Bone marrow is a material found in the bones. Stem cells are the immature cells in bone marrow. These cells can grow into platelets, red blood cells or white blood cells, all of which are necessary for the body to function properly. Bone marrow transplants are a lifesaving procedure for some patients. A transplant can be used as part of a treatment regimen for certain cancers, sickle cell or aplastic anemia and severe immune system disorders.
Types
There are three types of bone marrow transplants: umbilical cord, autologous and allogeneic. Umbilical cord blood transplants are done through cord blood banking of the patient's umbilical cord blood. A close relative's umbilical cord blood can be used in some cases.
Autologous bone marrow transplants are done when a patient's bone marrow is harvested prior to a procedure that may destroy it. The patient is infused with his own bone marrow after bone marrow destroying procedures are completed. This type is only possible if the bone marrow is healthy enough for harvesting.
Allogeneic bone marrow transplants are those in which the patient is infused with bone marrow from a compatible donor.
Harvesting Bone Marrow
Bone marrow is harvested from the patient or donor through a minor surgical procedure. The patient is put under general anesthesia, and a needle is placed in the hip area. The bone marrow is collected from this area. Generally, a donor must stay in the hospital overnight when a surgical harvesting is done.
In some cases, a procedure called apheresis may be performed. In this type of harvesting, the donor must take injections of filgrastim to boost blood-forming cells in the donor. The cells are harvested through an outpatient procedure in which blood is removed from the arm. The blood is put into a centrifuge, which separates the needed cells from the blood. The remaining blood is returned to the donor via a needle placed in the opposite arm.
Transplant Procedure
The recipient of bone marrow will have either chemotherapy or radiation treatments for several days prior to the transplant. This destroys bone marrow in the body to make room for the donor bone marrow, or healthy bone marrow. When the time comes for the transplant, a central venous line is inserted just above the heart. The medications and bone marrow are inserted via this line. Additionally, blood samples that are needed throughout the procedure are taken from this line. The procedure lasts several hours.
Because recipients are weakened due to strong chemotherapy or radiation prior to the procedure, they may become nauseated. To combat this, some centers provide the patient with anti-nausea medications.
Short-Term Recovery
Following a bone marrow transplant, the recipient is at an increased risk of illness due to his weakened immune system. Most bone marrow transplant patients spend 4 to 6 weeks in a special treatment facility to minimize the risk of being exposed to germs. Antibiotics and blood transfusions are often needed to fight off infections or illnesses that occur. During this recovery period, the patient may have flu-like symptoms, such as chills, nausea, achiness, fever, diarrhea and vomiting. Extreme fatigue is common, which makes normal activities such as watching television or reading a book a challenge.
Long-Term Recovery
Once a bone marrow recipient is discharged from the hospital, she is still susceptible to infections and illnesses. As such, recovery continues at home or at a lodging center near the hospital for up to 4 months following discharge from the hospital. Generally, contact with the general public is restricted due to a low white blood cell count. Several trips to the doctor are necessary each week to monitor the patient's progress. The symptoms associated with the transplant may continue during this period. Most bone marrow recipients are unable to return to work or school for at least 6 months after the procedure.
