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 stem cells, 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.
Stem cells are constantly being produced by your bone marrow,
and will develop into the types of cells your body needs.
Types of bone marrow transplants
Most people who need to undergo a bone marrow transplant have cancer, such
as leukemia or lymphoma. 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 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 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 patient’s (or host’s) 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 radiation therapy.
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.
Pre-transplant evaluation
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 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 a "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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