A bone marrow transplant is a specialized treatment in which healthy blood-forming stem cells replace diseased or damaged bone marrow. It is used in certain blood diseases and cancers, such as some leukemias, lymphomas and myeloma, and in some marrow and immune disorders. It aims to restore the body's ability to produce healthy blood cells; the treating team decides if it suits each patient, and no cure can be promised.
The cells come from the patient (autologous) or a suitable donor (allogeneic), collected from the blood or from the marrow under anesthesia. Preparatory chemotherapy or radiation usually comes first, depending on the disease.
The hospital stay often lasts several weeks in an infection-limiting environment with close monitoring, followed by recovery that may take months. New cells usually appear in the blood after two to four weeks, while recovery of immunity and assessment of the final result may take months to a year or more.
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Healthy stem cells replace the diseased or damaged marrow so that blood cells can be produced again, and this may help treat or control some blood diseases and cancers. The outcome depends on the disease, its stage and the patient's condition, and it cannot be guaranteed.
The specialist team decides after assessing the type and stage of the disease, the patient's age and general health, and heart, lung, kidney and liver function. A transplant is not right for every patient, and in some cases other treatments may be preferred.
Preparation includes thorough blood and organ tests, choosing the type of transplant, tissue (HLA) matching when a donor is involved, and placing a central venous catheter. Fertility, dental health and infection prevention are also discussed, and no medicine should be stopped except on the doctor's instructions.
After the preparatory treatment, the stem cells are given through the venous catheter in a short session similar to a blood transfusion. It is not open surgery, although collecting cells from the donor or the patient may be done from the blood or from the bone marrow under anesthesia.
A transplant usually requires several weeks in hospital, followed by intensive and then regular follow-up over months, with restrictions on contact with others, food and exertion. Blood tests are done regularly and medicines are given to prevent infection. The pace of recovery differs from one patient to another.
New cells usually begin to appear in the blood after two to four weeks, but recovery of immunity and assessment of the response take months or longer. How long the benefit lasts varies with the disease, and the team follows it with regular tests.
They include infection, bleeding, severe fatigue, mouth sores and effects on organs, and in allogeneic transplants, graft-versus-host disease. The transplant may fail or the disease may return. This is a treatment with serious risks, which the treating team explains in detail before a decision is made.
The transplant itself usually leaves no major surgical scars, though a small mark may remain where the venous catheter was placed or where marrow was collected, if that was done. This varies from patient to patient.
Treatment requires a long stay: the patient often remains in hospital for several weeks, then stays near the treating center for weeks or months for follow-up. Only the treating doctor can decide when it is safe to travel.
In an autologous transplant, the patient's own cells are collected and stored, then returned after the preparatory treatment. In an allogeneic transplant, the cells come from a matched donor, related or unrelated. The team chooses the suitable type according to the disease and the match.
