Bone Marrow Transplants: Procedure, Risks, Benefits, Recovery, Prognosis

Medically Reviewed by Dr. K on 23 May 2022

What Is a Bone Marrow Transplant?

A bone marrow transplant is a process that replaces weakened or diseased bone marrow with healthy marrow. Bone marrow is a spongy tissue within the bones where the body produces and stores blood cells.

Your blood cells start as haematopoietic stem cells, which are really young “immature” cells. They leave your bone marrow and enter your bloodstream after they have matured. A stem cell transplant is another name for a bone marrow transplant.

Damaged bone marrow produces insufficient blood cells and immune system cells. Certain illnesses and cancers may be cured with a transplant. It also entails a lengthy treatment period and the possibility of adverse side effects. Your doctor will discuss all of the benefits and drawbacks of the transplant with you.

Why Is a Bone Marrow Transplant Done?

Haematopoietic stem cells are found in the bone marrow. They develop into:

  • Red blood cells that transport oxygen across the body
  • White blood cells that aid in the immune system's function
  • Platelets that enable the blood to clot

A bone marrow transplant will help with:

  • Replacing stem cells that have been killed by cancer chemotherapy.
  • Replacing diseased marrow that is incapable of producing its own stem cells.
  • Detecting and eliminating cancer cells.

If you have any of the following conditions, you may require a transplant:

  • Leukemia, whether acute or recurrent
  • Lymphoma, whether Hodgkin's or non- Hodgkin's
  • Waldenstrom macroglobulinemia
  • Multiple myeloma i
  • Aplastic anaemia
  • Amyloidosis
  • Myelofibrosis
  • Myeloproliferative disorders (MPDs)
  • Germ cell tumors
  • Sarcoma
  • Undergoing any cancer treatments, such as heavy doses of chemotherapy or radiation

Types of Bone Marrow Transplants

There are two main types of bone marrow transplants:

  • Autologous: Collecting stem cells from your own marrow or blood and stores them. Your own stem cells are then injected into the bloodstream. The cells migrate to the bone marrow and replicate, assisting it in regenerating stable stem cells.
  • Allogeneic: You get stem cells from an individual whose bone marrow matches the genetics of yours during cancer treatment. It may be a personal relative, such as a parent or sibling, or anyone from the national donor registry. A syngeneic transplant occurs where the donor is an identical relative of the same tissue form as you. Doctors may also extract stem cells from a newborn's umbilical cord tissue.

Preparing For A Bone Marrow Transplant

Your doctor will determine if you are a candidate for a bone marrow transplant. They'll do a clinical examination and tests to examine your blood to determine how well your organs are functioning.

If a transplant seems to be a viable choice, they will discuss the treatment with you and what you should anticipate.

You will need to go to the hospital a couple days before the transplant to get a central venous catheter inserted into a vein in your chest. It would be used by the medical team to draw blood and administer medication. It will remain there until the therapy is completed.

Collecting cells for an autologous bone marrow transplant

Your doctor can extract stem cells from the marrow in your hip bone using a long needle. It's performed under general anaesthesia in an emergency theatre, which ensures you'll be unconscious and won't feel anything. It requires about an hour or two to complete the operation. You have the choice of returning home that day or the next morning. You may feel sore and weak for a few days following this procedure.

Apheresis is a technique that allows them to take cells straight from the blood. For a couple days before the procedure, you'll need to take a medication named filgrastim, which causes the bone marrow to produce and release a large number of stem cells. The blood will then be drawn from a vein in your arm and passed into a filter that divides the stem cells. The remaining cells are returned to your bloodstream. You won't have to remain in the hospital for apheresis since it's an outpatient treatment. It normally takes between two and four hours.

Collecting cells for an allogeneic bone marrow transplant

Your doctor will pair you with someone who has the same kind of antibody, called a human leukocyte antigen, on their white blood cells (HLA). Your HLA form is inherited from your parents.

The donor would go through the same procedure and extract their stem cells whether they are a family or a stranger. If parents want to donate cells from their child's umbilical cord blood, the cord would be clamped and cut after the baby is born.

 

Bone Marrow Transplant Procedure

You'll begin with a procedure known as conditioning. This normally entails a heavy dose of chemotherapy for around 10 days, perhaps with radiation. It varies from person to person and is determined by the physical wellbeing as well as the disorder being handled.

Conditioning frees up space in your bone marrow for fresh cells to mature. It even temporarily weakens the immune system so that the body doesn't have to battle the new cells.

Conditioning can have the following side effects:

  • Mouth sores
  • Nausea and vomiting
  • Hair loss
  • Lung or breathing problems
  • Difficulty eating
  • Premature menopause
  • Fertility issues

You'll receive healthy blood stem cells via the central venous catheter after a couple of days of rest. You'll most likely be awake for this, so it should not be painful.

