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Bone Marrow Transplant (Stem Cell Transplant) – 2020 Updated Procedure

If your bone marrow doesn’t produce sufficient red blood cells or blood stem cells, you might need a bone marrow transplant. In order to replace damaged bone marrow, a bone marrow transplant (also known as stem cell transplant) is taken into consideration to infuse healthy blood-forming stem cells into your body. 

Healthy bone marrow cells from your body (autologous transplant) or donor stem cells (allogeneic transplant) can be used in this transplantation. 

Allogeneic transplants[1] include utilizing a donor’s cells. The donor must be a similar genetic match.. Sometimes, the best option is a compatible parent or sibling, but you can also find genetic matches from a donor registry. When you have a disease that has weakened your bone marrow cells, allogeneic transplants are required.

According to the Center for International Blood and Marrow Transplant Research[2], about 20,000 patients receive transplants either autologous or allogeneic in the US each year. This number is expected to steadily increase over the next few years. 

If you are undergoing a bone marrow transplant, you need to know a lot of things about the cost, procedure, and risk of a bone marrow transplant. Find out more about bone marrow transplant, here in this article.

Overviews

What Is Bone Marrow Transplant?

bone marrow transplant

A bone marrow transplant is a semi-invasive procedure to replace a bone marrow that has been weakened or lost as a result of sickness, infection, or chemotherapy. In this procedure, blood stem cell transplantation travels to the bone marrow where new blood cells are formed and promote new marrow development.

Some forms of cancer like leukemia, myeloma, lymphoma, and other diseases of the blood and immune system affecting the bone marrow can be treated with transplantation.

The spongy, fatty tissue inside the bones is bone marrow[3]. The following blood components are produced: red blood cells carry oxygen and nutrients across the body, white blood cells battle infection, and platelets are responsible for forming clots. 

Immature blood-forming stem cells known as hematopoietic stem cells, or HSCs, also comprise bone marrow. Many cells are already segregated and continue to replicate. However, these stem cells are unspecialized, meaning that they have the ability to replicate by cell division or divide into several different forms of blood cells and grow. Throughout your lifetime, the HSC contained in the bone marrow can build new blood cells.

Damaged stem cells are replaced with healthy cells by transplantation. To prevent diseases, bleeding problems, or anemia, this helps our body produce enough white blood cells, platelets, and red blood cells. In such cases, before undergoing chemotherapy or radiation treatment, stem cells will be harvested or grown in a safe lab environment. 

How Does A Bone Marrow Transplant Work?

The two kinds of Bone marrow transplant are AUTO and ALLO transplants[4]. These two kinds of transplants are performed similarly but the source of the stem cells is different. In general, each phase involves the selection of replacement stem cells, the care of the patient to prepare their body for transplantation, the actual day of transplantation, and then the duration of recovery.

Chemotherapy, other drugs, and blood transfusions can be administered to you by your health care team via a catheter placed in a large blood vessel near the chest wall…This helps decrease the number of needle sticks patients would require daily blood checks and other procedures during and after the transplant.

Please note that transplants are complex medical procedures. Sometimes, certain steps may occur in a different order or on a different timetable to customize your particular care. Ask your health care professional if you need to be in the hospital for medical reasons. Remember to talk about what to expect before, during, and after your transplant with your doctor.

Bone Marrow Transplant Procedure

Generally, bone marrow cells will be harvested from your donor[5] a day or two before your procedure if you have an allogeneic transplant. They’ll be retrieved from the stem cell bank if your own cells are used.

Cells are collected in 2 ways. They are harvested from either one of two hip bones through a needle or from your blood. For this operation, you’re under anesthesia, ensuring you’ll be free from any pain. A donor is given five shots during leukapheresis to help the healthy stem cells migrate from the bone marrow and into the bloodstream. Then, blood is drawn into an intravenous (IV) line and the cells containing stem cells are separated by a machine.

On the upper right portion of your chest[6], a needle called a central venous catheter, or port will be mounted. This makes it possible for the fluid containing the new stem cells to flow into your body. Then the stem cells spread around the body. Since the bone marrow transplant is performed for a few days over multiple sessions, the port is left in place.

