Bone marrow transplant

Overview

Stem cell transplants, also known as bone marrow transplants, involve the replacement of cancerous, abnormal, or damaged stem cells with healthy ones. Typically, peripheral blood stem cells, which are immature stem cells found in the bloodstream, are used in most transplant procedures, although some may utilize bone marrow or stem cells from umbilical cord blood. Depending on the case, the transplant may involve the use of the patient’s own healthy stem cells or stem cells donated by another individual. This medical intervention is employed by healthcare providers to address specific types of cancer, blood disorders, and autoimmune diseases, aiming to restore the patient’s health by rejuvenating their stem cell population. 

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  

Stem cell transplants are typically considered when other treatments prove ineffective or when a medical condition reoccurs after treatment. Healthcare professionals may utilize stem cell transplants to address various medical conditions, including certain types of cancer, blood disorders, and autoimmune diseases. 

Blood cancers: 

Stem cell transplants are employed in cases where alternative treatments fail or when blood cancers resurface. Some blood cancers that may be treated using this procedure include: 

• Chronic myeloid leukemia and chronic lymphocytic leukemia. 
• Multiple myeloma. 
• Myelodysplastic syndrome. 
• Hodgkin lymphoma and non-hodgkin lymphoma. 
• Myelofibrosis and polycythemia vera. 
• Acute myeloid leukemia. 
• Acute lymphoblastic leukemia.

Blood disorders: 

Blood disorders are conditions that impair the normal functioning of blood components. Stem cell transplants can be employed to address the following blood disorders: 

• Aplastic Anemia. 
• Sickle Cell Anemia. 
• Severe Combined Immunodeficiency Syndrome. 
• Thalassemia.

Other conditions: Stem cell transplants may also be utilized in the treatment of other medical conditions, such as: 

• Relapsing-Remitting Multiple Sclerosis, an autoimmune disease. 
• Recurrent Testicular Germ Cell Tumors after chemotherapy. 

Risk 

The greatest risk associated with a stem cell transplant is the possibility that the transplanted stem cells may not effectively slow down or eliminate the underlying illness. The potential complications arising from the procedure can vary depending on factors like your overall health, age, and prior treatments, including pre-transplant chemotherapy (conditioning). When contemplating a stem cell transplant, your healthcare provider will detail these potential complications, allowing you to assess and balance them against the potential benefits. Allogeneic stem cell transplants tend to have a higher likelihood of causing complications, primarily Graft vs. Host Disease (GvHD) and infection.

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  
• Chills.  
• Difficulty in breathing  
• Runny nose, coughing, or sneezing.  
• Painful urination.   
• Frequent urination.  
• Rash.  
• Lightheadedness or dizziness