accredited, and world-class educated and experienced surgeons who perform these procedures, though without the outrageous cost of medical malpractice insurance that add burdens to procedure costs.