 Multiple sessions offer the best opportunity for the new stem cells to incorporate themselves into the body. This practice is referred to as grafting. You’ll also get blood transfusions, liquids, and nutrients via this port. To fend off infections and help the new marrow develop, you will need medicine. 

Bone Marrow Transplant Risks

bone marrow transplant

There are several side effects after bone marrow transplants that patients have to suffer from, including:

According to Fred Hutch’s research[7], the mortality rate of bone marrow transplant has decreased by 34% in recent years. Research by Fred Hutch shows that the average risk of death after a bone marrow transplant showed a decline for years. 

A research team at the Fred Hutchinson Cancer Research Center[7] recorded a striking increase in survival in patients who undergo bone marrow transplants from the 1990s to the early 2000s. The survey reveals that the pattern has persisted. According to new research published in the Annals of Internal Medicine, the overall risk of death after transplantation fell 34 percent between 2003-2007 and 2013-2017.

There may also be reactions that may accompany some medical procedure for a person who receives a bone marrow transplant, including:

  • breath difficulty
  • blood pressure decrease 
  • Head pain
  • Pain
  • Fever
  • Chills

The chance of contracting complications is dependent on numerous factors like: 

  • Age
  • general wellbeing
  • kind of transplant

In addition, the 5-year overall survival rate for a particular stage of multiple myeloma is 60 percent, referring to the American Cancer Society[8]. This implies that about 60 percent are as expected to live for at least 5 years as individuals who do not have cancer. A comparative rate of survival compares people of the same type and stage of cancer to people in the general population.

Bone Marrow Transplant Cost

As per the Abramson Cancer Center at the University of Pennsylvania[9], numerous health insurance plans bear all or half of the total expense. Expenses can differ based on the location as well as the hospital. The total cost of a bone marrow transplant is approximately $350,000-$800,000, depending entirely on the procedure.

Greater costs are incurred with allogeneic transplants whereas to remove bone marrow, donors will have to be screened, placed through general anesthesia, and submitted to a surgery room. In the initial year after transplantation, a 2012 report[10] examining the overall cost of pediatric Bone marrow transplantation, covering donor hunt and expenditures, is around $175,815, with a wide estimate of $35,000-$780,000.

Bone Marrow Transplant Recovery

bone marrow transplant

After the stem cell infusion, the recovery stage[11] starts. It’s time to wait for the cells to be inserted or “taken” during this period, then begin to replicate and create new blood cells. Depending on the patient and the form of transplant, it takes 2 to 6 weeks to begin seeing a gradual return to regular blood counts.

You may have a reduced number of red and white blood cells and platelets for the first couple of weeks. When your counts are lowest right after transplantation, you might be given antibiotics to help prevent you from getting infections. You can get some health problems that need an anti-bacterial, anti-fungal, antiviral drug mix, additional chemotherapy, or radiation therapy. These are normally provided before a certain low level is reached by the white blood cell count. You may also have complications, such as infection with too few white blood cells (neutropenia)

However,  many patients have high fevers[12] and require IV antibiotics. Red blood cell and platelet transfusions are also needed before the bone marrow begins functioning, and the infused stem cells produce new blood cells. The side effects of autologous, allogeneic, and syngeneic stem cell transplants are much the same, except for graft-versus-host disease, which only occurs with allogeneic transplants. Stomach, pulse, lung, liver, or kidney issues can be problems after the transplant.

You can also go through feelings of fear, anxiety, sadness, excitement, or annoyance. Due to the amount of time you feel sick and disconnected from others, adapting emotionally after the stem cells can be difficult. In this period, you might feel as if you are on an emotional roller coaster. Support from family, friends, and the transplant team is very important to your recovery process. 

Conclusion

Bone marrow transplant goals rely on the particular situation, but typically include managing or curing your condition, prolonging your life, and enhancing your quality of life. With few side effects and complications, many individuals successfully complete bone marrow transplantation. Others face various difficult issues, both in the short and long term.

