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A bone marrow transplant is a medical procedure performed to replace bone marrow that has been damaged or destroyed by disease, infection, or chemotherapy. This procedure involves transplanting blood stem cells, which travel to the bone marrow where they produce new blood cells and promote growth of new marrow.
Bone marrow is the spongy, fatty tissue inside your bones. It creates the following parts of the blood:
Bone marrow also contains immature blood-forming stem cells known as hematopoietic stem cells, or HSCs. Most cells are already differentiated and can only make copies of themselves. However, these stem cells are unspecialized, meaning they have the potential to multiply through cell division and either remain stem cells or differentiate and mature into many different kinds of blood cells. The HSC found in the bone marrow will make new blood cells throughout your lifespan.
A bone marrow transplant replaces your damaged stem cells with healthy cells. This helps your body make enough white blood cells, platelets, or red blood cells to avoid infections, bleeding disorders, or anemia.
Healthy stem cells can come from a donor, or they can come from your own body. In such cases, stem cells can be harvested, or grown, before you start chemotherapy or radiation treatment. Those healthy cells are then stored and used in transplantation.
Bone marrow transplants are performed when a person’s marrow isn’t healthy enough to function properly. This could be due to chronic infections, disease, or cancer treatments. Some reasons for a bone marrow transplant include:
A bone marrow transplant is considered a major medical procedure and increases your risk of experiencing:
The above symptoms are typically short-lived, but a bone marrow transplant can cause complications. Your chances of developing these complications depend on several factors, including:
Complications can be mild or very serious, and they can include:
Talk to your doctor about any concerns you may have. They can help you weigh the risks and complications against the potential benefits of this procedure.
There are two major types of bone marrow transplants. The type used will depend on the reason you need a transplant.
Autologous transplants involve the use of a person’s own stem cells. They typically involve harvesting your cells before beginning a damaging therapy to cells like chemotherapy or radiation. After the treatment is done, your own cells are returned to your body.
This type of transplant isn’t always available. It can only be used if you have a healthy bone marrow. However, it reduces the risk of some serious complications, including GVHD.
Allogeneic transplants involve the use of cells from a donor. The donor must be a close genetic match. Often, a compatible relative is the best choice, but genetic matches can also be found from a donor registry.
Allogeneic transplants are necessary if you have a condition that has damaged your bone marrow cells. However, they have a higher risk of certain complications, such as GVHD. You’ll also probably need to be put onmedications to suppress your immune system so that your body doesn’t attack the new cells. This can leave you susceptible to illness.
The success of an allogeneic transplant depends on how closely the donor cells match your own.
Prior to your transplant, you’ll undergo several tests to discover what type of bone marrow cells you need.
You may also undergo radiation or chemotherapy to kill off all cancer cells or marrow cells before you get the new stem cells.
Bone marrow transplants take up to a week. Therefore, you must make arrangements before your first transplant session. These can include:
During treatments, your immune system will be compromised, affecting its ability to fight infections. Therefore, you’ll stay in a special section of the hospital that’s reserved for people receiving bone marrow transplants. This reduces your risk of being exposed to anything that could cause an infection.
Don’t hesitate to bring a list of questions to ask your doctor. You can write down the answers or bring a friend to listen and take notes. It’s important that you feel comfortable and confident before the procedure and that all of your questions are answered thoroughly.
Some hospitals have counselors available to talk with patients. The transplant process can be emotionally taxing. Talking to a professional can help you through this process.
When your doctor thinks you’re ready, you’ll have the transplant. The procedure is similar to a blood transfusion.
If you’re having an allogeneic transplant, bone marrow cells will be harvested from your donor a day or two before your procedure. If your own cells are being used, they’ll be retrieved from the stem cell bank.
Cells are collected in two ways.
During a bone marrow harvest, cells are collected from both hipbones through a needle. You’re under anesthesia for this procedure, meaning you’ll be asleep and free of any pain.
During leukapheresis, a donor is given five shots to help the stem cells move from the bone marrow and into the bloodstream. Blood is then drawn through an intravenous (IV) line, and a machine separates out the white blood cells that contain stem cells.
A needle called a central venous catheter, or a port, will be installed on the upper right portion of your chest. This allows the fluid containing the new stem cells to flow directly into your heart. The stem cells then disperse throughout your body. They flow through your blood and into the bone marrow. They’ll become established there and begin to grow.
The port is left in place because the bone marrow transplant is done over several sessions for a few days. Multiple sessions give the new stem cells the best chance to integrate themselves into your body. That process is known as engraftment.
Through this port, you’ll also receive blood transfusions, liquids, and possibly nutrients. You may need medications to fight off infections and help the new marrow grow. This depends on how well you handle the treatments.
During this time, you’ll be closely monitored for any complications.
