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Bone Marrow Transplantation

What is a Bone Marrow Transplant?

Bone marrow is the soft tissue that can be found inside the bones, and it is responsible for producing and storing most of the body’s blood cells. Without bone marrow, humans wouldn’t be able to produce red and white blood cells, which are responsible for carrying oxygen and fighting infection, respectively.

A bone marrow transplant is a procedure during which healthy blood-forming cells are injected into a patient’s body. This is done when the patient’s bone marrow isn’t producing enough healthy blood cells or isn’t working properly and can’t fight off disease. 

During the procedure, healthy bone marrow cells are extracted either from the patient or a donor, filtered, and then injected into the patient’s bloodstream.

This procedure was first performed in 1968 and has been used since then to successfully treat a variety of diseases including cancer, immune deficiency disorders, leukemia and many more. 

Bone Marrow Transplantation - Sheba Medical Center

Why Is a Bone Marrow Transplant Needed?

People who need a bone marrow transplant often suffer from terminal illnesses such as cancer and their bone marrow isn’t working well enough to allow the body to recover.

When an illness is present and there aren’t enough healthy blood cells that are being produced, this is often the only chance of recovery.

What Are The Different Types Of a Bone Marrow Transplant?

We can divide the different types of bone marrow transplants into 4 categories, depending on where and from who the bone marrow was extracted.

Allogeneic (ALLO) Bone Marrow Transplant

An allogenic bone marrow transplant uses cells collected from a donor. For this to be a viable option, the patient and the donor need to be a match.

Autologous (AUTO) Bone Marrow Transplant

An autologous bone marrow transplant, or an autologous bone marrow transplant, uses cells that are collected from the patient. Healthy bone marrow cells are collected and then injected back into the patient’s body to replace those cells that aren’t working properly.

For this to be a viable option, the patient’s body needs to still be producing enough healthy and viable cells. During an autologous bone marrow transplant, the cells can be frozen after they’re collected and then stored for later use.

Syngeneic Bone Marrow Transplant

Syngeneic bone marrow transplant is the rarest type of bone marrow transplant because it requires the donor and the patient to be identical twins.

This is the simplest and least complicated type of transplant and there is absolutely no chance of rejection because the patient and donor are definitely a 100% match.

Umbilical Cord Blood Transplant

An umbilical cord blood transplant is performed with the blood that was collected from the placenta and the umbilical cord taken from healthy newborn babies. This is a great option for a transplant because cord blood is rich in blood-forming cells.

Cord blood is excellent at fighting cancer cells, and it’s more likely that there will be a match between the donor cells and the patient because newborn babies don’t have a fully developed immune system yet.

What Diseases Can Be Treated Using a Bone Marrow Transplant?

A bone marrow transplant can be used as a very effective treatment for the following diseases:

  • Acute lymphoblastic leukemia (ALL)
  • Acute myeloid leukemia (AML)
  • Chronic lymphocytic leukemia (CLL)
  • Chronic myelogenous leukemia (CML)
  • Ewing's sarcoma
  • Hodgkin's lymphoma
  • Medulloblastoma

Preparing For a Bone Marrow Transplant

If a doctor decides to perform a bone marrow transplant, the patient will have to be well prepared for it.

Pre-transplant Tests

Before a patient can receive a bone marrow transplant, their doctor needs to check whether they’re an eligible candidate.

Before any testing occurs, the medical professional will take factors such as the patient’s age, treatment history, and overall health into consideration. Afterward, they will order multiple medical tests.

These tests include:

  • A full physical and dental exam
  • Blood work and urine tests to check the patient’s liver and kidney functions
  • An EKG to check the patient’s heart functions
  • A CT scan or a chest X-ray to check the condition of the patient’s lungs
  • A blood count test
  • A test that will determine the status of the patient’s disease

If all of these medical tests are performed and the doctor determines the patient is a suitable candidate, the next step would be an intravenous catheter insertion.

This catheter is there to allow medical professionals to provide nutritional support, medication, chemotherapy, and draw blood without having to give multiple different IVs to the patient.

How Are Cells Collected?

As we already mentioned, the process of a bone marrow transplant requires cell collection. These cells can be collected either from the patient or a donor who is a match, and it can be done in two different ways: via a peripheral blood cell collection or a bone marrow harvest.

A special machine called a cell separator is used for cell collection. The cell separator can separate the blood into the different components it comprises, meaning it can differentiate between white and red blood cells, plasma, and platelets.

The donor will have a needle inserted into a large vein in each arm and then the machine will start drawing out blood. During the process, the blood will be taken from one arm, the machine will separate the cells, and then return the blood to the other arm.

During this process, the donor may feel certain symptoms such as nausea, feeling cold, leg cramping, fatigue, dizziness, and nausea.

Another way of collecting cells is directly through the bone marrow itself instead of the donor’s blood. This extraction is performed by inserting a thin needle under general anesthesia and the cells are collected from the bones in the pelvis.

For this collection process, a medical professional will insert a long needle into the bone and draw the marrow into the syringe. This won’t interfere with the donor’s health or immune system because the body will quickly replace the extracted cells.

