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Bone marrow transplant or Hematopoietic stem cell transplant is a specialised treatment to replace diseased bone marrow with healthy cells. The goal of BMT is to control or cure disease, improve quality of life, and extend life.
In this treatment, the bone marrow is either derived from your body (autologous transplant) or donor (allogeneic transplant).
Bone marrow is basically a soft, spongy tissue found in the centre of bones that manufactures bone marrow stem cells and other substances that further help in blood cell production and storage.
When the bone marrow doesn't work properly and doesn't produce enough blood cells (red blood cells, white blood cells, and platelets), you may need to undergo a bone marrow transplant procedure.
The situation usually occurs if you are suffering from certain types of cancer like myeloma, lymphoma, leukaemia, and other immune system and blood diseases that impinge bone marrow functioning.
Your doctor will decide whether the BMT will work for you. He will examine your body and conduct a series of blood and other necessary tests to check how well your heart, lungs, and liver are working.
If the doctor finds everything okay, he may suggest a stem cell transplantation procedure and discuss which type of bone marrow transplant (autologous or allogeneic transplant) would be best for you.
A few days before the procedure, your doctor will ask you to visit the hospital to get a central venous catheter (a thin, flexible tube) into a large vein in your neck or chest. Through this tube, the doctor will take the blood and give medication to you. It will remain with you until the procedure completes.
The process of collecting stem cells is different for autologous transplants and allogeneic transplants. The process is usually similar to a blood product donation and usually carries no risk for the donor.
Autologous Bone Marrow Transplant
In this type of bone marrow transplant, your doctor may take stem cells from your veins through an apheresis machine in the blood bank. It is usually an outpatient procedure, meaning you can go home the same day. The complete process takes around 3-4 hours.
He may give you injections of growth factors, which trigger stem cell production and move these cells into your circulating blood for easier collection.
The doctor will take blood from your vein and pass it through a machine to separate the stem cells and send the remaining back to your body. The separated stem cells are then stored in a cool container for future use.
Allogeneic Bone Marrow Transplant
Your doctor will seek a donor whose HLA (human leukocyte antigens - complex of genes that help code for proteins that differentiate between self and non-self) match yours. Your HLA type will most probably match with any of your family members.
Once the doctor finds a donor, he will extract the stem cells through the earlier discussed process.
Stem cells can also be generated through the umbilical cord's blood (a cord that connects the baby to the mother's placenta). Mothers can decide to donate the umbilical cord after the baby's birth. The blood from these umbilical cords will be stored in a cord blood bank until it is required for the bone marrow transplant.
The process starts with conditioning. You will undergo high doses of chemotherapy, maybe with radiation. The process will be continued for a few days depending on the disease being treated and your physical well-being.
Conditioning clears the diseased cells in the bone marrow and weakens the immune system, so it won't react against the new cells.
There are also some side effects of conditioning, which are as follows:
After a few days of conditioning, new stem cells will be infused into your body through the central venous catheter. During the procedure, you'll be awake, as it doesn't hurt.
When the stem cells reach your bone marrow, they'll initiate churning out new red blood cells, white blood cells, and platelets. This process is called engraftment, which takes a couple of weeks.
The recovery process is different for everyone depending on how your body reacts to the new stem cells and how fast your body is recovering.
You'll spend a few weeks in a hospital where the medical team will monitor your recovery. Since your immune system is weak due to conditioning, your doctor will prescribe some medications to keep you away from infections and graft vs host disease.
You may also need periodic blood transfusions until the new stem cells produce enough blood cells. The doctor will take your blood and bone marrow samples for the first few days to check for engraftment.
Once your blood cell count reaches an average level, and your condition meets all the specific criteria, you'll be discharged from the hospital.
But you need to meet your doctor often. The complete recovery process may take a year or longer. Until then, you must religiously follow your doctor's advice and medications.
Your doctor may also ask you to:
Besides blood counts level and the disease being treated, the following factors have an impact on the success rate of the procedure:
Autologous Transplant
Some individuals experience bleeding, skin rash, diarrhoea, infection, cataract, numbness in limbs, fertility problems, breathing problems, muscle spasms, leg cramps, and low blood cell count.
In some conditions, it can lead to painful inflammation in the digestive tract and mouth, stem cell failure, and organ damage, and may increase the likelihood of the formation of new cancer.
If you experience any side effects or abnormal things, consult your doctor immediately.
Allogeneic Transplant
If you get stem cells from a donor, there is a risk of graft vs host disease:
During or after the bone marrow transplant, you may need emotional support. And there would be many misconceptions around you. So, consult with a doctor to clear any doubt you have in your mind and get the proper treatment.
Also, Read: What You Need to Know About Bone Cancer
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