BONE MARROW TRANSPLANT: WHAT IT IS AND WHY IT’S DONE

Every three minutes, an American is diagnosed with blood cancer; 186,000 lives will be lost to leukemia by 2035. Living with or waiting for a bone marrow transplant can be challenging, and it is normal to have worries and fears. Thus, it's important to join the fight against blood cancer.

“Will you marrow me?” This is the patient's daily request. Bone marrow transplants can save the lives of people with many diseases. It has been used successfully since 1968 to treat over 70 diseases.

What is a Bone Marrow Transplant?

A bone marrow transplant, also called a stem cell transplant, is a medical treatment that replaces your bone marrow with healthy stem cells. These replacement cells can be taken either from your own body or from a donor. What are stem cells? What is bone marrow? Find the answers below.

Bone marrow is the soft, spongy tissue found in the center of most bones. It contains hematopoietic (blood cell producing) stem cells. In other words, it is the place where most of the body's blood cells are created and stored.

Stem cells are the blood cells that make other blood cells, and they reside in the bone marrow. When these cells are damaged, they cannot become red blood cells, white blood cells, and platelets. That's why, in this procedure, stem cells are transplanted into your bone marrow or blood to restore your body's ability to create the cells mentioned.

The following diseases are the most common ones that benefit from a bone marrow transplant:

• Leukemia
• Severe aplastic anemia
• Lymphomas
• Multiple myeloma
• Immunodeficiency disorders
• Certain solid tumor cancers

What are the types of BMT?

Depending on the donor, there are two main types of bone marrow transplants:

1. Autologous transplantation.

• The donor is the patient himself.
• It is called autotransplant or stem cell rescue.
• Stem cells are collected from the patient, either by bone marrow harvesting or by apheresis (the process of collecting stem cells from the peripheral blood).
• After being frozen and given intensive treatment, the harvested cells are returned to the patient.

2. Allogenic transplantation.

• The donor is another person who shares the same genetic type as the patient.
• It is called an allo transplant that requires a "donor match".
• Stem cells are collected by bone marrow harvesting or apheresis from a genetically compatible donor, usually a sibling.
• Other donors may be a parent who is at least half as genetically compatible as the recipient. Unrelated donors can sometimes also be found through national bone marrow registries.
• After being frozen and given intensive treatment, the harvested cells are given to the recipient.

If your health care team cannot find a suitable donor, there are other options, such as umbilical cord blood transplantation. In this type of transplant, stem cells are collected from the umbilical cord immediately after the birth of a child. They are tested, typed, counted, and then frozen until they are needed for transplantation.

How can you prepare for BMT?

• Before the transplant, the bone marrow transplant team conducts a thorough assessment. The decision to have you undergo a bone marrow transplant will be based on many factors, including the following:
  • Your age, general health, and medical history
  • The extent of your disease
  • The availability of a donor
  • Your tolerance to certain medications and procedures
  • Your expectations for the course of the disease and the outcome of the transplant
  • Your preferences
• A complete history and physical examination are performed, including several tests to evaluate your blood and organ functions.
• You may be asked to come to the transplant center up to 10 days before your transplantation for hydration, evaluation, central venous catheter placement, and other preparations. A catheter, which is a small tube, is surgically placed into a large vein under one of your clavicles. During treatment, blood products and medications will be given through this catheter.

How is Bone Marrow Transplant done?

We have summarized the procedure for both the donor and the patient so that you can get an idea of what to expect:

• Harvesting the cells:
  • Autologous transplantation: As already mentioned, auto-transplantation is when the stem cells are harvested from the recipient themselves, treated, and then infused back to them. First, you will receive injections of a drug to increase the number of stem cells in your body. Next, your health care team will collect the stem cells from a vein in your arm or chest and store them until needed. Then, you will get a high dose of chemotherapy for several days. It is designed to eradicate the patient's hematopoietic and immune system and, if present, the malignant tumor.
  • Allogeneic transplantation: Your health care team will collect cells from either the peripheral blood (usually through the arm) or the bone marrow of your donor. If the cells come from the blood, your donor will receive daily injections of a drug to increase the white blood cells in his or her blood for a few days before the collection. The stem cells are then harvested. You (the recipient) will receive chemotherapy for several days to prevent rejection of the "foreign" stem cells by suppressing the host's immune system.
• Infusing the recipient: This stage corresponds to the day of your transplant. You will receive your stem cells or those of the donor in your bloodstream through the central venous catheter. As mentioned above, you will be given chemotherapy to suppress your immune system for several days before the transplant.

How is the recovery after BMT?

Recovery often occurs in stages, beginning with intensive medical follow-up after the day of the transplant.

For the first couple of weeks, you will have low numbers of red blood cells, white blood cells, and platelets. For this reason, you may receive a combination of antibacterial, antifungal, and antiviral medications to prevent any infections.

The time it takes to heal and begin to see a steady return to normal blood counts varies depending on the patient and the type of transplant, but is usually 2-6 weeks.

What are the possible side effects of BMT?

Like any cancer treatment, BMT can cause side effects. These are different for everyone and depend on the type of transplant, your general health, and other factors.

Side effects from an AUTO transplant

One of the most important factors to watch out for after a bone marrow transplant is the risk of infection. Because your immune system is weakened, you are more susceptible to bacteria, viruses, and fungi in the first 6 weeks after transplantation.

Other side effects include:

• Nausea and vomiting
• Mouth sores
• Fatigue
• Low platelet count, which makes it harder for the blood to clot
• Low red blood cell count, causing anemia
• Diarrhea

Side effects from an ALLO transplant

This transplant has exactly the same side effects as the previous one, but there is only one additional factor, namely graft-versus-host disease. This disease is caused by donor-derived immune cells reacting against recipient tissues.

How much does BMT cost?

BMT is one of the most expensive health care procedures. The cost of a bone marrow transplant depends on many factors such as the type of transplant and where it is performed.

If you need an allogeneic bone marrow transplant, your donor’s medical expenses may be covered by your insurance company. Donors themselves never pay to donate, and are never paid to donate. Compared to autologous transplantation, allogeneic bone marrow transplants are even more expensive because of the time and effort required to find a match, as well as the medical procedure itself.

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Sources:

• https://www.mayoclinic.org/tests-procedures/bone-marrow-transplant/care-at-mayo-clinic/pcc-20384858
• https://allbloodcancers.org/statistics/
• https://www.cancer.net/navigating-cancer-care/how-cancer-treated/bone-marrowstem-cell-transplantation/what-bone-marrow-transplant-stem-cell-transplant
• https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/bone-marrow-transplantation
• https://www.cancer.net/navigating-cancer-care/how-cancer-treated/bone-marrowstem-cell-transplantation/side-effects-bone-marrow-transplant-stem-cell-transplant
• https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/stem-cell-transplant/process.html

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