Bone Marrow Transplant
What is a bone marrow transplant?
A bone marrow transplant replaces diseased or destroyed bone marrow with healthy cells. Bone marrow is the spongy center of most bones that contains hematopoietic stem cells.
Stem cells are unique. There are many different types of stem cells capable of changing into many different types of cells. ‘Hematopoietic’ stem cells create all types of blood cells—red blood cells, white blood cells, and platelets. Diseased or destroyed bone marrow isn’t able to make normal blood cells. A bone marrow transplant restores this function by repopulating the bone marrow with healthy stem cells from a donor. Stem cell transplant is another name for this procedure.
There are two types of bone marrow transplant depending on the donor source:
- Allogeneic bone marrow transplants—or ALLO transplants—use stem cells from another person. An important step in ALLO transplants is HLA (human leukocyte antigen) matching. HLAs are blood proteins. When they closely match between donor and recipient, the transplant is more likely to be successful.
- Autologous bone marrow transplants—or AUTO transplants—use your own stem cells. In ALLO transplants, doctors collect and freeze your stem cells in advance for later use.
Why is a bone marrow transplant performed?
The main use for bone marrow transplant is to treat blood cancers, bone marrow diseases, and certain other diseases, such as immune deficiencies. Examples of blood cancer uses include bone marrow transplant for leukemia, lymphoma, and multiple myeloma. Bone marrow diseases include aplastic anemia and sickle cell disease. In these cases, doctors wipe out the diseased bone marrow with powerful chemotherapy or radiation. Then, they replace the bone marrow with healthy stem cells.
Another use of bone marrow transplant is called rescue transplantation. In this case, doctors have used high-dose chemotherapy to treat a non-blood cancer, such as testicular cancer. A side effect of this kind of treatment is the destruction of bone marrow. Bone marrow transplantation replaces or “rescues” the destroyed bone marrow.
Who performs a bone marrow transplant?
A bone marrow transplant requires a team of specialists including:
- Hematologists: Doctors who specialize in researching, diagnosing and treating diseases, disorders and conditions affecting the blood.
- Immunologists: Doctors who specialize in managing diseases, disorders and conditions related to the immune system.
- Oncologists: Doctors who specialize in preventing, diagnosing and treating cancer.
Other members of the team may include transplant nurse coordinators, infectious disease doctors, social workers, psychologists, dietitians, and various therapists. Experience is vital when choosing a bone marrow transplant team. Do your research and find a center that has successfully treated other patients with your condition.
How is a bone marrow transplant performed?
The procedure for bone marrow transplant involves several steps.
Pre-transplant testing and evaluation
This step makes sure you are eligible and able, both physically and psychologically, to undergo the transplant. The process can take several days or weeks.
Stem cell collection
This process has changed dramatically over the years. The current version of stem cell transplant vs. bone marrow transplant from the past is very different. Historically, doctors had to aspirate or remove donor bone marrow in a surgical procedure. The most common site for harvesting bone marrow was the hip bone. This procedure may still be appropriate in some cases.
Today, research has discovered that hematopoietic stem cells are also present in the blood. So, doctors can harvest them directly from the blood using a filtering process called apheresis. In apheresis, blood circulates through a machine that separates and collects the stem cells. Then, the remaining blood returns to the body. You, or your HLA-matched donor, will have an IV line in each arm. The lines will connect to the apheresis machine to allow blood to circulate through it and back. Several sessions may be necessary to collect enough stem cells for a transplant.
For most bone marrow transplants, you must undergo a process called conditioning. Other names for it include myeloablation, pre-transplant treatment, and bone marrow preparation. It involves eliminating the diseased bone marrow and suppressing the immune system. Doctors use chemotherapy, radiation therapy, or both to accomplish these goals.
The transplantation procedure is relatively simple. It’s an infusion of donor stem cells into the bloodstream. To handle the infusion, you must have a central line in a large vein. If you don’t already have one, doctors will place it about 10 days before the transplant, usually in either the chest or the neck. Placing the catheter is an outpatient procedure. The transplant itself most often takes place in a hospital or transplant center. A hospital stay is usually necessary to monitor progress and prevent infection.
