Bone Marrow-dont Erase

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Bone MarrowTransplantation


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What is a bone marrowtransplantation?


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Bone marrow transplantation(BMT) is a special therapy forpatients with cancer or otherdiseases which affect the bonemarrow. A bone marrow

transplant involves taking cellsthat are normally found in thebone marrow (stem cells),

filtering those cells, and givingthem back either to the patientor to another person. The goal ofBMT is to transfuse healthy bonemarrow cells into a person after


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Bone marrowtransplantation

is not yet astandardtreatment

therapy, but

has been usedsuccessfully totreat diseases

such as

leukemias,lymphomas,aplasticanemia,

immune


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What is bone marrow?


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Bone marrow is thesoft, spongy tissuefound inside bones. Itis the medium fordevelopment andstorage of about 95percent of the body'sblood cells.

The blood cells thatproduce other bloodcells are called stemcells. The mostprimitive of the stemcells is called thepluripotent stem cell,which is different thanother blood cells with

.


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Why is a bone marrow transplant

needed?

The goal of a bone marrow transplant is to cure manydiseases and types of cancer. When a person's bone

marrow has been damaged or destroyed due to adisease or intense treatments of radiation orchemotherapy for cancer, a marrow transplant may beneeded.


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What are somediseases thatmay benefit

from bonemarrowtransplantation?


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The following diseases are the onesthat most commonly benefit from bone

marrow transplantation:

leukemias

aplastic anemia

lymphomas

multiple myeloma

immune deficiency disorders

solid-tumor cancers, such as breast or ovarian


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What are the different types ofbone marrow transplants?

a.) Autologous bone marrowtransplantb.) Allogeneic bone marrow

transplantc.)Umbilical Cord BloodTransplant


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b.) Allogeneic bonemarrow transplant

The donor shares thesame genetic type asthe patient. Stem cells

are taken either by bonemarrow harvest orapheresis (peripheralblood stem cells) froma genetically-matcheddonor, usually a brotheror sister.


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c.) Umbilical Cord BloodTransplant

Stem cells are taken from an umbilical cordimmediately after delivery of an infant. Thesestem cells reproduce into mature, functioning

blood cells quicker and more effectively than dostem cells taken from the bone marrow of anotherchild or adult. The stem cells are tested, typed,

counted, and frozen until they are ready to betransplanted.


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How are a

donor andrecipient

matched?

hi i l i h


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Matching involves typing humanleukocyte antigen (HLA) tissue. Theantigens on the surface of these specialwhite blood cells determine the geneticmake-up of a person's immune system.

There are at least 100 HLA antigens,however, it is believed that there are afew major antigens that determine

whether a donor and recipient match.The others are considered "minor" and

their effect on a successful transplant isnot as well defined.

Medical research is still investigatingthe role all antigens play in the process

of a bone marrow transplant.The moreanti ens that match the better the


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The bone marrowtransplant team:

The group of specialistsinvolved in the care of patientsgoing through transplant isoften referred to as the"transplant team." Eachindividual works together to

provide the best chance for a


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The team consists of the following:

a. physicians

B. bone marrow transplant nurse coordinator

c. social workers

d. dietitians

e. physical therapists

f. pastoral care

g. other team members

pharmacists

respiratory therapists

lab technicians

infectious disease specialists

dermatologists


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Preparation for the recipient:

1. For a patient receiving the transplant, the followingwill occur in advance of the procedure:

2. Prior to the transplant, an extensive evaluation iscompleted by the bone marrow transplant team. All

other treatment options are discussed and evaluatedfor risk versus benefit.

3. A complete medical history and physicalexamination are performed, including multiple teststo evaluate the patient's blood and organ functions(i.e., heart, kidney, liver, lungs).

4. A patient will often come into the transplant center

up to 10 days prior to transplant for hydration,


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Preparation for the donor:1. Donor sources available include: self, sibling,parent or relative, non-related person, or umbilicalcord from a related or non-related person. There arenational and international registries for non-related

persons and cord blood. For family members, theymay be typed because of the desire to help. Theserelatives may or may not elect to have their typeregistered for use with other recipients.

2. If the potential donor is notified that they may be amatch for a patient needing a transplant, they willundergo additional tests. Tests related to their health,exposure to viruses, and complete genetic analysis

will be done to determine the extent of the match.


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How are the stem cellscollected?

A bone marrow transplant isdone by transferring stem cells

from one person to another.Stem cells can either becollected from the circulating

cells in the blood (the peripheralsystem) or from the bonemarrow.


