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Bone marrow or stem cell transplantationPublished by BUPA's health information team, healthinfo@bupa.com, December 2007. This factsheet is for people who are having a bone marrow or stem cell transplant, or who would like information about it. A bone marrow or stem cell transplant is where abnormal stem cells from a person's bone marrow are destroyed and replaced with healthy stem cells, either from that person or from a donor.
About bone marrow transplantsThe bone marrow is a spongy substance in the centre of most bones. Your bone marrow contains stem cells, which are the most basic kind of cell. These stem cells in your bone marrow mature and into three types of cells:
They are then released into your bloodstream. Although it's often called a bone marrow transplant, the procedure is really a transplant of the stem cells in the bone marrow - a bit like a blood transfusion. A bone marrow transplant involves having your own stem cells in your bone marrow killed off by a high dose of chemotherapy and replaced with healthy stem cells. The healthy stem cells are fed into your blood through a drip and they find their way to your bone marrow to make new cells. The stem cells can either come from:
The stem cells are either taken directly from the donor's bone marrow, or taken from his or her blood using a machine called a cell separator (this is called a peripheral stem cell harvest). Why would I need to have one?Bone marrow transplantation is used in the treatment of cancers - such as leukaemias, lymphomas and myelomas - that affect the bone marrow. You may have a bone marrow transplant if:
A bone marrow transplant is a very intensive treatment, and your age and general health will be taken into consideration when deciding whether this is a suitable treatment for you. Generally you need to be under 65 to have this treatment. Preparing for the procedureA donor will usually be a close relative because their cells need to match yours. There is a one in four chance that a brother or sister's cells will match yours (ie that they will be a "match"). To find out if a potential donor is a match, you will both need to have a blood test. The doctor will look at both of your blood cells under a microscope to see if they have the same proteins on the surface. This is called tissue typing or HLA matching (HLA stands for human leukocyte antigen). It's sometimes possible to find a matching donor who isn't related to you. This may be done by your doctor trying to find a matched unrelated donor (MUD) for you from the Anthony Nolan Bone Marrow Register. It can sometimes take several months for different people to be screened to find you a donor. ChemotherapyBefore you can have the bone marrow transplantation, your leukaemia or other cancer needs to be at the lowest possible level. Ideally you should be in remission. If you aren't in remission, the cancer can be reduced using Harvesting the stem cellsThe first step is to collect, or "harvest", the stem cells. The exact process depends on whether the stem cells are coming from a donor or from you. Peripheral stem cell harvestIf the stem cells are coming from your own bone marrow (an autologous transplant), you will have a dose of chemotherapy first, and then a course of injections of growth factors. These injections encourage the stem cells to move from your bone marrow into your bloodstream. You will have regular blood tests, and when there are enough of your stem cells in your blood, these can be harvested. Harvesting the stem cells from your blood takes about three to four hours. During this time you will be lying down on a bed or a couch, and will normally have a drip connected to both of your arms. Blood will be taken from one arm, and this will go through a machine called a cell separator. This machine separates out the stem cells from the other blood cells. It will keep the stem cells and return any other blood cells to your bloodstream through the drip in your other arm. The stem cells are then frozen until you have had your high dose of chemotherapy. Sometimes the drip will be connected to veins in your legs instead of your arms, or through a central line in your chest. Harvesting a donor's stem cells follows the same process, except they are not given chemotherapy. Harvesting stem cells from the bone marrowStem cells can also be harvested by extracting bone marrow through a needle inserted into either your or your donor's pelvic bones. This is done under general anaesthesia, so you or your donor will be asleep during the procedure and feel no pain. High dose of chemotherapyThe next step of the treatment is for you to have a very high dose of chemotherapy, to completely destroy your own bone marrow and any remaining cancer cells in your body. This treatment takes several days and it can make you feel very sick. You may be given medicines to help relieve the sickness. About the procedureThe actual transfer of the stem cells is a relatively simple procedure. A needle is inserted into a vein and the cells are injected. They find their own way to the bone marrow and settle there. It will take some time (usually between two and four weeks) for the new stem cells reach your bone marrow and start making new blood cells. Side-effectsSide-effects are the unwanted, but mostly temporary effects of a successful treatment. Straight after a bone marrow transplant the levels of blood cells in your body will be very low. This will cause a number of side-effects, including:
While your levels of blood cells are low, you will need blood and platelet transfusions and antibiotics to protect you from infection. You may also need to have fluids You may need to stay in hospital until your blood cells have gone back up to a safe level. Autologous treatment normally causes fewer side-effects than an allogenic transplant, because your body is less likely to reject stem cells that have come from your own body. ComplicationsComplications are when problems occur during or after the procedure. Graft-versus-host diseaseOne possible complication of receiving bone marrow cells from a donor is called graft-versus-host disease. This happens when the white blood cells of the donor attack the tissues of your body. You will be given medicines to prevent this, so normally the symptoms are mild. But sometimes it can cause severe skin rashes, sickness, vomiting, diarrhoea, muscle weakness and yellowing of the skin (jaundice). Having graft-versus-host disease doesn't mean that the transplant has not worked. In fact, it may actually help by attacking any cancer cells in your body that have survived the high-dose chemotherapy treatment. Graft failureRarely, the new stem cells that have been fed into your blood may not produce enough blood cells. You will need another stem cell transplant if this happens. What to expect afterwardsOnce the levels of your blood cells have returned to a safe level, you will be able to leave the hospital. The specialist team who looks after you will monitor you closely during regular outpatient appointments. You will be told specifically what problems to look out for, such as fever. The success of bone marrow transplantation depends very much on the reason that it was done, the exact method used and how old you are. Many of the methods used are still very new and advances are being made all the time, so this type of treatment looks ever more promising. With some types of leukaemia, bone marrow transplant offers the best chance of a cure. Further information
Sources
Related topicsThis information was published by BUPA's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by BUPA doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional. Publication date: December 2007. Expected review date: December 2009.
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