Bone marrow transplant

Description

There are three kinds of bone marrow transplants:

• Autologous bone marrow transplant: "Auto" means "self." Stem cells are removed from you before you receive high-dose chemotherapy or radiation treatment and stored in a freezer (cryopreservation). After high-dose chemotherapy or radiation treatments are done, your stems cells are put back in your body to add to your normal blood cells. This is called a "rescue" transplant.
• Allogeneic bone marrow transplant: "Allo" means "other." Stem cells are removed from another person, called a donor. Most times, the donor must at least partly match you genetically. Special blood tests are done to determine if a donor is a good match for you. A brother or sister is most likely to be a good match. However, sometimes parents, children, and other relatives may be good matches. Donors who are not related to you may be found through national bone marrow registries.
• Umbilical cord blood transplant: Stem cells are removed from a newborn baby's umbilical cord immediately after birth. The stem cells are stored until they are needed for a transplant. Umbilical cord blood cells are so immature, there is less of a need for matching.

Before the transplant, chemotherapy, radiation, or both may be given. This may be done in two ways:

• Ablative (myeloablative) treatment: High-dose chemotherapy, radiation, or both are given to kill any cancer cells. This also kills all healthy bone marrow that remains, and allows new stem cells to grow in the bone marrow.
• Reduced intensity (nonmyeloablative) treatment, also called a mini transplant: Patients receive lower doses of chemotherapy and radiation before a transplant. This has allowed older patients, and patients with other health problems to have a transplant.

A stem cell transplant is done after chemotherapy and radiation is complete. The stem cells are delivered into your bloodstream through a tube called a central venous catheter. The process is similar to getting a blood transfusion. The stem cells travel through the blood into the bone marrow. Usually, no surgery is needed.

Donor stem cells can be collected in two ways:

• Bone marrow harvest. This minor surgery is performed under general anesthesia, meaning the donor will be asleep and pain-free during the procedure. The bone marrow is removed from the back of both hip bones. The amount of marrow removed depends on the weight of the person who is receiving it.
• Leukapheresis. First, the donor is given 5 days of shots to help stem cells move from the bone marrow into the blood. During leukapheresis, blood is removed from the donor through an IV line in a vein. The part of white blood cells that contains stem cells is then separated in a machine before being returned to the donor.

Why the Procedure is Performed

A bone marrow transplant replaces bone marrow that is either not working properly or has been destroyed (ablated) by chemotherapy or radiation.

Your doctor may recommend a bone marrow transplant if you have:

• Certain cancers, such as leukemia, lymphoma, and multiple myeloma
• A disease that affects the production of bone marrow cells, such as:
  • Aplastic anemia
  • Congenital neutropenia
  • Severe immunodeficiency syndromes
  • Sickle cell anemia
  • Thalassemia  
• Had chemotherapy that destroyed your bone marrow

Risks

A bone marrow transplant may cause the following symptoms:

• Chest pain
• Chills
• Drop in blood pressure
• Fever
• Flushing
• Funny taste in the mouth
• Headache
• Hives
• Nausea
• Pain
• Shortness of breath

Possible complications of a bone marrow transplant depend on many things, including:

• The disease you are being treated for
• Whether you had chemotherapy or radiation before the bone marrow transplant
• Your age
• Your overall health
• How good of a match your donor was
• The type of bone marrow transplant you received (autologous, allogeneic, or umbilical cord blood)

Complications can include:

• Anemia
• Bleeding in the lungs, intestines, brain, and other areas of the body
• Cataracts
• Damage to the kidneys, liver, lungs, and heart
• Delayed growth in children who receive a bone marrow transplant
• Early menopause
• Graft failure, which means that the new cells do not settle into the body and start producing stem cells
• Graft-versus-host disease, a condition in which the donor cells attack your own body
• Infections, which can be very serious
• Inflammation and sorenes in the mouth, throat, esophagus, and stomach, called mucositis
• Pain
• Stomach problems, including diarrhea, nausea, and vomiting

Before the Procedure

Your health care provider will ask you about your medical history and do a physical exam. You will have many tests before your treatment begins.

Before your transplant, you will have one or two tubes, called catheters, inserted into a blood vessel in your neck or arms. This tube allows you to receive treatments, fluids, and sometimes, nutrition.

Your doctor or nurse should discuss the emotional stress of having a bone marrow transplant. You may want to meet with a mental health counselor. It is important to talk to your family and children to help them understand what to expect.

You will need to make plans to help you prepare for the procedure and handle tasks after your transplant. Things to consider include:

• Advanced care directives
• Arranging medical leave from work
• Bank or financial statements
• Care of pets
• Household chores
• Insurance coverage
• Payment of bills
• Schedules and care for your children

You may need to find housing for yourself or your family near the hospital.

After the Procedure

A bone marrow transplant is usually done in a hospital or medical center that specializes in such treatment. Most of the time, you will stay in a special bone marrow transplant unit in the center to limit your chance of getting an infection.

Depending on the treatment being used and where it is being done, all or part of an autologous or allogeneic transplant may be done as an outpatient. This means you do not have to stay in the hospital or medical center.

How long you stay in the hospital depends on how much chemotherapy or radiation you received, the type of transplant, and your medical center's procedures. While you are in the hospital, you will be isolated because of the increased risk of infection. The health care team will closely monitor your blood count and vital signs.

While you are in the hospital you may:

• Receive medications to prevent or treat infections, including antibiotics, antifungals, and antiviral drugs.
• Need many blood transfusions
• Be fed through a vein (IV) until you can eat by mouth and stomach side effects and mouth sores have gone away
• Be given medications to prevent graft-versus-host disease

Outlook (Prognosis)

How well you do after transplant depends on:

• The type of bone marrow transplant
• How well the donor's cells match yours
• What type of cancer or illness you have
• Your age and overall health
• The type of chemotherapy or radiation therapy you had before your transplant
• Any complications
• Your genes

A bone marrow transplant may completely or partially cure your illness. If the transplant is a success, you can go back to most of your normal activities as soon as you feel well enough. Usually it takes up to 1 year to recover fully.

Complications or failure of the bone marrow transplant can lead to death.

Alternative Names

Transplant - bone marrow; Stem cell transplant; Hematopoietic stem cell transplant; Reduced intensity, nonmyeloablative transplant; Mini transplant; Allogenic bone marrow transplant; Autologous bone marrow transplant; Umbilical cord blood transplant

References

Bishop MR, Pavletic SZ. Hematopoietic stem cell transplantation. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG, eds. Clinical Oncology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 32.

Vose JM, Pavletic SZ. Hematopoietic stem cell transplantation. In: Goldman L, Schafer AI. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 181.

Update Date: 2/7/2012

Updated by: Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.