Health

Bone Marrow Transplantation

Overview.

Stem cell bone marrow transplants, have become an important treatment to fight specific blood cancers. To date, over one million stem cell / bone marrow transplantations have been performed worldwide, and this number continues to rise. Following a transplant, many people with blood cancer live longer or have been cured.

A bone marrow transplant.

is a procedure that infuses healthy blood-forming stem cells into your body to replace your damaged or diseased bone marrow. A bone marrow transplant is also called a stem cell transplant.

You might need a bone marrow transplant if your bone marrow stops working and does not produce enough healthy blood cells.

Bone marrow transplants may use cells from your own body (autologous transplant) or from a donor (allogeneic transplant).

Types.

There are different types of bone marrow/stem cell transplants. The 2 main types are:

▪️Allogeneic stem cell transplant.

Stem cells for an allogenic transplant come from another person, called a donor. The donor’s stem cells are given to the patient after the patient has chemotherapy and/or radiation therapy. This is also called an ALLO transplant.

Many people have a “graft-versus-cancer cell effect” during an ALLO transplant. This is when the new stem cells recognize and destroy cancer cells that are still in the body. This is the main way ALLO transplants work to treat the cancer.

Finding a “donor match” is a necessary step for an ALLO transplant. A match is a healthy donor whose blood proteins, called human leukocyte antigens (HLA), closely match yours. This process is called HLA typing. Siblings from the same parents are often the best match, but another family member or an unrelated volunteer can be a match too. If your donor’s proteins closely match yours, you are less likely to get a serious side effect called graft-versus-host disease (GVHD). In this condition, the healthy transplant cells attack your cells.

If your health care team cannot find a donor match, there are other options.

▪️Autologous stem cell transplant.

Stem cells for an autologous transplant come from your own body. Sometimes, cancer is treated with a high-dose, intensive chemotherapy or radiation therapy treatment. This type of treatment can damage your stem cells and your immune system. That’s why doctors remove, or rescue, your stem cells from your blood or bone marrow before the cancer treatment begins.

If your health care team cannot find a donor match, there are other options.

▪️Umbilical cord blood transplant.

In this type of transplant, stem cells from umbilical cord blood are used. The umbilical cord connects a fetus to its mother before birth. After birth, the baby does not need it. Cancer centers around the world use cord blood.

▪️Parent-child transplant and haplotype mismatched transplant.

Cells from a parent, child, brother, or sister are not always a perfect match for a patient’s HLA type, but they are a 50% match. Doctors are using these types of transplants more often, to expand the use of transplantation as an effective cancer treatment.

Why it’s done.

A bone marrow transplant may be used to:

▪️Safely allow treatment of your condition with high doses of chemotherapy or radiation by replacing or rescuing the bone marrow damaged by treatment.

▪️Replace diseased or damaged marrow with new stem cells.

▪️Provide new stem cells, which can help kill cancer cells directly.

Bone marrow transplants can benefit people with a variety of both cancerous (malignant) and noncancerous (benign) diseases, including:

▪️Acute leukemia.

▪️Adrenoleukodystrophy.

▪️Aplastic anemia.

▪️Bone marrow failure syndromes.

▪️Chronic leukemia.

▪️Hemoglobinopathies.

▪️Hodgkin’s lymphoma.

▪️Immune deficiencies.

▪️Inborn errors of metabolism.

▪️Multiple myeloma.

▪️Myelodysplastic syndromes.

▪️Neuroblastoma.

▪️Non-Hodgkin’s lymphoma.

▪️Plasma cell disorders.

▪️POEMS syndrome.

▪️Primary amyloidosis.

Risks.

A bone marrow transplant poses numerous risks. Some people experience minimal problems with a bone marrow transplant, while others can have serious complications that require treatment or hospitalization.

Sometimes, complications are life-threatening.

Your particular risks depend on many factors, including the disease or condition that caused you to need a transplant, the type of transplant, and your age and overall health.

Possible complications from a bone marrow transplant include:

▪️Graft-versus-host disease (allogeneic transplant only).

▪️ Stem cell (graft) failure.

▪️ Organ damage.

▪️ Infections.

▪️ Cataracts.

▪️ Infertility.

▪️New cancers.

▪️ Death.

▪️ Your doctor can explain your risk of.

complications from a bone marrow transplant. Together you can weigh the risks and benefits to decide whether a bone marrow transplant is right for you.

The conditioning process.

After you complete your pretransplant tests and procedures, you begin a process known as conditioning. During conditioning, you’ll undergo chemotherapy and possibly radiation to:

▪️Destroy cancer cells if you are being treated for a malignancy.

▪️ Suppress your immune system.

▪️ Prepare your bone marrow for the new stem cells.

The type of conditioning process you receive depends on a number of factors, including your disease, overall health and the type of transplant planned. You may have both chemotherapy and radiation or just one of these treatments as part of your conditioning treatment.

Side effects of the conditioning process can include:

▪️Nausea and vomiting.

▪️ Diarrhea.

▪️ Hair loss.

▪️ Mouth sores or ulcers.

▪️ Infection.

▪️ Bleeding.

▪️ Infertility or sterility.

▪️ Anemia.

▪️ Fatigue.

