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 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 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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