Bone Marrow Transplant

Bone marrow is a spongy tissue found in the center of many bones in thehuman body. The following bones contain either the red or yellow form of bone marrow:

upper arm

lower leg

ribs

breast bone

vertebra of the spine

Blood cells are made in the bone marrow. Immature blood cells in the bonemarrow, called stem cells, divide and mature to form various types of mature blood cells.These include:

red blood cells that carry oxygen

white blood cells that fight infection

platelets, which are cells that help blood to clot

Some diseases such as leukemia result in unhealthy bone marrow. Whenthis happens, the person may need to have a bone marrow transplant. During thisprocedure, a doctor will take healthy stem cells from one person – the donor – and injectthem through a needle into the blood of a person who needs the transplant. The stemcells travel through the blood into the person’s bone marrow. Ideally, the stem cellsattach and make new blood cells, thus fixing the problem.

Who is a candidate for the procedure?

Conditions that depress the bone marrow and may require a bone marrowtransplant include the following:

aplastic anemia,a condition in which damaged or destroyed stem cells in the bone marrow limitproduction of red blood cells

bone marrow depression, where the bone marrow has been damaged by treatmentssuch as chemotherapyor radiation therapy

cancers, such as the blood cancers called leukemiaand lymphoma

inherited blood disorders, such as thalassemia

some immunodeficiency disorders,such as severe combined immunodeficiency syndrome, a rare inherited condition

How is the procedure performed?

Usually, bone marrow comes from a donor. The procedure is much morelikely to succeed when the donor’s bone marrow closely matches that of the person itis going to. Close relatives such as a sibling or parent are most likely to have matchingbone marrow. In some cases, the person may donate his or her own marrow beforetreatment with chemotherapyor radiation therapy.Then the doctor transplants the person’s own bone marrow back into him or her when itis needed.

Donating bone marrow is generally a painless procedure. A doctor will takethe bone marrow from the hipbone with a special needle. Most donors are able to gohome the same or the next day.

Receiving bone marrow can be more uncomfortable. A doctor will inject ortransfuse bone marrow into the person through anintravenous tube,called an IV. An IV is a tube inserted through the skin and into a vein, usually in the chest or neck.

What happens right after the procedure?

Chemotherapyand/or radiationcan be valuable treatments for some diseases, such as cancer. But along with thedamage they can do to the bone marrow, these treatments can also destroy theimmune system cells. And that might cause the body to reject the transplanted bonemarrow. It may take 2 to 3 weeks or longer for the immune system and bone marrow tobegin working again. During this time, the person is at high risk for infections. Isolationand infection control measures are used to protect the person from infection. The person may bein the hospital for 4 to 6 weeks, or longer.

What happens later at home?

Recovery from a bone marrow transplant depends on many factors. Theseinclude the underlying disease and the body’s reaction to the procedure. Healthcareprofessionals will need to monitor the person closely for a few months after theprocedure. The doctor will decide when the person is ready to safely return to regularactivities.

What are the potential complications after the procedure?

The bone marrow donor has a very low risk of complications during andafter the procedure. But the things that might occur include:

severe bleeding

infection

allergic reactionsto anesthesia

The person getting the bone marrow transplant faces risks that are more serious:

Side effects such as sterility and kidney or liver damage from thechemotherapyand the medicines used to prevent rejection

Life-threatening infections

Graft versus host disease,also called GVHD. In GVHD, the donated cells attack the recipient’s body. This happens becausethe donated cells “see” the person’s body as foreign.

Bone marrow rejection

In addition, the underlying disease may return, or long-termmalfunction of the immune system may occur.