A bone marrow transplant or BMT is the procedure that replaces your damaged or diseased bone marrow with healthy ones. The healthy stem cells are necessary when your bone marrow stops working or fails to produce sufficient blood cells required for the body. The procedure is necessary to manage several health conditions. Read ahead to know more about the procedure.
Types Of Bone Marrow Transplant
Depending on how you obtain the healthy bone marrow, it is classified into two types. The types of bone marrow transplants are:
Autologous Transplants
It is the type that involves the use of your stem cells. So, a patient undergoing the transplant needs to harvest healthy cells before undergoing cancer therapy. It is because of the cancer therapies like chemotherapy and radiation therapy damage healthy cells. After the cancer treatment, the harvested cells are returned to your body. It is not always available as you need to harvest healthy cells. But, the type of transplant avoids serious risks like GVHD.
Allogeneic Transplants
The transplant involves the use of donor cells. So, you get the bone marrow from another person who is a close genetic match to the patient. Often, the doctors suggest testing a relative with close genetic ties. But, you can also find matches from a donor registry. You need the transplant when any condition has resulted in the damage of your bone marrow cells. But, getting the bone marrow from the donor can trigger serious complications like GVHD. Therefore, your doctor puts you on immunosuppressant medications. It will suppress the immune system and avoid attacking the new cells. But, this move can leave you susceptible to other illnesses. The success of the transplant depends on the close matching of the donor marrow to your own. So, your doctor must find the best genetically compatible bone marrow to ensure success.
What Is The Need For Bone Marrow Transplant?
Before learning why you need a BMT, you need to know the function of bone marrow. It is the soft, spongy tissue. You can find it inside the bones. Its main function is to produce blood-forming cells, also known as blood stem cells. The stem cells produce the following:
- Red blood cells to supply oxygen-rich blood throughout the body
- White blood cells to fight an infection
- Platelets to stop bleeding
Due to undergoing cancer therapies or other reasons, you can suffer damage to the bone marrow. So, you need the transplant for the following:
- Allow safe cancer treatment with high doses of radiation or chemotherapy
- Replace the diseased or damaged bone marrow with new cells
- Kill cancer cells directly using the new stem cells
Bone marrow transplantation is ideal for people who are suffering from cancerous diseases as well as non-cancerous problems. So, it can help manage a wide variety of problems like:
- Aplastic anemia
- Adrenoleukodystrophy
- Bone marrow failure syndromes
- Immune deficiencies
- Hemoglobinopathies
- Hodgkin’s lymphoma
- Non-Hodgkin’s lymphoma
- Inborn errors of metabolism
- Immune deficiencies
- Neuroblastoma
- Multiple myelomas
- POEMS syndrome
- Plasma cell disorders
- Myelodysplastic syndromes
- Primary amyloidosis
Risks Associated With Bone Marrow Transplant
While BMT can help manage several diseases, it is not free without complications. The transplant poses numerous risks. Depending on the individual undergoing the treatment, the side effects can vary from minimal to severe. In serious cases, the patient needs to undergo treatment or stay in the hospital to deal with the severe side effects. In some cases, the risks are life-threatening. The risk of BMT depends on the following factors:
- Your age
- The condition or disease resulting in the need for transplant
- Type of bone marrow transplant
- The overall health of the patient
People undergoing BMT need to talk to their doctor about the risk associated with the procedure. The possible complications from the BMT include:
- Graft-versus-host disease (GVHD) that affect allogeneic transplant alone
- Organ damage
- Stem cell (graft) failure
- Cataracts
- Thyroid problems
- Infections
- Develop new cancers
- Infertility
- Death
You need to get a professional opinion from the doctor. With the help of your doctor, you need to weigh the risks and benefits associated with BMT. Then, take the right decision.
Graft-Versus-Host Disease: The Risky Complications
When you read about BMT, you will come across the term GVHD several times. You may wonder what it means. It is the potential risk arising in patients who accept stem cells from donors. So, patients who undergo allogeneic transplants face the risk of graft-versus-host disease. You develop the condition because the donor stems, which forms your new immune system starts attacking the tissues and organs. It is because the immune system feels it as smoothing foreign or dangerous.
Patients can suffer from GVHD any time after undergoing the transplant. So, people who undergo allogeneic transplants need to maintain caution as they can suffer from the issue at any point. The risk is higher when the stem cells come from an unrelated donor. But, the issue is prevalent among patients who accept bone marrow from a donor.
Types Of GVHD
Graft-versus-host disease is of two kinds. The signs and symptoms occurring due to the problem differ with the type.
