BONE MARROW TRANSPLANTATION

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.

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

TYPES

• AUTOLOGOUS BONE MARROW TRANSPLANT

• ALLOGENEIC BONE MARROW TRANSPLANT

• UMBILICAL CORD BLOOD TRANSPLANT

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.

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.

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.

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.

COLLECTION OF BONE MARROW

Bone marrow harvest.

Leukapheresis.

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

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

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, especially if a sibling match is not available.

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).

ADVERSE REACTIONS

Chest pain ChillsDrop in blood pressure FeverFlushing Funny taste in the mouthHeadache HivesNausea PainShortness of breath

COMPLICATIONS

AnemiaBleeding in the lungs, intestines, brain, and other areas of the bodyCataractsClotting in the small veins of the liverDamage to the kidneys, liver, lungs, and heartDelayed growth in childrenEarly menopauseGraft failureGraft-versus-host diseaseInfections, MucositisPainDiarrhea, nausea, and vomiting

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

DermatologistsGastroenterologists

Psychologists