According to 2004 information from the National Marrow Donor Program, 45,000 to 50,000 bone marrow transplants are done every year worldwide. There are two types of transplants: autologous and allogeneic. An autologous transplant is when the patient's own blood cells are collected and frozen, and then used after preparative treatment. Allogeneic transplants involve cells from a donor that have been matched to the patient.
Patient Evaluation
According to the National Marrow Donor Program, people who require a bone marrow transplant are those who have been diagnosed with any type of leukemia, an inherited immune system disorder, severe aplastic anemia, Hodgkin's disease, myelodysplastic syndromes and non-Hodgkin's lymphoma. Patients undergo tests and screenings according to their disease to ensure proper treatment. According to the Mayo Clinic, some of these tests may include blood tests to screen for infections, x-rays and CT scans, a spinal tap, and physical and dental exams. Blood tests are done to measure the hormone levels of the heart, kidneys, liver and lungs and to screen for infections. A psychological exam may be done, as well.
Preparative Treatment
Before receiving the new bone marrow cells, patients undergo a high dose of chemotherapy and possibly radiation to destroy the diseased cells. According to the National Marrow Donor Program, this phase is based upon the patient's age, disease and previous treatment, but generally lasts between four and 10 days.
Transplant Day
A day or two after completing the preparative treatment, the patient receives the bone marrow transplant. The bone marrow comes in a blood bag and is infused through the patient's central line. This process can take an hour or more depending on the amount of bone marrow needed, reports the National Marrow Donor Program. The patient may be slightly sedated during this process, but it is not painful. Engraftment occurs once the cells have traveled through the patient's blood and settle in the bone marrow where the cells begin to reproduce platelets, and red and white blood cells. Daily blood tests are done to measure the number of healthy cells in the patient's blood. A count of 500 or more for three days in a row is a sign of engraftment. This generally takes place twenty days after the transplant.
Recovery
According to the National Marrow Donor Program, the first 100 days following the transplant are the most critical because most infections occur within that time frame. Even after one to two years after the transplant, the patient's immune system may not be fully recovered. When the patient becomes stronger, he can leave the hospital, but will still require outpatient care. Patients are very weak and tired for many months following the transplant and require a great deal of care. However, after about a year, many patients return to their normal activities and report a better quality of life.
