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Bone marrow transplant

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Contents of this page:

Illustrations

Bone marrow aspiration
Bone marrow aspiration
Formed elements of blood
Formed elements of blood
Bone marrow from hip
Bone marrow from hip
Bone-marrow transplant - series
Bone-marrow transplant - series

Alternative Names    Return to top

Transplant - bone marrow

Definition    Return to top

A bone marrow transplant is a procedure that transplants healthy bone marrow into a patient whose bone marrow is not working properly.

Description    Return to top

Bone marrow is a soft, fatty tissue inside the bones. This is where blood cells (red blood cells, platelets, and white blood cells) are produced, and develop.

In some diseases of the blood cells -- especially cancers such as leukemia -- high doses of chemotherapy may be needed to destroy the cancer. However, this also destroys normal bone marrow and prevents it from making enough blood cells.

In other cases in which hereditary or acquired disorders cause abnormal blood cell production, a transplant of healthy bone marrow may correct these problems. Transplanted bone marrow will restore production of white blood cells, red blood cells, and platelets.

Bone marrow transplant patients are usually treated in specialized centers. The patient stays in a bone marrow transplant unit, or BMT, to limit exposure to infections.

The healthy bone marrow may be taken from the patient before chemotherapy or radiation treatment (autograft). Or, it may be taken from a donor (allograft). The donor can be a relative (usually a brother or a sister), or an unrelated person (found through the national marrow donor program).

Donated bone marrow must match the patient's tissue type. Donors are matched through special blood tests called HLA tissue typing (see HLA antigens).

Bone marrow is taken from the donor in the operating room while the donor is unconscious and pain-free (under general anesthesia). Some of the donor's bone marrow is removed from the top of the hip bone. The bone marrow is filtered and treated. It can be transplanted immediately or frozen and stored for later use.

Transplant marrow is given to the patient through a vein (IV). It is naturally carried into the bone cavities, where it grows to replace the old bone marrow.

The patient is prepared for transplant by getting high doses of chemotherapy or radiation (conditioning). This serves two purposes:

Following conditioning, the patient is ready for bone marrow infusion. After infusion, it takes 10 - 20 days for the bone marrow to establish itself. During this time, the patient will need support with blood cell transfusions.

Why the Procedure is Performed    Return to top

Bone marrow transplant may be recommended for:

Bone marrow transplant is not recommended for patients with:

Risks    Return to top

The risks for any anesthesia are:

Chemotherapy given before the bone marrow transplant (conditioning) may cause side effects such as:

While waiting for bone marrow to grow, the patient is at high risk for infections. Although the risk lowers over time, the person will have an increased risk of getting serious infections for years after a bone marrow transplant.

The major problem with bone marrow transplants when the marrow comes from a donor is graft-versus-host disease. The transplanted healthy bone marrow cells may attack the patient's cells as though they were foreign bodies. In this case, the patient must take drugs to suppress the immune system. However, these drugs also decrease the body's ability to fight infections.

Outlook (Prognosis)    Return to top

Ideally, a bone marrow transplant lengthens the patient's life.

After a transplant, you can go back to most of your normal activities as soon as you feel well enough. Talk to your doctor first, however.

Other problems with a bone marrow transplant are those of all major organ transplants -- finding a donor, and paying for the transplant. The donor is often a sibling with matching tissue. The more siblings the patient has, the more chances there are of finding a matching donor.

Recovery    Return to top

You will be in the hospital for 4 - 6 weeks. During this time, you will be isolated and under strict monitoring because of the increased risk of infection.

You will need attentive follow-up care for 2 - 3 months after being released from the hospital. It takes 6 months to more than a year for the immune system to fully recover from this procedure. Some people do not fully recover.

References    Return to top

Vose JM. Bone marrow transplantation. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKenna WG. Abeloff: Clinical Oncology. 3rd ed. Philadelphia, Pa:Churchill Livingstone;2004:chap 28.

Vose JM, Pavletic SZ. Hematopoietic stem cell transplantation. In: Goldman L, Ausiello D. Goldman: Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 184.

Update Date: 6/10/2008

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and James R. Mason, MD, Oncologist, Director, Blood and Marrow Transplantation Program and Stem Cell Processing Lab, Scripps Clinic, Torrey Pines, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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