Bone Marrow Transplant
Bone marrow transplantation is a procedure wherein stem cells from bone marrow that produce various blood cells like red blood cells, white blood cells and platelets are injected into a recipient after a short course of chemotherapy called conditioning.
Procedures & Surgeries
An interesting observation here is that the type of bone marrow used for transplant is different from the different types of BMT. There are two types of BMT:
Allogenic BMT: Donor and Recipient are two separate individuals and BMT is done using the stem cells of donor. It may be:
1. Matched Related, where donor is HLA matched relative usually a sibling.
2. Matched Unrelated, where donor is not a relative of patient and usually found from one of the various national or international registries.
3. Partially Matched Related, where donor is from a patient’s family but partially matched (haploidentocal).
Autologous BMT: Donor and Recipient are same individuals. BMT is done using the patient’s own stem cells. The procedure involves giving high dose chemotherapy to patient in order to remove primary disease. Thereafter, an autologous transplant is conducted to rescue damaged bone marrow. This type of transplant has minimal complication and is preferred for diseases like multiple myeloma.
Although the experience during these phases may be quite different for each patient, a general overview is provided. There are three main phases to the BMT process, which will be reviewed here:
Transplant Treatment Process
For your transplant journey, the transplant process is divided into five steps to guide a patient. The steps begin with how to prepare for the journey and include what to expect along the way.
1. Preparation - The preparation phase begins when the patient arrives at the treatment centre and begins the process of medical evaluation, orientation, informed consent, and other preliminary activities like
a. Complete discussion regarding the procedure and its complications
b. Central Venous Catheter Evaluation and insertion
c. Bone Marrow/Stem Cells Harvest
2. Conditioning – The conditioning phase begins the actual transplant process. Patient is admitted and during this phase, high-dose chemotherapy, radiation therapy, or both are initiated. Chemotherapy and radiation therapy are given in doses that obliterate the marrow function and result in the greatest possibility of destroying the disease.
3. Transplant – The transplant phase is actually short and involves the infusion of donor bone marrow or stem cells. After the conditioning regimen is completed, the patient receives the infusion of bone marrow or stem cells over half to one hour like blood transfusion.
4. Engraftment and Early Recovery – Approximately 10 to 28 days after transplant, signs that the new bone marrow or stem cells are engrafting (growing and developing) can be expected. Close monitoring will continue along with supportive care. Preparation for the return of the patient to the referring physician or centre will begin.
5. Long Term Recovery-The long term recovery phase involves leaving the treatment center,dealing with any ongoing clinical issues, and re-establishing life patterns. Patients need to follow up for long term complications of BMT.
BMT is required for conditions mentioned below:
- Multiple Myeloma
- Hodgkin Lymphoma
- Non-Hodgkin Lymphoma
- Acute Lymphoblastic leukemia (ALL)
- Acute Myeloid Leukemia (AML)
- Chronic Myeloid Leukemia (CML)
- Myelodysplastic syndrome
Non Cancerous Conditions
- Thalassemia, sickle cell anemia, transfusion dependent anemia
- Aplastic anemia
- Fanconi anemia, pure red cell aplasia
- Metabolic disorders
- Immunodeficiency states
No, Bone Marrow Transplant is a medical procedure. Mostly, stem cells are collected via peripheral vein and the whole procedure is like donating blood or platelet. In some patients Bone marrow harvest is done which involves general anaesthesia to the donor.
Yes, Bone marrow transplant is a complex procedure that carries significant risks of serious complications.
Generally, the risks are reduced if:
- you are young – studies have shown the younger you are, the more likely the treatment is to succeed
- you receive stem cell donation from a sibling (brother or sister)
- you have no serious health conditions (apart from the condition you're being treated for)
The major problem with stem cell transplants is the recipient's ability to withstand high doses of chemotherapy (and sometimes radiotherapy), which are often needed before the transplant.
No, there are risks to donor. BMT is an extremely safe procedure for the donor; risk of complications being very small. Most of the times donor may have some bodyache which can be managed by paracetamol tablet alone. The main risks associated with a bone marrow transplant are discussed below:
1.Graft versus host disease
In some cases, the transplanted cells (graft cells) recognise the recipient's cells as "foreign" and try to attack them. This is known as graft versus host disease (GvHD) and often occurs after stem cell transplantation. GvHD is the most common complication seen in Allogenic BMT. About 40% of the patients develop GvHD.
There are two types of GvHD:
a.Acute GvHD usually occurs during the first three months following the transplant. It may involve skin (generalized rash or itching), Gut (diarrhoea or abdominal pain), liver (jaundice).
b.Chronic GvHD can develop at any time between three months and two years after the transplant. The symptoms can persist or may come and go for many years. They can range in severity from mild to life-threatening. Patient can have dry eyes, joint pain, skin changes, breathing difficulty, difficulty in swallowing. It develops from acute GvHD and can cause symptoms for many years.
After having a bone marrow transplant, your risk of developing an infection will increase. This is because the conditioning you receive before the transplant will weaken your immune system. The risk of infection may be increased further if you need to take immune suppressants.
It's very important to prevent infections developing. If you get an infection it could quickly develop into a more serious condition, such as a lung infection (pneumonia).
An ideal situation for the donor should be to stay near transplant centre for a week or so after transplant as patient may require platelet support from his donor.
If the patient does not have a matched sibling, the other options available are matched unrelated donor and partially matched sibling donor transplant. However, cost can significantly go up in matched unrelated donor transplant because of costs involved in procuring stem cells. Partially matched transplant is another option but it involves increased risk of GvHD and infections.
Team That Cares
Meet our team of expert medical professionals who offer the best treatment in a caring environment. Find a specialist now.
Latest on Health
Be aware. Be healthy
- Aug 12
- Dr. Rahul Naithani
It is common not to know that you are suffering from Leukemia- A deadly disease that usually begins in the bone marrow where blood cells are formed. Bone marrow or stem cell transplant is potentially a curative option in Acute Leukemia. Here's what is essential to know more about leukemia anatomy.
- Jul 14
Are you excessively feeling fatigued or exhausted? This may not sound pleasant as you have to constantly battle to avoid it before Anemia takes a toll on your health. Anemia can be frightening and can require serious interventions if ignored. Learn more to know about its hidden causes.
- Jun 07
- Dr. Gaurav Dixit
It is common not to know that you are suffering from Leukemia- A deadly disease that usually begins in the bone marrow where blood cells are formed. Though advances in treatment options have made the deadly blood cancers into manageable chronic conditions. Here's what is essential to know more about leukemia anatomy.