It is sometimes important to note, however, that there are many patients who have had to wait to undergo the transplant process, but eventually had successful transplants and returned with a strong quality of life to normal activities. It can be great to have support from your friends, family, and support groups. 

Frequently Asked Questions

What are the two kinds of Bone marrow transplant?

Autologous transplant and allogeneic transplant.

What is a Bone Marrow Transplant?

A bone marrow transplant is a procedure to replace your damaged or diseased bone marrow by infusing healthy blood-forming stem cells into your body.

What is an Allogenic transplant?

Allogeneic transplants[1] include utilizing a donor’s cells. A similar genetic match must be donors.

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  1. Satwani, P., Sather, H., Ozkaynak, F., Heerema, N.A., et al. (2007). Allogeneic Bone Marrow Transplantation in First Remission for Children with Ultra-high-risk Features of Acute Lymphoblastic Leukemia: A Children’s Oncology Group Study Report. Biology of Blood and Marrow Transplantation. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2731715/.
  2. Majhail, N., Mau, L.-W., Payton, T., and Denzen, E. (2015). National Survey of Blood and Marrow Transplant Center Personnel, Infrastructure and Models of Care Delivery Report prepared by CIBMTR Health Services Research Program Conducted in Partnership with Be The Match ® Patient and Health Professional Services. Available from: https://www.cibmtr.org/ReferenceCenter/SlidesReports/Documents/CIBMTR_Center_Survey_Report.pdf.
  3. Medlineplus.gov. (2020). Bone Marrow Diseases. Available from: https://medlineplus.gov/bonemarrowdiseases.html#:~:text=Bone%20marrow%20is%20the%20spongy,that%20help%20with%20blood%20clotting.
  4. Htut, M., D’Souza, A., Krishnan, A., Bruno, B., et al. (2018). Autologous/Allogeneic Hematopoietic Cell Transplantation versus Tandem Autologous Transplantation for Multiple Myeloma: Comparison of Long-Term Post Relapse Survival. Biology of Blood and Marrow Transplantation, 24(3), 478–485. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5826888/.
  5. Bain, B.J. (2001). Bone marrow aspiration. Journal of Clinical Pathology, 54(9), 657–663. Available from: https://jcp.bmj.com/content/54/9/657.
  6. Jcdr.net. (2010). JCDR – Bone marrow aspiration, Bone marrow trephine biopsy, Bone marrow examination. Available from: https://www.jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&volume=8&issue=8&page=FC13&issn=0973-709x&id=4760.
  7. Fred Hutch. (2020). Big gains in bone marrow transplant survival since the mid-2000s. Available from: https://www.fredhutch.org/en/news/center-news/2020/01/survival-gains-bone-marrow-transplant.html.
  8. Cancer.org. (2015). American Cancer Society. Available from: https://www.cancer.org/cancer/multiple-myeloma/detection-diagnosis-staging/survival-rates.html.
  9. Penn Medicine – Abramson Cancer Center. (2020). Bone Marrow and Stem Cell Transplant Program – Abramson Cancer Center. Available from: https://www.pennmedicine.org/cancer/navigating-cancer-care/programs-and-centers/bone-marrow-transplant-and-stem-cell-transplant-program.
  10. Preussler, J.M., Denzen, E.M. and Majhail, N.S. (2012). Costs and Cost-Effectiveness of Hematopoietic Cell Transplantation. Biology of Blood and Marrow Transplantation, 18(11), 1620–1628. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678555/.
  11. Wilke, C., Holtan, S.G., Sharkey, L., DeFor, T., et al. (2016). Marrow damage and hematopoietic recovery following allogeneic bone marrow transplantation for acute leukemias: Effect of radiation dose and conditioning regimen. Radiotherapy and Oncology, 118(1), 65–71. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4764403/.
  12. ISMRD. (2019). Journal Entries – ISMRD. Available from: https://www.ismrd.org/resources/family-stories/this-is-jennys-story-of-reclaiming-her-life-after-bone-marrow/journal-entries/.
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