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Adult Bone Marrow Transplant

Today, the treatment of hematological diseases related to bone marrow, lymphatic system and blood such as lymphoma, multiple myeloma, acute and chronic leukemia, which are common in both adults and children, is of vital importance. Bone marrow transplantation is one of the most important treatment options for hematological cancers whose treatment rates are increasing day by day. Bone marrow transplantation, called stem cell transplantation, can be performed on both adults and children.

What is adult bone marrow transplant?

The cells responsible for blood production in the human organism are stem cells in the bone marrow. Transplantation of cells with these highly specialized functions is generally referred to as 'bone marrow transplant'.

How is a bone marrow transplant done?

Bone marrow produces blood cells. Stem cells are immature cells found in the bone marrow that make up all the different blood cells. Hematopoietic stem cells are used in transplants. Stem cells are transferred to the patient (recipient) via the vascular access. Intravenous devices called central venous catheters are used for this purpose. After transplantation, immature cells begin to live in the bone marrow and turn into a variety of mature blood cells, including:

  • Oxygen-carrying red blood cells

  • Platelets that help blood clot

  • White blood cells that help fight infection

With a bone marrow transplant, damaged stem cells are replaced with healthy cells. This helps the body make enough white blood cells, platelets, or red blood cells to avoid infections, bleeding disorders, or anemia.

There are different types of blood stem cell transplants. The type of transplant depends on the source of blood stem cells.

  • In bone marrow transplants (BMT), blood stem cells collected from the bone marrow are used.

  • Peripheral blood stem cell transplants (PBSCT) use blood stem cells collected from the bloodstream.

  • Cord blood transplants (CBT) use blood stem cells collected from a newborn baby's placenta and umbilical cord.

In which diseases is bone marrow transplant performed?

A bone marrow transplant is done when the patient's marrow is not healthy enough to function properly. This may be due to chronic infections, various diseases, or cancer treatments. Bone marrow transplants may benefit people with diseases such as:

  • Acute leukemia

  • Adrenoleukodystrophy

  • Aplastic anemia

  • Bone marrow failure syndromes

  • Chronic leukemia

  • Hemoglobinopathies

  • Hodgkin lymphoma

  • Immune deficiencies

  • Congenital metabolic errors

  • Multiple myeloma

  • Myelodysplastic syndromes

  • Neuroblastoma

  • Non-Hodgkin lymphoma

  • Plasma cell disorders

  • POEMS syndrome

  • Primary amyloidosis

  • Treatment-refractory or relapsed solid organ tumors

What cells are produced in the bone marrow?

The donor can be discharged after being kept under observation for 24 hours after collection. The collected marrow is passed through special filters in order to separate the fat and small bone fragments that may have been mixed into the marrow. If it is not used immediately, it is frozen by being placed in special liquids. When it is used, it is thawed and given to the patient, similar to a blood transfusion. These blood stem cells, which enter the patient's body, settle in the bone marrow and begin the production of blood cells, usually within 2-4 weeks.

What are the types of bone marrow?

There are two types of bone marrow transplant (stem cell transplant), autologous or allogeneic.

What is autologous stem cell transplant?

The aim of autologous transplantation is to allow hematologic recovery after high-dose therapy. Cells are taken from the patient's own bone marrow before chemotherapy and replaced with new ones after cancer treatment. In other words, in some cases, high-dose, intense chemotherapy or radiotherapy is used in cancer treatment. As a matter of fact, cancer treatment can damage our stem cells and immune system. Doctors ensure that the person's own stem cells are collected and frozen before cancer treatment begins. These stem cells, which are stored after cancer treatment, are given back to the person. This process is called stem cell recovery. Autologous stem cell transplantation is mostly used to treat diseases such as lymphoma, solid tumors in children, and multiple myeloma in adults. In autologous stem cell transplantation, the probability of the recipient rejecting the stem cells and the risk of tissue rejection disease (GVHD) is very low. Therefore, autologous stem cell transplant is safer than allogeneic transplants.

What is an allogeneic stem cell transplant?

Allogeneic stem cell transplantation is the process of stem cell transplantation performed from the sibling, relatives or unrelated donor of the patient, that is, the person to whom the stem cell transplantation will be performed. Allogeneic transplants, unlike autologous transplants, generate a new immune system response to fight cancer. In other words, during the transplantation process, immune system (immune system) cells are also transplanted along with the donor's stem cells. If the lymphocytes of the donor transferred to the patient during the allogeneic transplant perceive some cells that the patient sees differently as foreign, they start a war against them, and this may cause 'graft versus host' disease, which causes severe damage to the recipient's organs. In order to reduce the risk of allogeneic stem cell transplantation, drugs that suppress the immune system are given to the patient immediately after the transplantation, and the warrior capacity of the donor's lymphocytes is tried to be suppressed. In order not to start a war due to tissue differences after allogeneic stem cell transplantation, it is desirable to have as close a tissue compatibility as possible between the patient and the donor.

What are the risks of bone marrow transplant?

Bone marrow (stem cell) transplantation may take a long time for the immune system to be in order and for the production of healthy new blood cells. Immune recovery after transplantation depends on many variables. For example, immune recovery may take up to five years, depending on the stem cell source used, immune suppressive interventions, various problems that develop, and cell subtypes that can show improvement at different times. Bone marrow transplant patients are at risk of infection during this time and should take precautions. Also, a decrease in the number of blood cells; may cause anemia, excessive bleeding, bruising, and an increased risk of infection. Some patients may require a blood transfusion for a period of time.

What are the possible complications associated with a bone marrow transplant?

  • Graft-versus-host disease (allogeneic transplant only)

  • Stem cell (graft) error

  • Organ damage

  • Infections

  • Cataract

  • Infertility

  • New cancers

Graft versus host disease (GVHD): Graft versus host disease occurs in allogeneic transplants when the transplanted cells begin to attack other cells in your body. It is a complex clinical syndrome with organ dysfunction as a result of a severe immunological reaction mediated by healthy T-lymphocytes taken from the donor and given to the patient with stem cells, and is considered to be the most important cause of mortality and morbidity after allogeneic stem cell transplantation (CHN). GVHD can occur immediately after transplant or more than a year later.

There are two types of GVHD: acute and chronic. Acute GVHD usually occurs earlier, in the first months after transplant. It usually affects your skin, digestive system or liver. Chronic GVHD can cause severe damage to many organs. Chronic GVHD signs and symptoms include:

  • Joint or muscle pain

  • Shortness of breath

  • Persistent cough

  • Vision changes

  • Skin changes, including scarring or skin stiffness under the skin

  • Skin rashes

  • Yellow color to your skin or the whites of your eyes (jaundice)

  • Mouth sores

  • Diarrhea

  • Nausea, vomiting

What is done before a bone marrow transplant?

You will undergo a series of tests and procedures to assess your overall health and condition, and to ensure that you are physically ready for the transplant. Evaluation may take several days or longer. In addition to these, a surgeon or radiologist inserts a long thin tube (intravenous catheter) into a large vein in your chest or neck. The catheter, often called the central line, stays in place for the duration of your treatment in most cases. Your transplant team will use the centerline to infuse transplanted stem cells, drugs, and blood products into your body.

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