2. Bone marrow is the soft, fatty tissue inside your
bones. Stem cells are immature cells in the bone marrow
that give rise to all of your blood cells.
A bone marrow transplant is a procedure to replace
damaged or destroyed bone marrow with healthy bone
marrow stem cells.
3. INDICATIONS
• Certain cancers, such as leukemia, lymphoma, and
multiple myeloma
• A disease that affects the production of bone marrow
cells, such as aplastic anemia, congenital
neutropenia, severe immunodeficiency
syndromes, sickle cell anemia, thalassemia
• Had chemotherapy that destroyed the bone marrow
4. TYPES
• AUTOLOGOUS BONE MARROW TRANSPLANT
• ALLOGENEIC BONE MARROW TRANSPLANT
• UMBILICAL CORD BLOOD TRANSPLANT
5. AUTOLOGOUS BONE MARROW
TRANSPLANT:
The term auto means self. Stem cells are removed
from you before you receive high-dose chemotherapy or
radiation treatment. The stem cells are stored in a
freezer (cryopreservation). After high-dose
chemotherapy or radiation treatments, your stems cells
are put back in your body to make (regenerate) normal
blood cells. This is called a rescue transplant.
6. ALLOGENEIC BONE MARROW
TRANSPLANT
The term allo means other. Stem cells are removed
from another person, called a donor. Most times, the
donor's genes must at least partly match your genes.
Special blood tests are done to see if a donor is a good
match for you.
A brother or sister is most likely to be a good match.
Sometimes parents, children, and other relatives are
good matches. Donors who are not related to you may
be found through national bone marrow registries.
7. UMBILICAL CORD BLOOD TRANSPLANT
This is a type of allogeneic transplant. Stem cells are
removed from a newborn baby's umbilical cord right after
birth. The stem cells are frozen and stored until they are
needed for a transplant. Umbilical cord blood cells
are very immature so there is less of a need for
matching. But blood counts take longer to recover.
8. TWO WAYS OF TREATING
BONEMARROW
Before the transplant, chemotherapy, radiation, or both
may be given.
Ablative (myeloablative) treatment: High-dose
chemotherapy, radiation, or both are given to kill any
cancer cells. This also kills all healthy bone marrow that
remains, and allows new stem cells to grow in the bone
marrow.
Reduced intensity treatment, also called a mini
transplant: Patients receive lower doses of
chemotherapy and radiation before a transplant. This
allows older patients, and those with other health
problems to have a transplant.
10. Bone marrow harvest.
This minor surgery is done under general
anesthesia. The bone marrow is removed from the back
of both hip bones. The amount of marrow removed
depends on the weight of the person who is receiving it.
Leukapheresis.
Peripheral blood stem cells (PBSCs) are collected
by apheresis, a process in which the donor is connected
to a special cell separation machine via a needle
inserted in arm veins. Blood is taken from one vein and
is circulated though the machine which removes the
stem cells and returns the remaining blood and plasma
back to the donor through another needle inserted into
the opposite arm
11. MATCHING STUDIES
Matching involves typing HUMAN
LEUKOCYTE ANTIGEN (HLA) TISSUE. The
antigens on the surface of these special white
blood cells determine the genetic makeup of a
person's immune system. There are at least 100
HLA antigens
12. PREPARATION FOR THE RECIPIENT
Prior to the transplant, an extensive evaluation is
completed by the bone marrow transplant team. All other
treatment options are discussed and evaluated for risk
versus benefit.
A complete medical history and physical examination
are performed, including multiple tests to evaluate the
patient's blood and organ functions (for example, heart,
kidney, liver, and lungs).
A patient will often come into the transplant center up to
10 days prior to transplant for hydration, evaluation,
placement of the central venous line, and other
preparations
For an allogeneic transplant, a suitable (tissue typed and
matched) donor must be available. Finding a matching
donor can be a challenging and lengthy process,
13. PREPARATION FOR THE DONOR:
Donor sources available include: self, sibling, parent or
relative, nonrelated person, or umbilical cord from a
related or nonrelated person. There are national and
international registries for nonrelated persons and cord
blood.
If the potential donor is notified that he or she may be a
match for a patient needing a transplant, he or she will
undergo additional tests. Tests related to his or
her health, exposure to viruses, and genetic analysis
will be done to determine the extent of the match.
Once a match for a patient needing a bone marrow
transplant is found, then stem cells will be collected
either by a bone marrow harvest (collection of stem cells
with a needle placed into the soft center of the bone
marrow) or peripheral blood stem cell collection (stem
cells are collected from the circulating cells in the blood).
14. ADVERSE REACTIONS
Chest pain Chills
Drop in blood pressure Fever
Flushing Funny taste in the
mouth
Headache Hives
Nausea Pain
Shortness of breath
15. COMPLICATIONS
Anemia
Bleeding in the lungs, intestines, brain, and other areas
of the body
Cataracts
Clotting in the small veins of the liver
Damage to the kidneys, liver, lungs, and heart
Delayed growth in children
Early menopause
Graft failure
Graft-versus-host disease
Infections,
Mucositis
Pain
Diarrhea, nausea, and vomiting
16. THE BONE MARROW TRANSPLANT
TEAM
Doctors.
Bone marrow transplant nurse coordinator
Social workers
Dietitians
Physical therapists
Pastoral care
Other team members
Pharmacists Respiratory therapists
Lab technicians Infectious disease specialists
Dermatologists Gastroenterologists
Psychologists
