Bone Marrow Transplant

Bone Marrow Transplant

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Overview

Bone marrow is a spongy part inside some of the bones of our body like our hip & thigh bone. It contains hematopoietic stem cells which produce the three types of blood cells: Red blood cells carry oxygen to all the cells of the body; White Blood cells that keep you safe from infections; and Platelets that help in the clotting of blood. That is why bone marrow transplant is also known as stem cell transplant.

Why is a bone marrow transplant done?

Various ailments both acute as well as chronic may affect the functioning of the bone marrow. The transplant is suggested by the doctors only when there is no other way out.

Some of the conditions that may require bone marrow transplant are:

  • Multiple Myeloma
  • Amyloidosis
  • Acute or chronic Leukemia
  • Hodgkin’s or Non-Hodgkin’s Lymphoma
  • Myelofibrosis
  • Sarcoma
  • Germ cell tumours
  • Plasma cell disorders
  • Neuroblastoma
  • Immune disorders
  • Macroglobulinemia
  • Autoimmune disorders
  • After cancer treatments like chemotherapy or radiation

What to do once a bone marrow transplant has been advised?

Once the bone marrow transplant is advised to you, you have to decide which type of transplant will be suitable for you. You may discuss this with your doctor who will guide you through it.

There are two types of bone marrow transplants:

Autologous

This transplant involves injecting your own previously preserved stem cells into your body. This is an option when you are about to undergo chemotherapy and you may be advised by your doctors to preserve your stem cells in case a need arises. These stem cells are stored in a stem cell bank and used if you require a bone marrow transplant in the future.

Allogeneic

In an allogeneic transplant, the stem cells are taken from a compatible donor which mostly is a close relative but it can be someone unknown as well. The stem cells from the donor are retrieved before the procedure and then injected into the recipient. In some cases, the mothers after giving birth to their baby, donate the stem cells from the newborn's umbilical cord for preservation that can be utilised for someone in future. This is known as a cord blood transplant.

How to prepare for the surgery?

Before finalizing you as a candidate for a bone marrow transplant, you will have to go through various screening tests and procedures to determine whether you are healthy enough to undergo the transplant. These screening tests may include routine blood tests as well as scans.

What happens before the surgery?

In case of an allogeneic transplant, you will be required to find a suitable donor. The transplant team may also do a preliminary health checkup of the donor to ascertain his compatibility with you. After this, the stem cells shall be taken from the donor’s blood or bone marrow as per the doctor’s advice and stored in a stem cell bank.

If you are undergoing an autologous transplant, then the blood stem cells will be collected from your body. To ensure a boost in the number of stem cells and release these into the blood, you will be injected with a growth factor for a few days. Thereafter, blood will be taken from a vein to be directly put in a machine that aids in a process called apheresis. In this process, all the specialised cells of the blood including white blood cells, red blood cells, platelets and stem cells are separated and stored for use in the future.

What happens during the surgery?

Before undergoing the actual procedure, you will be required to go through a conditioning process. In this, certain chemotherapy drugs will be administered to you to suppress your immune function. This is done to ensure that your body accepts the new cells and there is no exaggerated response to the same. Also, if you have cancer, the chemotherapy drugs will be able to destroy the malignant cells. The intensity of the conditioning drugs will depend on various factors including your disease condition, age and overall health status. These conditioning drugs may also result in certain side effects such as:

  • Mouth ulcers
  • Nausea
  • Vomiting
  • Infection
  • Bleeding
  • Anaemia
  • Heart, liver or lung failure

Once the conditioning is done, the stem cells will be injected into your blood via an intravenous catheter that will be placed near your neck in your chest. This central line will remain for a few days for injecting the medications into your system. This is entirely a painless procedure that does not require anaesthesia.

What happens after the surgery?

The stem cells injected into your body are meant to enter your bone marrow and start multiplying. Thereafter, if all goes well, the production of new blood cells starts. This whole process known as engraftment may take many days or even weeks. The progress shall be monitored with regular blood tests and you may require an infusion of blood cells till your own bone marrow becomes functional. You should also be on the lookout for any side effects such as infection, nausea, vomiting and contact the doctor in case of any such occurrences. If you do not have any other side effects or symptoms, you may be discharged from the hospital after a few days. However, you may be required to visit the hospital for regular follow-ups. It is advisable for the patient & their family to arrange for a stay nearby to the hospital as it may take about a year for the body to get accustomed to the stem cells and to develop immunity.

What are the complications of a bone marrow transplant?

There may be a chance that there are no complications in your case after the transplant but it is essential to remain aware of the same.

Graft versus host disease (GVHD)

If you have undergone an allogeneic transplant, then you are at risk of GVHD which is more likely to occur if you have taken the stem cells from an unrelated donor. However, it can occur otherwise as well. The symptoms of GVHD may occur within the first month or even after a longer duration of time. These may include:

  • Skin rashes
  • Cough and breathlessness
  • Nausea and vomiting
  • Jaundice
  • Dry eyes
  • Joint pains
  • Change in appetite, bloating or Diarrhoea

The other complications that might occur are:

  • Organ damage
  • Cancer
  • Infection
  • Bleeding
  • Eye problems such as cataract
  • Infertility
  • Liver or kidney problems
  • Breathing problems
  • Cramps or numbness in arms or legs

Tips for a speedy recovery

After discharge from the hospital, you will have to be careful of your nutrition needs and physical activity. Consulting a nutritionist will be a wise decision so that you do not have any doubts about what to eat and avoid.

Apart from that:

  • Be careful of taking the medications on time
  • Staying physically active as much as possible
  • Staying away from any kind of infection
  • Avoiding alcohol or tobacco intake
  • Take supplements as per doctor’s advice

The entire transplant process can be overwhelming for some people, so if you feel that you are unable to cope with the stress or are facing anxiety issues, do not hesitate to opt for a counselling session with a mental health expert.

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