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Bone marrow (stem cell) transplantation

Published by Bupa's health information team, July 2009.

This factsheet is for people who are having a bone marrow or stem cell transplant, or who would like information about the procedure.

A bone marrow or stem cell transplant is where stem cells from a person's bone marrow are destroyed and replaced with new ones, usually from a healthy donor.

The bone marrow

The bone marrow is a spongy substance in the centre of your bones. Your bone marrow contains stem cells, which are the most basic kind of blood cell. These stem cells in your bone marrow mature into three types of cells. These are:

  • white blood cells - help fight infection
  • red blood cells - carry oxygen around your body
  • platelets - help blood to clot

The cells are then released into your bloodstream.

About bone marrow transplants

Although it's often called a bone marrow transplant, this procedure is really a transplant of the stem cells from the bone marrow.

A bone marrow transplant involves killing your own stem cells with a high dose of chemotherapy, and replacing them with healthy stem cells. The healthy stem cells are fed into your blood through a drip and find their way to your bone marrow to make new cells. The stem cells can either come from:

  • another person (a donor) - this is called an allogeneic transplant
  • your own bone marrow (if the stem cells were extracted at an earlier time when they were still healthy) - this is called an autologous treatment

The stem cells can be taken directly from the bone marrow of the donor or from the blood - this is known as peripheral stem cell harvest. They can also be taken from babies' umbilical cords, although this treatment is controversial and still being researched.

Other new treatments being researched include the following.

  • Mini transplants involve giving standard dose chemotherapy because the person isn't fit enough or young enough for a high dose. It's given over five days and then donor stem cells or bone marrow are transplanted.
  • Tandem transplants are when high-dose chemotherapy is given followed by a stem cell transplant. The treatment is repeated within three to six months.

Bone marrow transplantation is used in the treatment of cancers, such as leukaemias, lymphomas and myelomas that take over the stem cell stores. Once affected, the stem cells can't replace the blood cells your body needs to be healthy.

You may have a bone marrow transplant if:

  • you have certain types of leukaemia
  • your cancer is in remission (the symptoms go away and the disease is under control but not necessarily cured)
  • your cancer relapses (returns) after initial treatment
  • your cancer hasn't responded to other treatment

A bone marrow transplant is a very intensive treatment. Your doctor will take your age and general health into consideration when deciding whether it's a suitable treatment for you. Generally you need to be under 70 to have this treatment.

Preparing for a bone marrow transplant

A 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 will be a 'match'. After a blood test, the doctor will look at both of your blood cells to see how well they match. This is called tissue typing.

It's sometimes possible to find a matching donor who isn't related to you through the National Bone Marrow Registry or the Anthony Nolan Bone Marrow Register.

About the procedure

Chemotherapy

You may need to have chemotherapy, and possibly radiotherapy, before a bone marrow transplant if your cancer or leukaemia isn't in remission. This is because the cancer needs to be at the lowest possible level for a bone marrow transplant to be effective.

Harvesting the stem cells

The 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 blood stem cell harvest

You will be given injections of growth factors over a 10-day period. These control the making of blood cells and will help the bone marrow to make lots of stem cells for harvesting. They can also help your stem cells to make blood cells at a faster rate so you can recover from the transplant more quickly.

Harvesting the stem cells from blood takes about three to four hours. You lie down on a bed or couch, and will usually have a drip connected to each of your arms. If it's not possible to use both your arms, your doctor will discuss the other options that are available. Blood is taken from one of your arms and goes through a machine called a cell separator. This 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. Sometimes the stem cells are cleaned or 'purged' to kill off any remaining cancer cells, although this is such a new treatment that it's still being tested.

The stem cells are then frozen until you have had your high dose of chemotherapy.

Harvesting stem cells directly from the bone marrow

Stem cells can also be harvested by extracting them from the bone marrow through a needle inserted into either your own or your donor's pelvic bones, or sometimes breast bone. You will be sedated or given a general anaesthetic before this procedure.

High dose of chemotherapy

You will then 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 can make you feel sick. You will be given medicines to help relieve this.

The transplant

A day or more after chemotherapy, your own or your donor's stem cells are fed through a drip into your bloodstream. It will take between two and four weeks before there are enough new stem cells in your bone marrow to start making new blood cells.

What to expect afterwards

While your levels of blood cells are low, you will need blood and platelet transfusions. You will also need to take antibiotics to protect you from infection because of a lack of white blood cells. You may need to stay in hospital until your blood cells have gone back up to a safe level.

Autologous treatment usually causes fewer side-effects than a donor (allogeneic) transplant, because your body is less likely to reject stem cells that have come from your own body.

Donor stem cell transplants are physically and emotionally demanding. You may need to stay in hospital for four to six weeks and it's likely you will feel very ill during some of this time. You will have your own room to protect you from infections.

Once the levels of your blood cells have returned to a safe level, you will be able to leave the hospital. This may take several weeks. You will have regular out-patient appointments afterwards and will be told specifically what problems to look out for, such as fever.

Outcome

The success of bone marrow transplantation depends on why it was done, the method used and your age (generally younger people tend to do better). As many of the methods used are still very new, and advances are constantly being made, this type of treatment looks ever more promising. For some leukaemias, bone marrow transplant offers the best chance of a cure.

What are the risks?

Side-effects

Side-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. Side-effects of this include:

  • infections as a result of a lack of white blood cells
  • anaemia - a condition when you have too few red blood cells or not enough haemoglobin in your blood
  • bleeding because of a lack of platelets
  • eating problems as a result of feeling sick, not feeling hungry or having a sore mouth after treatment

Complications

Complications are when problems occur during or after the procedure.

Graft versus host disease (GVHD)

One possible complication of receiving bone marrow cells from a donor is graft versus host disease (GVHD). 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 usually the symptoms are mild, although in some people they may be more serious.

Graft failure

Very rarely, the new stem cells that have been fed into the blood may not produce enough blood cells. If this happens you will need another stem cell transplant.

Related topics

Further information

Sources

This 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: July 2009

 

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