Bone Marrow Transplant: What should I expect?

The spongy tissue present inside the cavities of some bones, like the hip and thigh bones, are known as Bone Marrow, the primary function of which is to produce new blood cells. These cells go on to develop into red blood cells that carry oxygen, white blood cells that fight infections, and platelets that control bleeding. Any malfunction of these cells produces a myriad group of blood diseases.

Bone Marrow transplant is required to replace an unhealthy marrow with a healthy marrow tissue. It is also known as a Blood or Marrow Transplant (BMT), BMT is needed to combat diseases such as:

• Blood Cancers – Leukaemia or Lymphoma
• Bone Marrow Diseases – Aplastic Anaemia
• Immune System or Genetic Diseases – Sickle Cell Disease

Bone Marrow Transplant can be of 3 types:

• Autologous Transplant – Using the blood-forming cells of the patient.
• Allogeneic Transplant – Using blood-forming cells from a donor
• Haploidentical Transplant – A kind of Allogeneic Transplant

The standard Bone Marrow Transplant procedure consists of the following steps:

1. Collecting Stem Cells

Healthy Stem Cells are first collected from any of the 3 places.

Blood:

Time taken – 2 to 3 hours. The most common source of Bone Marrow cells, you might have to do it a couple of times in order to get the necessary amount of stem cells. The donor, i.e., you or someone else, is first treated with a drug called Growth Factor to help boost the stem cell count.  At the time of collection, the blood is taken out from one arm through a thin tube; this blood then flows into a machine to filter out the stem cells. The rest of the blood goes out of the machine and back into the body through the other arm.  The donor is wide awake through the whole procedure. This is a painless process, and there is no need for an overnight stay at the hospital.  The Stem Cells collected are frozen if taken from the patient; else, they are readily used if taken from a donor.

Bone Marrow:

Time Taken – 1 to 2 hours the stem cells, along with some red blood cells, are extracted from different parts of the hip bone through a needle. The donor sleeps through the process, and the red blood cells are given back through an IV during recovery.  The donor needs to stay bandaged for 24 hours and they will remain a bit sore in the following days.  The stem cells that are collected are frozen if they’re taken from the patient; else, they are readily used if taken from a donor.

Cord Blood: If a mother chooses to donate her newborn baby’s stem cells, then they are extracted from the placenta and umbilical cord during childbirth. These are frozen for future use; the child is not affected in any way.

2. Conditioning of the Receiver’s Body

Time Taken: Up to a week; radiation is given in one session or split up over a few days

Chemotherapy or radiation therapy precedes the transplant. The type of transplant, the illness, and the overall health of the patient decide the kind of therapy needed. This process of making the body ready to receive transmission is known as conditioning. The objectives are to:

• Clear space in the bone marrow for new cells
• Turn the immune system down, so it doesn’t reject the new cells
• Kill the cancer cells, if any are still present

3. Transplant of the Stem Cells

Time Taken: Couple of hours

This is the final step in which the stem cells are transplanted via a central line – a thin tube connecting to a vein in the chest. It is painless, and the recipient is awake.  After several weeks of the transplant, the blood cell count climbs back to normal.

Side effects:

• Preservatives used to freeze the cells causing side effects in the patient
• Chest Pain
• Fever, Headache, Hives
• Nausea, shortness of breath

4. Recovery

Precaution: Preventing contamination of infections from visitors. They are expected to wash their hands, wear masks, and gloves.

Common Side Effects:

• Nosebleeds
• Graft versus host disease (GVHD). The body treats the new cells (if from a donor) like a germ and attacks.
• Oral sores
• Diarrhea, vomiting
• Feeling exhausted

Care and Support:

• Blood Transfusions for boosting blood cell count
• Drugs to prevent GVHD
• Continuous observation, diagnostic tests
• Drugs to combat infections, side effects

Bone Marrow Transplant is a standard but rigorous procedure. Talk to your family, your doctor, in your times of need. It is important to get help to tone down the anxiety and pain that comes along with the medical treatment.