Stemcell/Bone marrow transplant

Overview

A bone marrow transplant is a medical procedure that involves removing diseased or destroyed stem cells and replacing the same with healthy cells. A bone marrow transplant (also called stem cell transplant), involves infusing healthy stem cells into the blood stream of the recipient that travel into the bone marrow where they produce new blood cells.

Bone marrow is a type of spongy tissue found in the bone that creates three important blood cells- red blood cells, white blood cells and platelets. Red blood cells help to carry nutrients and oxygen through the body, white blood cells help fight infections, while platelets allow in the formation of clots.

There are two types of bone marrow transplant procedures:

• Autologous bone marrow transplant- In this, the patient’s own healthy stem cells are taken stored and frozen to be later used in the same body for replacing damaged or destroyed bone marrow. An autologous bone marrow transplant is also known as autologous stem cell transplant.
• This is the right option if your body is generating sufficient numbers of healthy bone cells. This type of bone marrow transplant procedure is used to treat plasma cell disorders, myeloma, hodgkin’s lymphoma and non-hodgkin’s lymphoma.
• Allogeneic bone marrow transplant- A donor’s healthy stem cells are collected, stored and later transplanted into the recipient’s or patient’s body. The donor may be an acquaintance or family member. The blood stem cells in allogeneic stem cell transplant is collected from the donor’s blood or collected from the blood of a donated umbilical cord or from the bone marrow of the donor’s hipbone.
• Allogeneic bone marrow transplant is used for treating both cancerous and non-cancerous diseases, including aplastic anemia, acute leukemia, hodgkin’s lymphoma, chronic leukemia, immune deficiencies, plasma cell disorders, multiple myeloma, non-hodgkin’s lymphoma, etc.

Whichever bone marrow transplant procedure you go through, there are some common preparations before the treatment.

Before the treatment

The preparations before bone marrow transplant involve:

• You will undergo several tests before the transplant procedure to help your doctor evaluate the type of bone marrow cells you need, autologous or allogeneic.
• In case of autologous stem cells transplant, the patient is given a type of drug to help improve the flow of stem cells in the bloodstream. Once the doctor feels that you have sufficient stem cells in your blood, you are asked to visit the clinic where a stem cell separator machine is used with a needle injected in your arm to draw blood.
• The machine separates the cells, while the blood is transferred into your body through the other arm. These cells are then stored, thawed, processed and frozen for later use.
• In case of allogeneic stem cell transplant, a matching donor is to be found. If a donor is located, he/she has to undergo various blood tests, physical examination, to ensure that he/she is a suitable candidate for bone marrow transplant.
• The person is asked to visit the doctor’s clinic where a stem cell separator machine is used to collect healthy cells from the blood. The cells are then stored, processed and frozen for later use.
• The person has to undergo a chemotherapy or radiation therapy to help destroy cancerous cells in the bone marrow before he/she gets new stem cells.
• There are other preparations to be taken before the procedure. These include preparing your insurance papers, taking medical leave from work, arranging for travel, packing clothes, renting a neat accommodation near the hospitals, etc.
• During chemotherapy or radiation therapy, the patient may suffer many side effects that should be treated with medications.
• A medical provider will conduct a thorough physical examination and ask about the patient’s medical history.
• Just before the transplant, the patient will have a couple of tubes inserted through the arm or neck in the blood vessel to help reach fluids, nutrition and treatment into the body. It may also be used to draw blood.
• The patient is usually referred to a psychiatrist who will discuss about the emotional stress before the transplant.

How it is performed

For autologous patients:

For allogeneic patients:

• After a high dose of chemotherapy and radiation therapy is used to destroy cancerous cells in the patient’s body, he/she is asked to visit the hospital once again for the transfusion.
• On the day of the transfusion, the stem cells that were collected from the patient’s own body and stored in the laboratory are infused through an IV channel in the arm.
• After the infusion, the stem cells travel through the bloodstream into the patient’s bone marrow where they start producing new stem cells. Within 1-3 weeks new stem cells grow and produce red blood corpuscles, white blood corpuscles and platelets.
• After the person goes through a conditioning regime that involves chemotherapy or radiation therapy, he/she is ready for the transplant procedure.
• An intravenous channel is created in the arm through which the previously stored healthy stem cells of the donor are infused in the blood stream.
• The stem cells then travel to the bone marrow where it starts producing new blood cells.

Recovery

After the bone marrow transplant, you ate kept under observation for some hours. You are also given antibiotics to fight any kind of infection. The recovery of bone marrow transplant takes some time before your immune system start functioning normally. It may take a year or two for your immune system to get back to normal. You may have to undergo biopsy tests and other immunization updates in between to ensure that your body is functioning properly.