Bone Marrow Transplant, Stem Cell Transplant

Overview

A bone marrow transplant involves replacing bone marrow that isn’t making enough healthy blood cells with healthy blood-forming stem cells infused into the body. This process might be referred to as a stem cell transplant.

While bone marrow or umbilical cord blood stem cells are occasionally used in transplants, peripheral blood stem cells, or immature stem cells in the bloodstream, are used in the majority of cases. In the event that the patient has a bone marrow transplant, the healthcare provider may use either from the donor (allogeneic transplant) or their own healthy bone marrow (autologous transplant). Healthcare providers perform this treatment to treat autoimmune illnesses, blood problems, and specific types of cancer.

Types

The bone marrow transplant is categorized into two types:

• Allogeneic: When bone marrow isn’t making enough healthy blood cells, an allogeneic stem cell transplant replaces it with donor healthy blood stem cells.
• Autologous: In an autologous stem cell transplant, malfunctioning bone marrow is replaced with healthy blood stem cells from the patient’s own body.

Stem cell transplants using autologous materials are utilized more often than those using allogeneic stem cells.

Reasons for undergoing the procedure

There are several purposes for a bone marrow transplant. The treatment replaces or saves the bone marrow that was damaged by the chemotherapy or radiation, it allows the safe use of large dosages of these treatments. It also replaces damaged bone marrow with new stem cells. In order to directly assist in the removal of cancer cells, the process also includes the provision of new stem cells.

Bone marrow transplants are usually given to patients when no other treatments work or if their medical condition returns after treatment. Bone marrow transplants are performed by healthcare providers to treat various illnesses, including blood cancers, tumors, blood abnormalities, and some autoimmune diseases.

• Blood cancers: In cases when other treatments are ineffective or a blood cancer returns, healthcare providers may turn to bone marrow transplantation. Healthcare providers could apply this technique, for instance, to treat the following types of blood cancers:
  • Acute lymphoblastic leukemia.
  • Acute myeloid leukemia.
  • Chronic myeloid leukemia and chronic lymphocytic leukemia.
  • Hodgkin lymphoma and non-Hodgkin lymphoma.
  • Multiple myeloma.
  • Myelodysplastic syndrome.
  • Myelofibrosis and polycythemia vera.
• Blood disorders: Disorders of the blood prevent some components of the blood from performing their functions. Bone marrow transplants might be used by healthcare providers to treat:
  • Aplastic anemia.
  • Severe combined immunodeficiency syndrome.
  • Sickle cell anemia.
  • Thalassemia
• Other conditions: Bone marrow transplants may be used by healthcare providers to treat autoimmune diseases such as relapsing-remitting multiple sclerosis or testicular germ cell cancers that return following treatment.

Risk

A bone marrow transplant carries various risks, with outcomes ranging from minor inconveniences to severe complications requiring medical intervention or hospitalization. In some cases, life-threatening consequences can even occur. The primary concern revolves around the possibility that the newly transplanted bone marrow may not effectively treat or cure the recipient’s underlying disease.

Several factors come into play when assessing these risks, including the patient’s overall health, age, and their medical history, particularly any prior chemotherapy treatments received before transplantation. To help patients make informed decisions about whether to proceed with a bone marrow transplant, their healthcare provider will thoroughly discuss potential complications and weigh them against the potential benefits.

The following risk and complication may include:

• Graft vs. Host Disease (GvHD). (only for allogeneic transplant)
• Bone marrow failure.
• Infection.
• Organ damage.
• Cataract.
• Infertility.
• New development of cancer

Before the procedure

In the event that the patient qualifies for a bone marrow transplant, the healthcare provider will carry out the following examinations to verify that the patient is physically capable of handling the procedures involved in the transplant, such as conditioning chemotherapy prior to treatment and transplant side effects:

• Electrocardiogram (EKG).
• Echocardiogram (Echo).
• Computed tomography (CT) scan.
• Complete blood count (CBC).
• Blood tests including liver function or kidney function.
• Biopsy to study cancerous cells.

In one of the large veins in the upper chest, the healthcare provider may insert a central venous catheter (CVC) prior to the blood tests. Throughout the transplant procedure, CVCs replace the need for many needle jabs to take blood or introduce intravenous tubes.

The healthcare provider may prescribe medicine to the patient to increase stem cell production if they are receiving their own stem cells. To monitor stem cell generation, they will do follow-up blood tests. Healthcare providers will draw blood from them if they are getting their own stem cells so that healthy stem cells may be extracted for transplant. This is how it functions:

• The cell separator machine is connected to the veins in both arms by the healthcare providers.
• The device draws blood from one arm’s veins.
• Stem cells are filtered from the blood using the cell separator machines.
• Blood returns to the veins of the opposing arm.
• Although it might take three to four hours, the procedure is painless.
• To ensure patients have enough stem cells for the transplant, the healthcare provider may need to draw blood multiple times.

During the procedure

The procedure could be comparable to getting medicine or a blood transfusion through an intravenous catheter (IV) tube, regardless of whether the patient is receiving donated bone marrow or their own bone marrow. In order to help avoid adverse effects or lower the possibility that their body may reject the new bone marrows, the healthcare provider may first give them fluid and medicine. Following that, bone marrows will be infused.

The procedure might take a couple of hours to complete. The healthcare provider will regularly monitor the patient for fever, chills, and other possible adverse effects while they are getting fresh bone marrows.

After the procedure

The new bone marrows enter the body and make their way to the bone marrow through the circulation. They multiply and start producing fresh, healthy blood cells over time. To generate new blood cells, the bone marrows will require some time. Should the patient have been given donor bone marrows, the new bone marrows they get will replace the sick bone marrows and start the process of forming a new immune system, this is called engraftment.

In any case, the patient might have to spend many months in or near the hospital so that their healthcare provider can monitor their progress and assist them in recovering, including counting the number of new blood cells produced by their bone marrow Following their bone marrow transplant, people can anticipate the following:

• The effectiveness of their immune system to defend them against infections is impacted by pre-treatment chemotherapy, often known as conditioning. They will be alone in a thoroughly cleaned room with very little opportunity for physical interaction with other persons in order to lower the risk.
• After receiving a transplant, some patients have nausea, vomiting, and diarrhea. In addition to fluid replacement, the healthcare provider will administer medicines to help with the symptoms.
• Immunosuppressive medicine will be administered to the patient if they got donor cells in order to lessen the likelihood that their body may reject the transplant.
• Blood transfusions may be necessary for the patient to replenish platelets and red blood cells.

Outcome

 When traditional treatments prove ineffective in managing blood cancers or other blood-related conditions, bone marrow transplants can offer potential cures or disease control. The specific objectives of a bone marrow transplant may vary depending on the individual’s condition, but commonly include extending life, enhancing its quality, and effectively managing or treating the disease.

It’s important to note that many recipients of bone marrow transplants have endured challenging periods during their treatment journey. However, they have ultimately undergone successful transplants, and today they are enjoying an improved quality of life and the ability to resume their usual activities.

The patient’s healthcare provider will schedule routine follow-up visits with them. It’s important to keep in mind, though, that their immune system will probably be compromised for around a year following the transplant. In case the patient has any of the following symptoms, promptly get in touch with the healthcare provider:

• Fever (30 degrees Celsius or above)
• Chills.
• Difficulty in breathing
• Runny nose, coughing, or sneezing.
• Painful urination.
• Frequent urination.
• Rash.
• Lightheadedness or dizziness