What are the risks and potential complications of a bone marrow transplant?
All procedures have risks and potential complications. Complications can happen during the procedure or develop throughout recovery. Some complications can be serious and even life threatening.
Reactions during the infusion
During the stem cell infusion, your team will closely monitor your status and vital signs. You may experience any of the following reactions:
- Chest pain
- Fever or chills
Potential complications of bone marrow transplant
Potential bone marrow transplant complications include:
- Breathing problems from infection, fluid overload, bleeding, and graft-versus-host disease (GVHD), which happens when the donor’s cells begin attacking the recipient’s tissues. GVHD is only an issue with ALLO transplants.
- Fluid overload
- Low red blood cells resulting in anemia, or low platelets, which can lead to serious bleeding
- Organ damage due to infection, fluid overload, or GVHD
- Transplant problems, including transplant failure (called graft failure) and GVHD
Reducing your risk of complications
It isn’t always possible to prevent complications from a bone marrow transplant. Your transplant team will monitor you closely for early signs of a problem. You can help reduce your risk of certain complications by:
- Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during recovery
- Informing your doctor if there is any possibility of pregnancy
- Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain
- Taking your medications exactly as directed
- Telling all members of your care team if you have allergies
How do I prepare for a bone marrow transplant?
It’s common to go to the transplant center up to 10 days before the bone marrow transplant for inpatient care. Preparations for the bone marrow transplant will vary depending on the reason you need it and if you are using a donor or not.
Questions to ask your doctor
The time before a bone marrow transplant can be stressful. To remember everything you want to ask, consider making a list of questions, such as:
- What is involved in a bone marrow transplant? What other treatments will I need?
- Will you use my own stem cells or do we need to find a donor? What are the pros and cons of each option?
- What happens if we can’t find a suitable donor?
- How long will the transplant take?
- What restrictions will I have after the transplant?
- When will I be able to go home?
- When can I return to work and other activities?
- How often will I need follow-up visits with you or at the hospital?
- How and when will you know if the transplant was a success?
- What is my prognosis or long-term outlook?
What can I expect after a bone marrow transplant?
You can plan and prepare for a successful recovery better when you know what to expect.
How long will it take to recover?
Recovery after a bone marrow transplant takes a significant amount of time. You may spend several days in the hospital after the transplant to closely monitor for complications. Your transplant team will check your blood counts frequently to gauge the progress of engraftment. Engraftment happens when the stem cells begin making new blood cells in the bone marrow. It can take from 2 to 6 weeks. Some people are able to complete engraftment on an outpatient basis. Others need to stay in the hospital until it occurs.
During the first couple of weeks, you will be very susceptible to infections because the conditioning process damages your immune system. If you are in the hospital, you will most likely be confined to a clean environment to prevent exposure to germs. Antibiotics may be necessary in the first few weeks to prevent infection.
Once you are home, full recovery can take several months or longer. Until you have fully recovered, you will not be able to work or engage in other activities that would put you at risk of complications.
Will I feel pain?
You may feel pain or discomfort during the stem cell infusion. Pain can also be a sign of a complication. Tell your doctor about any pain you feel during or after the infusion and throughout your recovery.
When should I call my doctor?
Frequent follow-up visits will be part of your life for quite some time after you return home. If you have questions between these visits, call your doctor’s office or transplant center during normal business hours. Your transplant team will also give you instructions for after-hours concerns. Call doctor right away or seek immediate medical care if you experience:
- Breathing problems or shortness of breath
- Confusion or changes in level of alertness
- Chest pain, pressure or tightness
- Fever. Your doctor will give you instructions about when to call for a fever.
- Skin rash or eye irritation
- Yellow discoloration of the skin or eyes
- Unexpected bleeding
How might a bone marrow transplant affect my everyday life?
Continuous follow-up care is necessary after a bone marrow transplant. Your prognosis after the transplant depends on several factors. This includes your age, your overall health, the type of transplant, and whether you develop complications. If you use donor stem cells, you will need medicine to prevent graft-versus-host disease. Your doctor can help you understand your prognosis after a stem cell transplant.