The success of a bone marrow transplant is primarily dependent on how closely the donor and recipient genetically match. Sometimes, it can be very difficult to find a good match among unrelated donors.
The state of your engraftment will be regularly monitored. It’s generally complete between 10 and 28 days after the initial transplant. The first sign of engraftment is a rising white blood cell count. This shows that the transplant is starting to make new blood cells.
Typical recovery time for a bone marrow transplant is about three months. However, it may take up to a year for you to recover fully. Recovery depends on numerous factors, including:
There’s a possibility that some of the symptoms you experience after the transplant will remain with you for the rest of your life.
Doctors look for a donor who matches their patient’s tissue type, specifically their human leukocyte antigen (HLA) tissue type. HLAs are proteins — or markers — found on most cells in your body. Your immune system uses these markers to recognize which cells belong in your body and which do not. The closer the match between the patient’s HLA markers and yours, the better for the patient.
On average, about 1 in 430 U.S. Be The Match Registry members will go on to donate bone marrow or peripheral blood stem cells (PBSC) to a patient. Because of the vast variation in tissue types, we can’t predict an individual registry member’s chance of donating to a patient. If you have a relatively common tissue type, you might be one of many who could match a searching patient. If you have an uncommon tissue type, you may never match a patient, or you might be the only one out of more than 20 million potential donors on the registry who can save a person’s life. Every person who joins the registry gives patients more hope of finding the match they need. The most important thing you can do as a registry member is to stay informed and committed so that if you’re selected as the best donor, you’re ready to move forward.
More testing will be done to see if you are the best possible match for the patient. We may ask for another cheek swab or blood sample or we may be able to use a stored sample. Though almost all patient information is confidential, we can tell you the patient’s age, gender and disease.
If the patient’s doctor selects you as the best donor for the patient, we will schedule an information session so you can learn more about the donation process, risks and side effects. At that time, we can also tell you the type of donation the patient’s doctor has requested — either bone marrow or cells collected from the blood, (PBSC) donation.
Donating bone marrow is a surgical procedure done under general or regional anesthesia in a hospital. While a donor receives anesthesia, doctors use needles to withdraw liquid marrow from the back of the pelvic bone.
PBSC donation is a non-surgical procedure done in an outpatient clinic. PBSC donors receive daily injections of a drug called filgrastim for five days, to increase the number of blood-forming cells in the bloodstream. Then, through a process called apheresis, a donor’s blood is removed through a needle in one arm and passed through a machine that separates out the blood-forming cells. The remaining blood is returned to the donor through the other arm.
When you join the registry, you agree to donate by whichever method is needed. The patient’s doctor asks for either marrow or PBSC, depending on what is best for the patient.
Becoming a donor requires a time commitment. Before you donate, there are several steps to make sure you are the best donor for the patient. These steps include an information session to provide resources to help you make your decision, as well as appointments for additional blood tests and a physical exam. The time needed for the actual donation depends on the donation procedure.
The typical time commitment for the donation process is 20-30 hours of your time spread out over a four-to-six-week period. This does not include travel time, which is defined by air travel and staying overnight in a hotel. Nearly 40% of donors will travel during the donation process. Marrow and PBSC donation require about the same total time commitment.
We have extensive contacts with health care organizations and medical professionals who are experts in bone marrow and blood cell transplants and medical care. We will work with them to help find care for complications related to donation.
If you are on the Be The Match Registry and you donated through Be The Match, you will be covered by a donor life, disability and medical insurance policy for complications directly related to the donation.
Marrow donation is done under general or regional anesthesia so the donor experiences no pain during the collection procedure.
Discomfort and side effects vary from person to person. Most marrow donors experience some side effects after donation. Common side effects of marrow donation include:
Some donors said the experience was more painful than they expected; others said it was less painful. Some donors describe the pain as similar to achy hip bones or falling on their buttocks. Others say it feels more like a strained muscle in the back. The ache may last a few days to several weeks.
We want to assure donor safety, but no medical procedure is risk-free. The majority of donors from the Be The Match Registry feel completely recovered within a few weeks. A small percentage (2.4%) of donors experience a serious complication due to anesthesia or damage to bone, nerve or muscle in their hip region
The risk of side effects of anesthesia during marrow donation is similar to that during other surgical procedures. Serious side effects of anesthesia are rare. Common side effects of general anesthesia include sore throat (caused by the breathing tube) or mild nausea and vomiting. Common side effects of regional anesthesia are a decrease in blood pressure and a headache after the procedure.
We take all the necessary precautions to ensure the safety and well-being of the donor.
The amount of marrow donated will not weaken your own body or immune system. The average amount of marrow and blood donated is about one quart, less if the patient is a baby or child. This is only a fraction of your total marrow. Most donors are back to their usual routine in a few days, and your marrow naturally replaces itself within four to six weeks.
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