Bone Marrow Transplant

A bone marrow transplant, also referred to as a stem cell transplant or hematopoietic stem cell transplant, is a medical procedure aimed at replacing damaged bone marrow resulting from disease, infection, or chemotherapy.

The bone marrow, a spongy and fatty tissue found within the bones, houses hematopoietic stem cells responsible for generating new blood cells. Essentially, our bodies contain three main types of blood cells:

• Red blood cells, which transport oxygen and nutrients throughout the body.
• White blood cells, essential for fighting infections.
• Platelets, crucial for preventing excessive bleeding by promoting clotting.

During the transplant, healthy stem cells are introduced into the bloodstream, allowing them to migrate to the bone marrow, where they generate new blood cells and facilitate the regeneration of marrow tissue.

There are two types of transplants depending on the source of healthy stem cells:

• Allogeneic transplant: Healthy stem cells are sourced from another person.
• Autologous transplant: Healthy stem cells are harvested from the patient themselves before starting chemotherapy or radiation treatment.

Bone marrow transplants serve as treatment for various medical conditions that harm the bone marrow, including:

• Anaemia resulting from bone marrow failure
• Leukemia, a form of cancer affecting white blood cells
• Lymphoma, another type of cancer impacting white blood cells
• Myeloma, a cancer affecting plasma cells, responsible for antibody production
• Certain blood, immune system, and metabolic disorders
• Moreover, bone marrow transplants can aid in restoring bone marrow damaged due to intensive cancer treatments.

Your doctor will only advise a bone marrow transplant if other treatments have proven ineffective, and if you are in relatively good health considering your condition.

Typically, age does not impact eligibility for a bone marrow transplant. However, you may be deemed ineligible if you have significant health issues such as severe heart, lung, liver, or kidney disease.

Bone marrow transplants are intricate procedures carrying significant risks. Your doctor will discuss these risks along with potential benefits to assist you in making an informed decision about proceeding.

Complications associated with bone marrow transplants may include:

• Graft versus host disease (GvHD): Seen in allogeneic transplants, where transplanted cells attack other cells.
• Infections: Due to weakened immunity during recovery, you're at a higher risk of infections.
• Low platelets and red blood cells: Resulting from non-functioning bone marrow, leading to potential internal bleeding.
• Pain: High doses of chemotherapy and radiation can cause mouth sores and gastrointestinal irritation.
• Fluid overload: The kidneys may struggle with the large volume of fluid given intravenously.
• Respiratory distress: Infections or airway inflammation may cause breathing difficulties.
• Organ damage: The liver and heart are susceptible to damage during transplantation.

Preparing for a bone marrow transplant involves several essential steps

• Appointing a primary caregiver to provide support and update your medical team as needed.
• Arranging work and personal matters for your hospital stay.
• Preparing your home for your recovery post-discharge, including thorough cleaning to minimize infection risks.
• Undergoing various medical tests such as blood tests, physical exams, psychological evaluations, and imaging scans like CT or MRI scans.
• Visiting a dentist to address any necessary dental work before the transplant to reduce infection risks.
• Focusing on your diet and fitness by incorporating small, frequent meals, adding protein and calorie-rich foods, and engaging in gentle exercises like walking, cycling, or yoga to maintain overall health and fitness.

A bone marrow transplant does not entail surgery; instead, it involves the insertion of a needle into a vein. Hospital stays for bone marrow transplants may last from 2 to 4 weeks.

When undergoing an allogeneic stem cell transplant, the medical team will gather stem cells from the donor's blood or bone marrow. Conversely, during an autologous stem cell transplant, the team will extract stem cells from your body and subsequently reintroduce them.

Depending on your situation, your doctor may advise proceeding with conditioning treatment or treatment for multiple myeloma.

Conditioning Treatment

Conditioning treatment typically includes chemotherapy and sometimes radiation therapy, aiming to achieve three main objectives:

• Eliminate existing cancer cells.
• Clear existing bone marrow cells to make space for healthy stem cells.
• Suppress the immune system to minimize the risk of transplant rejection.

To simplify medication administration, a central line tube is inserted into a large vein near the heart, eliminating the need for multiple injections.

This process generally spans about a week, during which you'll stay in the hospital. Following the conditioning treatment, your doctor will advise 1 to 2 days of rest before proceeding with the transplant.

Multiple myeloma is a form of cancer that impacts a specific type of white blood cell known as plasma cells. It results in cancerous plasma cells accumulating in the bone marrow, displacing healthy blood cells.

Individuals diagnosed with multiple myeloma may undergo induction chemotherapy for several months to decrease the number of abnormal plasma cells in the bone marrow. Subsequently, conditioning treatment is typically recommended.

Stem cells are infused into the body through the central line, a process lasting several hours while remaining conscious.

Throughout the infusion, discomfort such as pain, chills, fever, hives, and chest pain may be experienced.

Following a bone marrow transplant, close medical supervision is necessary to monitor the body's response. Hospitalization for several weeks is typically required to allow the bone marrow to settle and produce new blood cells.

During this time, individuals may:

• Experience fatigue.
• Encounter symptoms like vomiting, diarrhea, and loss of appetite.
• Receive oral or tube-fed fluids to prevent malnutrition.
• Undergo periodic transfusions of red blood cells and platelets until the bone marrow resumes normal function.
• Stay in a sterilized environment to minimize infection risks.
• While many patients can return home within 1 to 3 months post-transplant, prolonged hospitalization may be necessary if complications, such as infections, arise.

The recovery process may span several months or longer, during which returning to work or resuming previous activities may not be possible.

Susceptibility to infections remains high for the next 1 to 2 years as the immune system gradually strengthens.

Regular follow-up appointments with the doctor are necessary during the recovery phase to monitor health and track progress.