The fresh cells can mature into red and white blood cells, as well as platelets once they enter your marrow. This procedure, known as engraftment, will take from two to four weeks.

Bone Marrow Transplant Recovery

Everyone's treatment is different, but you'll most likely be in the hospital for several weeks. Since the immune response will be weakened, you will be prescribed antibiotics to prevent potential infections. Blood transfusions could also be needed.

Your doctors will monitor your blood during the first few weeks to check for engraftment. For this, they may take a small sample of your bone marrow.

After meeting certain requirements, such as specific blood cell levels and no fever for two days, you can meet the necessary requirements for a safe discharge from the hospital. You'll still need someone at home to assist you with your treatment.

After the transplant, your immune system can take a year or longer to recover and stabilise. To avoid infections and graft versus host disease, you'll need to get regular checkups and continue with your prescriptions. Graft versus host disease is a condition in which the new cells attack your own cells and cause you to be very unwell.

You could be referred to a dietitian who will help you develop a diet program that can help you avoid diseases and stay healthy. They could advise you to:

  • Avoid foods and beverages with a greater chance of foodborne disease.
  • Select foods that provide the body with the nutrients it needs.
  • To cover nutritional gaps with additional multivitamins or supplements.
  • Limit your sodium intake.
  • Avoid consuming alcoholic beverages.
  • Observe general food safety precautions.

For the time being, you won't be able to return to work or perform other tasks. In addition, your doctor may recommend that you make a few lifestyle adjustments, such as:

  • Limit your time under intense sunlight as your skin may be more vulnerable and sensitive.
  • Avoid getting a tattoo or a piercing.
  • Take special precautions to avoid teeth cavities and dental infections.
  • Keep the house sanitary and mold-free.
  • Do not smoke tobacco.

Risks of Bone Marrow Transplants

Complications from a bone marrow transplant include:

  • Bleeding
  • Infection
  • Low blood cell counts
  • Skin rash
  • Diarrhea
  • Fertility problems
  • Cataracts
  • Muscle spasms or leg cramps
  • Numbness in your arms or legs
  • Painful inflammation in your mouth and digestive tract
  • Liver or kidney damage
  • Difficulty breathing
  • Organ damage

A transplant also increases the chances of developing another cancer in the future.

While it's uncommon, some of these issues may be fatal.

If you receive a transplant from a donor, keep an eye out for symptoms of graft versus host disease. These are some of them:

  • Rashes or blisters
  • Upset stomach
  • Changes in appetite
  • Diarrhea
  • Bloating
  • Blood in your stool
  • Yellow skin (jaundice)
  • Dark coloured urine

Graft versus host disease can become a long-lasting condition. If it does, you may have:

  • Dry eyes
  • Joint pain
  • Sores in your mouth
  • Persistent cough
  • Difficulty breathing
  • Irritation on your penis or in your vagina
  • Painful sex

Bone Marrow Transplant Outlook

Your doctor will explain what they're checking for in order to declare the transplant effective. This may involve blood counts that have returned to normal and the regulation of a disease.

A bone marrow transplant's effectiveness is determined by a number of factors, including:

  • Your age.
  • Your general well-being
  • What kind of treatment you receive.
  • What effect that has on your illness.
  • How tolerable such procedures or treatments are with you.
  • Whether or not you have any issues or complications.

Thousands of patients have recovered from their illnesses thanks to transplants. Doctors are now coming up with innovative approaches to help them.

Speak to a doctor or a care worker if you're having trouble dealing with depression or anxiety problems following your transplant. They will guide you to services such as community groups of people who understand the situation.

Sources

Referenced on  28/4/2021 

  1. Health Resources and Services Administration: “Understanding Transplantation as a Treatment Option.”
  2. American Cancer Society: “Why Would Someone Need a Stem Cell Transplant?” “The Transplant Process,” “What Are Stem Cells and Why Are They Transplanted?” “Stem Cell or Bone Marrow Transplant.”
  3. Johns Hopkins Medicine: “Bone Marrow Transplantation.”
  4. National Heart, Lung and Blood Institute: “Aplastic Anemia."
  5. American Society of Clinical Oncology: “Bone Marrow/Stem Cell Transplantation.”
  6. OHSU Knight Cancer Institute: “Understanding Bone Marrow and Stem Cell Transplants.”
  7. National Health Service (U.K.): “What happens: Stem cell and bone marrow transplants.”
  8. University of Wisconsin Health: “Food Safety for the Immunocompromised Patient.”
  9. Cleveland Clinic: “Nutrition After Blood & Marrow Transplant.”
  10. UCSF Benioff Children’s Hospital: “Dietary Concerns During a BMT.”
  11. Memorial Sloan Kettering Cancer Center: “Returning Home After Your Autologous Stem Cell Transplant.”
  12. Harvard Health Publishing: “Bone Marrow Transplant.”
  13. https://www.webmd.com/cancer/multiple-myeloma/bone-marrow-transplants

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