Bone Marrow and Transplantation
How the bone marrow functions
Bone marrow is the soft, spongy center of your
bone where blood is produced. Marrow is filled with blood-producing cells,
called hematopoietic progenitor cells (HPCs), which develop into mature
white blood cells, red blood cells, or platelets.
- White blood cells of various kinds make up part of your immune
system for fighting infections.
- Red blood cells are responsible for carrying oxygen throughout your body.
- Platelets clot your blood to prevent bleeding.
HPCs are constantly being produced by your bone
marrow, and will develop into the types of cells your body needs. HPCs are
sometimes called stem cells.
Types of bone marrow transplants
Most people who need to undergo a bone marrow
transplant have cancer, such as leukemia, lymphoma or multiple myeloma.
There are different types of bone marrow transplants. The type and severity of
your disease determine what type of transplant you will need.
An allogeneic transplant involves receiving
donor bone marrow, umbilical cord stem cells, or peripheral stem cells.
This donor is genetically matched and can be related or unrelated to you.
An autologous transplant involves receiving
your own bone marrow or peripheral stem cells. A syngeneic transplant
involves receiving your identical twin's bone marrow or peripheral stem cells.
Here is more information about the specific types of bone marrow transplants:
An allogeneic bone marrow transplant involves
receiving very high-doses of chemotherapy and/or radiation therapy, followed by
the infusion of your donor's bone marrow or peripheral stem cells. The high-dose
cancer-fighting treatments are given to eliminate the cancer in your body.
The infusion of the new marrow, cord blood, or
peripheral stem cells from the donor replaces the bone marrow destroyed by the
chemotherapy and/or radiation therapy. Allogeneic transplant patients have the
risk of developing a complication called graft-versus-host disease or GvHD. GvHD
is a condition where donor cells from the graft attack the patientís (or hostís)
organs or tissues The condition can be mild and treated on an outpatient basis,
or it can be severe and require treatment in the hospital.
You might be a potential candidate for an allogeneic
transplant if you have leukemia, aplastic anemia, myelodysplasia,
myelofibrosis, high-grade lymphoma or other types of cancers.
A non-myeloablative ("mini") allogeneic bone marrow
transplant involves receiving low-doses of chemotherapy and radiation
therapy followed by the infusion of your donor's bone marrow or peripheral stem
cells. The objective is to suppress your own bone marrow by receiving just
enough chemotherapy and radiation therapy to allow your donor cells to engraft
and grow within you. The hope is these donor cells will mount an immunologic
attack against your underlying cancer, generating a response called the
"graft-versus-leukemia" effect or "graft-versus-cancer" effect.
You might be a potential candidate for a mini allogeneic transplant if you have a slow-growing, indolent disorder, such as
chronic leukemia, multiple myeloma, myelodysplasia, and low-grade lymphoma.
The mini allogeneic transplant is not appropriate, for
example, if you have fast- growing acute leukemia.
An autologous bone marrow transplant involves
receiving very high-dose chemotherapy followed by the infusion of your
previously collected peripheral stem cells or bone marrow.
The high-dose chemotherapy treatments are given to
eliminate the cancer in your body. The infusion of your new marrow or peripheral
stem cells replaces the bone marrow destroyed by the chemotherapy and/or
You might be a potential candidate for an autologous
transplant if you have lymphoma, multiple myeloma, Hodgkin's disease, germ cell
cancer, or certain types of leukemia.
Before a bone marrow transplant can be approved as a
treatment option, you will have a pre-transplant evaluation. This
evaluation includes a complete physical, consultations with members of the Bone
Marrow Transplant Team, and a comprehensive series of tests. A pre-transplant
evaluation provides complete information about your overall health and helps
determine if you are eligible for a bone marrow transplant.
Bone marrow transplantation as a treatment option
After your transplant doctor has determined you are a
good candidate for a bone marrow transplant, a date for the transplant will be
determined and the process of insurance clearance will begin. Please understand
that insurance reimbursement for bone marrow transplantation is not automatic.
If you are to be admitted to the hospital for your
bone marrow transplant, you can expect your stay to be about 3 to 4 weeks,
depending on your recovery. During your recovery, you will learn about your new
medicines, how to recognize signs of complications and infections, and when you
can return to your normal activities.
If an allogeneic transplant or inpatient "mini"
transplant has been approved for you, you and your designated care-partner might
be required to stay within a 1-hour drive of the hospital for approximately 100
days after your transplant. After you go home, you can expect to recover
gradually, usually over 3 to 6 months.
If an outpatient "mini" allogeneic transplant has been
approved for you, you might be required to stay within a 1-hour drive of the
hospital for at least 30 days after your transplant. At that time, your doctor
will evaluate your medical condition to determine where you can continue your
follow-up care. Follow-up care after your transplant includes appointments with
your transplant or local doctor and tests to assess how you are recovering.
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