What are Bone Marrow and Stem Cell Transplantation?
These are procedures to help restore the production of blood cells by the body. Blood cells are produced and developed by bone marrow, the soft tissue inside bones. The body’s ability to supply itself with enough normal blood cells can be affected by blood diseases such as aplastic anemia, sickle cell anemia or thalassemia; by blood cancers such as leukemia or lymphoma; and by chemotherapy or radiation therapy. Chemotherapy and radiation are important tools to destroy cancerous blood cells, but they can also destroy normal blood cells. Bone marrow or stem cell transplants may be used in combination with chemotherapy or radiation to help offset this damage.
How is it done?
The patient will be evaluated for eligibility and prepared by the bone marrow transplantation center. The physician will decide the type of transplantation – using the patient’s own cells (autologous), or using a donor’s cells (allogeneic). The physician will determine the conditioning regimen, either chemotherapy alone or with radiation. The patient will be admitted to the bone marrow transplant unit, a special room with semi-sterilized conditions maintained by air filters to minimize infection. The patient will then receive chemotherapy to kill all blood cells both of cancer and normal cells. The immunosuppressive drug will be given and maintained at a therapeutic level to allow engraftment in case of allogeneic transplant. The stem cells, either from bone marrow or mobilized peripheral blood, will be given. Then time is allowed for recovery. From the start until completion, the process may take from a few months up to years. The patient will need to be under close observation, maintaining treatment and precautions to prevent complications. For allogeneic transplants, immunosuppressives will be administered and tapered off over a period of a year or more. After completing this process, the patient will need to be reimmunized for common infections.
Why is it done?
To cure some difficult-to-treat blood diseases: either malignant diseases such as leukemia and lymphoma, or benign diseases such as aplastic anemia, thalassemia, or sickle cell anemia.
Risks & complications
- Infection from low immunity during the process
- Graft versus host disease. In cases of allogeneic transplant, the patient’s body may reject the donor cells, causing injury to the recipient’s organs.
- The conditioning regimen can be toxic to the body. Depending on the disease, patient, and course of treatment, there is a risk of death; overall mortality averages 10%.
Risks can be reduced by following the Radiologist 's instructions before and after Procedure.
Alternatives
Often there is no alternative treatment. Some diseases may have other specific treatment such as some type of leukemia or lymphoma that may need a longer period of chemotherapy or targeted therapy
Candidate eligibility
This depends on the disease, patient’s age, general condition, and whether the patient has other diseases such as diabetes or heart disease.
Briefly, the disease needs to be amenable to treatment by bone marrow transplantation. Healthy candidates without severe heart, lung, kidney other systemic diseases are preferred. Before BMT, the candidate must be evaluated by several specialists. To discuss your eligibility, consult the BMT physician.