Bone Marrow Transplantation
What is bone marrow transplantation?
Bone marrow is the tissue responsible for the production of blood cells in our body. Blood has three types of cells; red blood cells that transport oxygen into organs and tissues, white blood cells that act in defense of the body against external factors, and platelets for clotting the blood. Cells responsible for the production of blood cells in the bone marrow are referred to as hematopoietic progenitor cells. In other words, the purpose of bone marrow transplantation is to transfer the stem cell, which is responsible for the production of other cells.
Bone marrow is not the only source of stem cells used for the bone marrow transplantation. The stem cells can also be derived from the blood and the umbilical cord.
When a disease develops in the bone marrow or when bone marrow is damaged, the body cannot produce healthy blood cell.
Bone marrow transplantation involves harvesting healthy stem cells from the person or tissue-matched healthy donor, processing the stem cells and infusing them to or back to the patient. The autologous bone marrow transplant uses the cells harvested from the patient. When the bone marrow is collected from another donor, the process is called allogeneic transplant.
Autologous bone marrow transplantation has some advantages. Since the patient's own cells are used, tissue compatibility is not a prerequisite. However, the patient must now have healthy bone marrow cells. In the autologous transplantation, the bone marrow of the patient is processed quickly and infused back without any delay. However, autologous bone marrow transplantation is also a part of the treatment for patients who will receive chemotherapy and/or radiotherapy in the future. The collected bone marrow cells are specially processed, frozen and stored for the future use. Since chemotherapy and/or radiotherapy damages the bone marrow, autologous transplantation is performed to replace the damaged marrow.
In allogeneic transplantation, bone marrow, taken from the tissue-compatible healthy donor, is used. This donor may be either your relative or any other foreign person. Irrespective of donor (whether related or not), the tissue compatibility is the prerequisite of the allogeneic transplantation.
Why is this procedure done?
Bone marrow transplantation can be done to ensure healthy and adequate blood cell production, because the patient's bone marrow cannot properly produce blood cells.
Bone marrow transplantation is also an option for congenital blood diseases. Abnormal or inadequate functioning of the bone marrow may result in insufficient production of blood cells, or the abnormal cells may not function properly.
Bone marrow transplantation is the only treatment option for blood cancer (leukemia) and lymph cancer (lymphoma) that are unresponsive to other treatments or develop after the treatment.
Finally, if cancer develops in other organs and tissues of the body, the patient will require treatments that damage the bone marrow, such as chemotherapy and radiotherapy. After such treatments are completed, bone marrow/stem cell is transplanted to sustain proper production of blood cells.
Bone marrow transplantation helps below listed diseases:
- Multiple Myeloma
- Aplastic Anemia
- Hodgkin lymphoma.
- Non-Hodgkin Lymphoma
Following a series of comprehensive evaluations and examinations, your doctor will decide whether bone marrow transplant is the treatment of choice for your condition or not.
Almost all diseases treated with bone marrow transplant are life-threatening diseases. For this reason, bone marrow transplantation can lead to very serious complications. In autologous bone marrow transplantation, the risk of such complications is very low, as patient's own bone marrow and/or stem cells are transplanted. Since the likelihood of these complications depends on a number of factors, very comprehensive assessments are needed to determine the complications that may be present and to take the necessary precautions and you often need to be examined by doctors rather than the doctor who treats your illness.
The complications associated with bone marrow transplantation are listed below:
- Reaction against the bone marrow graft (Graft versus Host Disease)
- Failure of the bone marrow or the stem cell to function in the recipient
- Side effects of chemotherapy given during the preparation phase before the bone marrow transplantation (diarrhea, vomiting, nausea, fever, mouth sores, serious infections, etc.)
Although all possible measures that modern medicine allows are taken to prevent occurrence of risks, it is no means possible to warrant that the risks will be completely eliminated.
Our expert transplant team will employ all practices to minimize the risk of complications and your primary physician, the transplant team and doctors of other departments will inform you, before the transplantation, about risks listed above and all other potential complications and will address all your concerns.
After it is decided that bone marrow transplantation can work in the treatment of your condition, you will need to have a series of comprehensive examinations and examinations. The first goal of this preparation phase is to determine whether your general health will allow the bone marrow transplantation. If any health problem is identified that may pose a risk on the bone marrow transplantation, they will be treated to make you more and better prepared for bone marrow transplantation.
The second goal of the preparations is to facilitate bone marrow transplantation and to minimize the complications that may occur afterwards.
In the case of autologous bone marrow or, more generally, stem cell transplantation, some drugs should be used, first in order to increase production of stem cells and then to ensure the increase the number of stem cells to be collected for the period that your doctor will instruct. A long and thin tube, known as central venous catheter, is placed into one of the great veins of the body. This catheter allows both administration of medicines that stimulate production of stem cells and infusion thereof.
Your doctor will decide on the source of the bone marrow source to be used to treat your condition. You may be transferred your own stem cells or stem cells can be harvested from a relative or a from a person you have never met.
If your own stem cells are used, your blood is processed in an apheresis device to collect blood stem cells from the blood.
In the case of allogeneic transplantation, your doctor will determine the most appropriate source (bone marrow, blood, umbilical cord) to harvest the stem cell.
If the bone marrow transplant is required to replace the bone marrow damaged by anti-cancer treatment, you will be placed on high-dose chemotherapy and/or radiotherapy. At this stage, you may experience complications of chemotherapy and radiotherapy and these complications must be treated to continue with the bone marrow transplant. Possible complications include, but not limited to hair loss, nausea, vomiting, diarrhea, mouth sores, infection, fatigue, malaise, infertility and bleeding.
After the complications are eliminated or alleviated enough to allow bone marrow transplantation, your immune system is suppressed so that your body does not reject the bone marrow. At this stage, you will be significantly prone to infections and therefore, you need to follow the measures very strictly.
Surgery and early postoperative period
The stem cells that are already collected from you or any other donor and prepared properly are infused through the central venous catheter. At this stage, you feel no pain and local anesthesia or sedation is not required.
All your vital signs are closely monitored throughout the infusion of stem cells. If a risk is encountered, the process is paused and sustained after the problem is treated.
The stem cells infused to your body distribute in your body and eventually reach your bone marrow. If no complication is faced, your stem cells will settle in your bone marrow and start producing new, healthy blood cells. The stage that transplanted stem cells can produce new blood cells is referred to as engraftment. You may need blood transfusion (erythrocyte suspension and platelet solution) before the production of new blood cells takes place.
Production of new blood cells will be monitored in the light of blood tests. In addition, blood and urine tests, imaging studies and close observation will be sustained to assess your general health and manage complications, if any.
Even if you are healthy enough to be discharged from the hospital after bone marrow transplantation, you should be closely followed up by your doctor for the time interval that may, sometimes, take many years.
Bone marrow can be transplanted to treat your condition (leukemia, lymphoma, etc.) or to manage adverse effects of other diseases (bone marrow damage secondary to hyigh-dose chemotherapy in tissue and organ cancers).
Bone marrow transplant requires patience, close observation and strict compliance to instructions of your doctor.
It is always possible to face complication at pre-transplant preparation phase, during transplantation and in the short- and long-term after the after transplantation. All of them will be assessed and treated one by one and you will eventually have to follow a long way to resume a healthy normal life.
The multidisciplinary team of Medicana Health Group has the experience, knowledge and medical equipment necessary to restore your general health.