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Bone Marrow Transplantation – Process and Risks

Bone marrow transplantation is a medical procedure in which diseased bone marrow is replaced with healthy stem cells. It is primarily used to treat blood cancers and severe immune disorders.

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Things worth knowing about "Bone Marrow Transplantation"

Bone marrow transplantation is a medical procedure in which diseased bone marrow is replaced with healthy stem cells. It is primarily used to treat blood cancers and severe immune disorders.

What is a Bone Marrow Transplantation?

A bone marrow transplantation (BMT) is a medical procedure in which a patient's diseased or destroyed blood-forming tissue is replaced with healthy stem cells. Bone marrow is the spongy tissue found inside bones that is responsible for producing blood cells -- red blood cells, white blood cells, and platelets. In severe diseases affecting the blood-forming system, a transplantation can be life-saving.

Today, the term stem cell transplantation is often used as a broader term, since stem cells can be harvested not only from the bone marrow but also from the peripheral blood or umbilical cord blood.

Types of Bone Marrow Transplantation

Allogeneic Transplantation

In an allogeneic transplantation, stem cells are donated by another person -- either a related family member or an unrelated donor. The donor must be as closely matched to the recipient as possible in order to minimize rejection reactions. This compatibility is determined through the HLA system (Human Leukocyte Antigen system).

Autologous Transplantation

In an autologous transplantation, the patient's own stem cells are collected and frozen before undergoing intensive chemotherapy or radiation therapy. After treatment, the preserved stem cells are returned to the patient. This method carries a lower risk of rejection but is not suitable for all conditions.

Syngeneic Transplantation

In the rare syngeneic transplantation, stem cells are donated by an identical twin. Because the genetic material is identical, the risk of rejection is minimal.

Indications -- When is a Bone Marrow Transplantation Performed?

A bone marrow transplantation is used to treat a range of serious conditions, including:

Leukemia, such as acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL)
Lymphomas, including Hodgkin and non-Hodgkin lymphoma
Multiple myeloma (plasma cell cancer)
Aplastic anemia (failure of blood cell production)
Severe combined immunodeficiency (SCID)
Myelodysplastic syndromes (MDS)
Certain metabolic disorders such as Gaucher disease

Treatment Process

Preparation (Conditioning)

Before the actual transplantation, the patient undergoes intensive pre-treatment known as conditioning therapy. This involves high-dose chemotherapy and, in some cases, total body irradiation. The goal is to destroy the diseased bone marrow and suppress the immune system so that the body accepts the new stem cells.

Transplantation

The stem cells are transferred similarly to a blood transfusion -- via an intravenous infusion. The stem cells migrate on their own into the bone marrow, where they begin producing new blood cells. This process is called engraftment and typically takes two to four weeks.

Follow-up Care

After transplantation, patients require intensive medical monitoring. The immune system is significantly weakened during this period, leading to an increased risk of infection. Regular blood tests, infection-preventive medications, and immunosuppressive drugs are necessary.

Risks and Side Effects

Bone marrow transplantation is a complex procedure with potentially serious risks:

Graft-versus-host disease (GvHD): In allogeneic transplantations, the donor cells may attack the tissues of the recipient. This reaction can be acute or chronic and may affect multiple organs.
Infections: Due to immunosuppression, patients are susceptible to bacterial, viral, and fungal infections.
Organ damage: The liver, lungs, and heart may be affected by intensive pre-treatment or transplant-related complications.
Graft failure: In rare cases, the stem cells do not successfully engraft in the bone marrow.
Relapse of the underlying disease: The original disease may return even after transplantation.

Prognosis and Outcomes

Outcomes depend strongly on the underlying disease, its stage, the age of the patient, and the degree of compatibility between donor and recipient. For certain forms of leukemia, allogeneic transplantation can achieve long-term remission rates of 50 to 70 percent. Advances in GvHD prevention and supportive care have significantly improved outcomes over recent decades.

References

Passweg JR et al. -- Use of haploidentical stem cell transplantation continues to increase: the 2015 European Society for Blood and Marrow Transplantation activity survey report. Bone Marrow Transplant. 2017;52(6):811-817.
Niederwieser D et al. -- Hematopoietic stem cell transplantation activity worldwide in 2012 and a SWOT analysis of the Worldwide Network for Blood and Marrow Transplantation Group. Bone Marrow Transplant. 2016;51(6):778-785.
National Cancer Institute (NCI) -- Bone Marrow Transplantation and Peripheral Blood Stem Cell Transplantation. Available at: www.cancer.gov

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