Acute GVHD
It usually occurs during the first few months after BMT. The condition can cause complications in the following parts of your body:
- Skin
- Liver
- Digestive tract
Chronic GVHS
The chronic form of GVHD occurs much later, after the transplant. The problem can affect many organs and cause complications like:
-
- Shortness of breath
- Joint/muscle pain
- Persistent cough
- Vision changes, like dry eyes
- Skin stiffness
- Rash
- Scarring under skin
- Mouth ulcers or sores
- Jaundice (causing the yellow tint to the whites of the eyes or skin)
- Dry mouth
- Nausea
- Diarrhea
- Vomiting
Cost Of Bone Marrow Transplant
The BMT transplant is very expensive in several countries, include the USA. The price can range from $1, 00,000 to more than $3, 00,000. The price is the same for both types of transplants. It includes the care you need for three to six months after the transplant. But, the cost reduces when you choose countries like India for the transplant procedure. You need to spend a median cost of $12,500 for an autologous transplant. Depending on the hospital the price can range from $11,000 to $40,000. While allogeneic transplant has a median cost of $18,000 (it ranges from $11,000 to $45, 0000).
Preparing For Bone Marrow Transplant
Before you undergo the actual procedure, it is important to prepare. The pre-transplant tests, as well as procedures, assesses your overall health and the current status of your condition. It is performed to make sure that you are physically prepared for the transplant. The series of tests and evaluations takes several days. In addition to undergoing the pre-transplant tests, the surgeon or radiologist implants an intravenous catheter (a long thin tube) into the neck or chest. The catheter, also known as the central line remains in the place until the treatment completes. The central line is needed to infuse the transplanted stem cells, medication as well as blood products into your body.
Bone Marrow Transplant Procedure
The actual BMT procedure has three major steps. The first steps involve collecting the stem cells for transplant, then making our body ready for the transplant, and finally the BMT. Read ahead to know each step in detail.
Collect Stem Cells For Transplant
Collecting stem cells for the transplant is the first step of BMT. The collection depends on the type of transplant you need to undergo.
Collecting Stem Cells For Autologous Transplant
If you are planning to use your stem cells for BMT, then you need to undergo apheresis. It is the procedure to collect your healthy stem cells. Before undergoing the procedure, you need to take daily doses of growth injection to increase your healthy stem cell production. The healthy cells move into the bloodstream, which is collected for transplant.
During apheresis, your doctor draws the blood from the vein. It is circulated through a machine to separate it into different parts, including stem cells. It is collected and frozen for the future. The doctor returns the remaining blood to your body.
Collecting Stem Cells For Allogeneic Transplant
If you undergo BMT using donor cells, then the first step is to find a compatible donor. Your doctor can test the stem cells with a close relation to or one from the donor registry. After finding the donor, your doctor gathers the stem cells for transplant. The stem cells are collected either from the blood or the bone marrow of the donor. Your transplant team comes to a decision on the best one for you based on your particular situation.
The allogeneic transplant by using the stem cells from the cord blood (umbilical cords). Mothers can choose to donate the umbilical cords of their babies after birth. The blood from the cord is frozen and stores. It remains in the cord blood bank until the need for bone marrow transplant arises.
Conditioning Process
It is the second step in bone marrow transplantation. The main aim of the steps is to destroy the damaged bone marrow. It makes it possible for your body to receive the new stem cells. The process takes place after the pre-transplant tests and procedures. In most cases, you undergo chemotherapy and radiation. The conditioning process attains the following:
- For cancer patients, it destroys the malignant cells
- Suppress the patient’s immune system
- Prepare the patient to accept the new stem cells
For the specific type of conditioning process, you need to undergo depends on various factors. The main factors influencing the decision are:
- Your disease
- The overall health of the patient
- The type of transplant you have planned to undergo
As a part of the conditioning process, your doctor can suggest combination chemotherapy and radiation therapy or either one of them.
Side Effects of Conditioning Process
When patients undergo the conditioning process, they can experience several side effects. The adverse effects of the process include:
- Diarrhea
- Nausea
- Vomiting
- Diarrhea
- Hair loss
- Mouth ulcers or sores
- Infection
- Bleeding
- Sterility or sterility
- Cataracts
- Anemia
- Fatigue
- Heart issues
- Liver Failure
- Lung failure
You need to take medications or undergo other treatment options to reduce the adverse effects caused by conditioning.
Reduced-Intensity conditioning
As the name suggests, it is the low-dose conditioning treatment that reduces the side effects. So, depending on your age as well as the history of health, the doctor suggests low doses of chemotherapy or radiation therapy. It kills some cancer cells and reduces the immune system’s reaction by suppressing it. Then, the infusion of donor cells takes place in your body. As time progresses, the donor cells replace your damaged bone marrow. The immune factors in the donor cells fight the malignant cells in your body. Immune factors in the donor cells may then fight your cancer cells.
Infuse Bone Marrow
It is the third and final step in bone marrow transplantation. After the conditioning process, the actual transplantation takes place. On the specified day of the transplant, your doctor infuses the new stem cells into the body through the central line. It works as a blood transfusion. The transfusion is a painless process. So, you never need anesthesia. You remain awake for the entire process. You can see the results of the BMT only after a few months. The new bone marrow requires time to produce all components needed for your body.
