Bone marrow transplant is a
procedure in which healthy bone marrow is transplanted into
a patient whose bone marrow is not functioning properly.
Problems in bone marrow are often caused by chemotherapy or
radiation treatment for cancer. This procedure can also be
done to correct hereditary blood diseases. The healthy bone
marrow may be taken from the patient prior to chemotherapy
or radiation treatment (autograft), or it may be taken from
a donor (allograft).
What is bone
marrow?
Bone marrow is the soft,
sponge-like material found inside bones. It contains
immature cells called stem cells that produce blood cells.
There are three types of blood cells: white blood cells,
which fight infection; red blood cells, which carry oxygen
to and from organs and tissues; and platelets, which enable
the blood to clot.
Why is it
done?
If a patient develops a disease
of the blood cells, especially cancers such as leukaemia, he
may require high doses of chemotherapy to destroy the
cancer. However, this also destroys normal blood cells.
Alternatively, hereditary or acquired disorders may cause
abnormal blood cell production. In these cases,
transplantation of healthy bone marrow may save a patient's
life. Transplanted bone marrow will restore production of
white blood cells, red blood cells, and platelets.
What is the
procedure?
Bone marrow transplant patients
are usually treated in specialised centres and the patient
stays in a special nursing unit (a bone marrow transplant
unit) to limit exposure to infections. The hospitalisation
period is from 4 to 6 weeks, during which time the patient
is isolated and under strict monitoring because of the
increased risk of infection and/or bleeding.
Donated bone marrow must match the patient's tissue type. It
can be taken from the patient, a living relative (usually a
brother or a sister), or from an unrelated donor. Donors are
matched through special blood tests called HLA tissue
typing.
Bone marrow is taken from the donor in the operating room
while one is unconscious and pain-free (under general
anaesthesia). Some of the donor's bone marrow is removed
from the top of the hip bone. The bone marrow is filtered,
treated, and transplanted immediately or frozen and stored
for later use. Then, transplant material is transfused into
the patient through a vein and is naturally transported back
into the bone cavities where it grows to replace the old
bone marrow.
Alternatively, blood cell precursors, called stem cells, can
be induced to move from the bone marrow to the blood stream
using special medications. These stem cells can then be
taken from the bloodstream through a procedure called
leukapheresis.
The patient is prepared for transplantation by administering
high doses of chemotherapy or radiation (conditioning). This
serves two purposes. First, it destroys the patient's
abnormal blood cells or cancer. Second, it inhibits the
patient's immune response against the donor bone marrow
(graft rejection).
Following conditioning, the patient is ready for bone marrow
infusion. After infusion, it takes 10 to 20 days for the
bone marrow to establish itself. During this time, the
patient requires support with blood cell transfusions.
What are the indications?
Bone marrow transplant may be recommended
for:
Bone marrow deficiency disease caused by:
abnormal red blood cell production,
such as thalassaemia or sickle cell disease
aggressive cancer treatments
(chemotherapy, radiation therapy), especially for
leukaemia or lymphoma
lack of normal blood cell production (aplastic
anaemia)
Immune system disorders (immunodeficiency) such as:
congenital neutropenia
severe combined immunodeficiency
syndrome
Bone marrow transplant is not recommended
for:
patients with heart, kidney, lungs, or
liver disorders
patients with other diseases that may
limit survival
What are the risks?
The risks for any anaesthesia are:
reactions to medications
problems breathing
Chemotherapy given prior to bone marrow
transplant (conditioning) can cause significant toxicity,
such as mouth sores, diarrhoea, liver damage, or lung
damage. While waiting for bone marrow to grow, the patient
is at high risk for infection as also bleeding.
The major problem with bone marrow transplants (when the
marrow comes from a donor, not the patient) is
graft-versus-host disease. The transplanted healthy bone
marrow cells may attack the patient's cells as though they
were foreign organisms. In this case, drugs to suppress the
immune system must be taken, but this also decreases the
body's ability to fight infections.
Other significant problems with a bone marrow transplant are
those of all major organ transplants - finding a donor and
the cost. The donor is usually a sibling with compatible
tissue. The more siblings the patient has, the more chances
there are of finding a compatible donor.
What is the prognosis?
Bone marrow transplant prolongs
the life of a patient who would otherwise die. Relatively
normal activities can be resumed as soon as the patient
feels well enough and after consulting with the doctor.
The patient will require attentive follow-up care for 2 to 3
months after discharge from the hospital. It may take 6
months to a year for the immune system to fully recover from
this procedure.
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