Conditioning Regimen

As a bone marrow transplant is a procedure that the patient’s body needs to be well-prepared for, they will have to go through something known as a conditioning regimen. This will happen anywhere between 5 and 10 days before the actual transplant.

The best way to understand what a conditioning regimen is would be to see it as a preparation process – the body is getting prepared to receive the cells. This process is important because it suppresses the immune system so the patient’s body won’t reject the new bone marrow and so there would be enough room for the cells to develop.

In most cases, the conditioning regimen will require the administration of chemotherapy agents or radiotherapy. There are multiple different chemotherapy agents that may be administered during the conditioning regimen.

During this time, the patient will experience the typical side effects related to chemotherapy such as hair loss, nausea and vomiting, weakness, and organ damage.

What's The Procedure For a Bone Marrow Transplant?

After the patient has gone through the pre-transplant tests and the conditioning regiment, they’re ready for the bone marrow transplant. The transplant is done intravenously, and given as an IV infusion.

This is a quick and simple procedure that can take anywhere from 15 minutes to several hours, depending on the volume of cells the patient is receiving. While the transplant is going on, a medical professional will keep track of the patient’s vital signs to see if anything looks irregular.

During the transplant, the patient may feel certain side effects such as stomach cramps, blood pressure changes, or a ticklish sensation at the back of the throat.

Graft Versus Host Disease (GvHD)

Even though a bone marrow transplant is a safe procedure, complications can still happen. If the patient receives an allogeneic transplant (cells that were taken from a donor), there is a chance of them developing graft versus host disease (GvHD).

GvHD can occur if the bone marrow cells that enter the patient’s immune system see their organs and tissues and something foreign, so they attack them. GvHD can happen to any patient who receives a bone marrow transplant, although the risk is greater if the patient and the donor aren’t related.

GvHD can be acute and chronic.

Acute GvHD typically occurs within the first month after the transplant occurs and it can affect the patient’s liver, digestive tract, or skin.

Chronic GvHD on the other hand develops later and can affect multiple organs at the same time. It also has multiple signs and symptoms:

  • Shortness of breath
  • Nausea and vomiting
  • Mouth sores and dry mouth
  • Joint and muscle pain
  • Changes in vision
  • Rashes
  • Vision changes
  • Diarrhea
  • Skin changes
  • A persistent cough

A large number of people who get GvHD as a result of an allogeneic transplant do see a gradual improvement within a few months or sometimes years. In some cases, GvHD can be life-threatening but the mortality rate is relatively low.

Recovery From a Bone Marrow Transplant

After the bone marrow transplant procedure, the patient will either remain in the hospital for a couple of weeks or go home but have a caretaker who will look out for them. While they’re recovering, the bone marrow cells will start to work their way through the bloodstream.

Bone Marrow Transplant Engraftment

When the cells enter the body, they will travel through the bloodstream and reach the body marrow. Over the next couple of weeks, usually approximately 30 days, they will multiply and start producing new and healthy blood cells. This is a process known as engraftment.

The medical professionals responsible for your transplant will monitor your lab reports to keep track of the engraftment process. They will measure:

  • White blood cells
  • Platelets
  • Absolute neutrophil count
  • Hemoglobin

Until the new white blood cells fully engraft, the patient is at a much higher risk of infection than usual. This is because the immune system is significantly weaker when it doesn’t have enough white blood cells.

There are also some side effects that you should keep an eye out for after the transplant, such as:

  • Extreme fatigue
  • Frequent and often painful and/or bloody urination
  • High fever and chills
  • Severe headaches
  • Lightheadedness
  • Stomach pains
  • Bleeding
  • Chest pain
  • Diarrhea
  • Shortness of breath and/or coughing
  • A feeling of confusion

Bone Marrow Transplant Diet

After a bone marrow transplant procedure, the patient needs to follow a strict diet to ensure the engraftment process goes over smoothly and their immune system stays protected.

Here are some of the general rules you should remember:

  • Never eat any rare-cooked or raw meat
  • Don’t share your food with anyone else
  • Before handling any food, make sure you wash your hands thoroughly with soap and warm water
  • Only eat pasteurized dairy products
  • Don’t eat any leftovers that have been in the fridge for longer than three days, even if they still seem good
  • If eating eggs, make sure they’re fully cooked
  • Don’t eat any unrefrigerated condiments
  • If dining out, choose restaurants that are clean, cook their food well, and aren’t too crowded

The most important thing to remember is that after a bone marrow transplant, it’s essential to do everything possible to maintain your health. A good rule of thumb is to always eat and maintain a healthy diet that is high in calories and protein.

The Story of Ivan Who Received a Bone Marrow Transplant at Sheba Medical Center

Yulia Egorova’s young son, Ivan, was diagnosed with leukemia in Russia and needed a bone marrow transplant. After extensive research to locate the best medical facility for this advanced procedure, Yulia decided on the Bone Marrow Transplant Clinic at Sheba Medical Center. Ivan underwent a bone marrow transplant at Sheba, and the donor cells survived. He recently returned to school and lives life just like other kids.

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