▪️ Cataracts.

▪️ Organ complications, such as heart, liver or lung failure.

You may be able to take medications or other measures to reduce such side effects.

The conditioning process.

After you complete your pretransplant tests and procedures, you begin a process known as conditioning. During conditioning, you’ll undergo chemotherapy and possibly radiation to:

▪️Destroy cancer cells if you are being treated for a malignancy.

▪️ Suppress your immune system.

▪️ Prepare your bone marrow for the new stem cells.

The type of conditioning process you receive depends on a number of factors, including your disease, overall health and the type of transplant planned. You may have both chemotherapy and radiation or just one of these treatments as part of your conditioning treatment.

Side effects of the conditioning process can include:

▪️Nausea and vomiting.

▪️ Diarrhea.

▪️ Hair loss.

▪️ Mouth sores or ulcers.

▪️ Infection.

▪️ Bleeding.

▪️ Infertility or sterility.

▪️ Anemia.

▪️ Fatigue.

▪️ Cataracts.

▪️ Organ complications, such as heart, liver or lung failure.

You may be able to take medications or other measures to reduce such side effects.

Reduced-intensity conditioning.

Based on your age and health history, your doctor may recommend lower doses or different types of chemotherapy or radiation for your conditioning treatment. This is called reduced-intensity conditioning.

Reduced-intensity conditioning kills some cancer cells and suppresses your immune system. Then, the donor’s cells are infused into your body. Donor cells replace cells in your bone marrow over time. Immune factors in the donor cells may then fight your cancer cells.

What you can expect.

During your bone marrow transplantYour bone marrow transplant occurs after you complete the conditioning process. On the day of your transplant, stem cells are infused into your body through your central line.

The transplant infusion is painless. You’ll be awake during the procedure.

After your bone marrow transplant.

When the new stem cells enter your body, they travel through your blood to your bone marrow. In time, they multiply and begin to make new, healthy blood cells. This is called engraftment. It usually takes several weeks before the number of blood cells in your body starts to return to normal. In some people, it may take longer.

In the days and weeks after your bone marrow transplant, you’ll have blood tests and other tests to monitor your condition. You may need medicine to manage complications, such as nausea and diarrhea.

After your bone marrow transplant, you’ll remain under close medical care. If you’re experiencing infections or other complications, you may need to stay in the hospital for several days or sometimes longer. Depending on the type of transplant and the risk of complications, you’ll need to remain near the hospital for several weeks to months to allow close monitoring.

You may also need periodic transfusions of red blood cells and platelets until your bone marrow begins producing enough of those cells on its own.

You may be at greater risk of infections or other complications for months to years after your transplant. You’ll have periodic lifelong follow-up appointments with your doctor to monitor for late complications.

How do you know if the transplant worked?

A successful transplant may mean different things to you, your family, and your health care team. Here are 2 ways to know if your transplant worked well.

▪️Your blood counts are back to safe levels.

A blood count measures the levels of red blood cells, white blood cells, and platelets in your blood. At first, the transplant makes these numbers very low for 1 to 2 weeks. This affects your immune system and puts you at a risk for infections, bleeding, and tiredness. Your health care team will lower these risks by giving your blood and platelet transfusions. You will also take antibiotics to help prevent infections.When the new stem cells multiply, they make more blood cells. Then your blood counts will go back up. This is one way to know if a transplant was a success.

▪️Your cancer is controlled.

Curing your cancer is often the goal of a bone marrow/stem cell transplant. A cure may be possible for certain cancers, such as some types of leukemia and lymphoma. For other diseases, remission of the cancer is the best possible result. Remission is having no signs or symptoms of cancer.

you need to see your doctor and have tests regularly after a transplant. This is to watch for any signs of cancer or complications from the transplant, as well as to provide care for any side effects you experience. This follow-up care is an important part of your recovery.

What is recovering from a bone marrow transplant like?

Recovery from a bone marrow/stem cell transplant takes a long time. Recovery often has stages, starting with intensive medical monitoring after your transplant day. As your long-term recovery moves forward, you will eventually transition to a schedule of regular medical checkups over the coming months and years.

During the initial recovery period, it’s important to watch for signs of infection. The intensive chemotherapy treatments that you get before your transplant also damage your immune system. This is so your body can accept the transplant without attacking the stem cells. It takes time for your immune system to work again after the transplant. This means that you are more likely to get an infection right after your transplant.

To reduce your risk of infection, you will get antibiotics and other medications. If you had an ALLO transplant, your medications will include drugs to prevent and/or manage GVHD. Follow your health care team’s recommendations for how to prevent infection immediately after your transplant.

It is common to develop an infection after a bone marrow transplant, even if you are very careful. Your doctor will monitor you closely for signs of an infection. You will have regular blood tests and other tests to see how your body and immune system are responding to the donor cells. You may also get blood transfusions through your catheter.

Your health care team will also develop a long-term recovery plan to monitor for late side effects, which can happen many months after your transplant.

Reference :

bone marrow transplant/https://www.mayoclinic.org/tests-procedures/bone-marrow-transplant

Bone Marrow Transplantation/https://www.shebaonline.org

What is a Bone Marrow Transplant (Stem Cell Transplant)?/https://www.cancer.net

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