Recovery Process After Bone Marrow Transplant
After undergoing BMT, the new stem cells start entering your body. It travels through your bloodstream to the bone marrow. As time progresses, the new stem cells start multiplying. It starts making new and healthy blood cells. The process is referred to as engraftment. You need to have patience as it takes several weeks for the blood cell count to return to normal. In some people, the process takes a longer time. During the recovery period, you need to follow the steps suggested:
Undergo Tests
During the recovery period (days and weeks after the transplant), you need to undergo certain tests. The blood tests, as well as other tests, helps your doctor monitor your condition closely.
Close Monitoring By Medical Team
After BMT, your doctor monitors your progress closely. It is to detect the presence of infection or other complications. When such issues are detected, you need to stay in the hospital to manage the problem. The time you spend in the hospital depends on the type of transplant you undergo and the risk of complications you face. So, stay close to the hospital for monitoring. Depending on the severity, you need to spend several weeks to months near the hospital.
Periodic Blood Transfusion
After the transplant, you need a periodic transfusion of red blood cells as well as platelets. You need the transfusion until your bone marrow starts producing the blood cells needed for your body.
Take Medications
Your doctor prescribes medications for several complications that can arise due to the transplant. So, you need to take the following:
- People undergoing BMT can expect complications like diarrhea and nausea. So, you need medicines to manage it.
- If you undergo allogeneic transplant (BMT that uses stem cells from a donor), then you need medications to prevent GVHD (graft-versus-host disease). You also need to take immunosuppressive medications to reduce the body’s immune system reactions.
- The transplant can affect your immune system. So, until your immune system recovers, you need medications to prevent infections.
Lifestyle Changes For Recovering From Bone Marrow Transplant
From the bone marrow transplant, you need to change your lifestyle to enhance the quality of life. You need to make some positive changes to see the desired results.
Change Your Diet
From undergoing BMT, you need to change your diet to ensure overall health. So, you need to avoid fatty and oily foods. It increases your weight, which is not good after the transplant. Therefore, you need to see a nutritional specialist (Dietician) to work out a healthy meal plan. It must meet your daily calorie needs and complement your lifestyle. The dietician can offer you food suggestions to manage the adverse effects triggered due to radiation and chemotherapy (for example, nausea). The recommendation offered by the dietician includes:
- You need to follow the food safety guidelines precisely to prevent any foodborne infections.
- It is important to eat healthy foods. So, include vegetables, fruits, lean meats, whole grains, fish, poultry. Also, consume healthy fats like olive oil.
- Limit your salt intake
- Restrict alcohol consumption
- As some food items (grapefruit and grapefruit juice) affect a certain group of immunosuppressive medications (calcineurin inhibitors), try to avoid them.
- Include physical activity in your schedule. It helps control your weight. It also strengthens the bones, strengthens muscles, enhances your endurance, and strengthens the muscles, and keeps your heart healthy. So, as you recover, increase your physical activity.
Prevent Cancer
It is important to take steps to prevent cancer after the BMT. Therefore, you need to follow the pointers suggested below to reduce the risk of developing cancer:
- Wear sunscreen while going outside.
- Smoking is a bad habit that can cause cancer. Therefore, quit smoking.
- You need to make sure to get the cancer screening as per the doctor’s recommendation. It is essential to detect the issue as early as possible.
Follow-Up Appointments
After the BMT, you face the risk of infections or other complications. You are prone to the issues for months to years after the transplant. Therefore, you need periodic checkups. Lifelong follow-up appointments can help your doctor detect any late complications.
Results Of Bone Marrow Transplant
A BMT can completely cure certain types of diseases while others can go into remission. The main goal of the treatment depends on your specific situation. So, you can expect the following results from the therapy:
- Offer complete cure
- Control the disease
- Extend the life of the patient
- Improve the quality of life
Depending on the person who undergoes BMT, the side effects vary. So, some people only suffer from fewer complications, while others experience numerous challenging problems. The problems can occur short-term or long-term. As the individual reaction of the therapy depends on the person, it becomes difficult to predict the results before the transplant. Some people suffer from challenges during the initial transplant process. But, several instances establish that several survivors have successful results even with initial glitches. They have also returned to normal activities with an enhanced quality of life. So, you must always look forward to the treatment with a positive attitude.
Coping And Support After Bone Marrow Transplant
Waiting for a transplant or living with it can affect your emotional wellbeing. You need to have fears and concerns regarding the procedure. So, you need to have a healthy support system. Talk to your close friends and family members who can understand the emotion you go through. The positive energy from the close-knit group helps overcome the fear and anxiousness associated with the procedure.
You can also find a support group online or near you with people experiencing similar conditions. You and your family can share your concerns, fears, difficulties, and other issues with other members. Listening to the successes of other people will motivate you. The support group will have members who have already had a transplant or who are waiting for it. Sharing experiences can make you feel better.
Conclusion
Bone marrow transplant has a long record of success in managing certain types of cancers effectively. Advancing age is not a barrier in receiving the treatment and having a good prognosis. But, you need to discuss the risk and benefits of the options and determine it is the right one for you. Your mental and physical preparation is vital for making the decision. With medical assistance, you can access the life-saving treatment for enhanced quality and quantity of life.
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