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How are the stem cells

collected?a.) Peripheral blood stemcells (PBSCs)

b.) bone marrow harvest


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a.) peripheral blood stem cells(PBSCs)

Peripheral blood stem cells (PBSCs)

are collected by a apheresis, a process in which

the donor is connected to a special cell separation machinevia a needle inserted in the vein. Blood is taken from onevein and is circulated though the machine which removesthe stem cells and returns the remaining blood and plasmaback to the donor through another needle inserted into the

opposite arm. Several sessions may be required to collectenough stem cells to ensure a chance of successfulengraftment in the recipient.

A medication may be given to the donor for about

one week prior to apheresis that will stimulate the bonemarrow to increase roduction of new stem cells. These


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b.) bone marrow harvest

Bone marrow harvesting

involves collecting stem cells with a needleplaced into the soft center of the bone, the marrow.Most sites used for bone marrow harvesting arelocated in the hip bones and the sternum. Theprocedure takes place in the operating room. Thedonor will be anesthetized during the harvest and will

not feel the needle. In recovery, the donor mayexperience some pain in the areas where the needlewas inserted.


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The bone marrow

transplant procedure:

The preparations for a bone

marrow transplant vary depending onthe type of transplant, the diseaserequiring transplant, and your

tolerance for certain medications.Consider the following:


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a.) Most often, high doses of chemotherapy and/or radiationare included in the preparations. This intense therapy is

required to effectively treat the malignancy and make roomin the bone marrow for the new cells to grow. This therapyis often called ablative, or myeloablative, because of theeffect on the bone marrow. The bone marrow produces all

the blood cells in our body. Ablative therapy prevents thisprocess f cell production and the marrow becomes empty.An empty marrow is needed to make room for the new stemcells to grow and establish a new production system.


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b.) After the chemotherapy and/or radiation

is administered, the marrow transplant isgiven through the central venous catheterinto the bloodstream. It is not a surgicalprocedure to place the marrow into the

bone, but is similar to receiving a bloodtransfusion. The stem cells find their wayinto the bone marrow and begin reproducing

and establishing new, healthy blood cells.


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c.) Supportive care is given to

prevent and treat infections,side effects of treatments, andcomplications. This includes

frequent blood tests, closemonitoring of vital signs, strictmeasurement of input andoutput, daily weigh-ins, andproviding a protected and

sterile environment.


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During infusion of bonemarrow, the patient may

experience the following:

pain

chills fever hives

chest pain


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After infusion, the patient may:

spend several weeks in the hospital.be very susceptible to infection.Experience excessive bleeding.have blood transfusions.be confined to a sterile environment.

take multiple antibiotics and other medications.be given medication to prevent graft-versus-hostdisease - if the transplantation was allogeneic. Thetransplanted new cells (the graft), tend to attack thepatient's tissues (the host), even though the donor is

a relative, such as a brother, sister, or parent.undergo continual laboratory testing.experience nausea, vomiting, diarrhea, mouth sores,and extreme weakness.

experience temporary mental confusion andemotional or s cholo ical distress.

When does engraftment


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. When does engraftmentoccur?

Engraftment of the stem cells occurs whenthe donated cells make their way to themarrow and begin reproducing new bloodcells. Depending on the type of transplant

and the disease being treated, engraftmentusually occurs around day +15 or +30.Blood counts will be performed frequentlyduring the days following transplant to

evaluate initiation and progress ofengraftment. Platelets are generally thelast blood cell to recover.

Engraftment can be delayed because of

infection, medications, low donated stem

M What complications


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M. What complicationsand side effects may

occur following BMT?Complications may vary, depending on thefollowing:type of marrow transplant

type of disease requiring transplantpreparative regimen

age and overall health of the recipient

variance of tissue matching between donorand recipient

presence of severe complications

Th f ll i li ti th t ith b


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The following are complications that may occur with a bonemarrow transplantation. However, each individual may experiencesymptoms differently. These complications may also occur alone,or in combination:

infectionsInfections are likely in the patient withsevere bone marrow suppression. Bacterialinfections are the most common. Viral and

fungal infections can be life threatening.Any infection can cause an extendedhospital stay, prevent or delayengraftment, and/or cause permanent

organ damage. Antibiotics, anti-fungalmedications, and anti-viral medications areoften given to prevent serious infection inthe immunosuppressed patient.


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low platelets and low red blood cellsThrombocytopenia (low platelets) and

anemia (low red blood cells), as a result ofa non-functioning bone marrow, can be

dangerous and even life threatening. Lowplatelets can cause dangerous bleeding inthe lungs, gastrointestinal (GI), and brain.

pain

Pain related to mouth sores andgastrointestinal (GI) irritation is common.High doses of chemotherapy and radiationcan cause severe mucositis (inflammation

of the mouth and GI tract).


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fluid overloadFluid overload is a complication that canlead to pneumonia, liver damage, and highblood pressure. The primary reason for fluid

overload is because the kidneys cannotkeep up with the large amount of fluidbeing given in the form of intravenous (IV)medications, nutrition, and blood products.

The kidneys may also be damaged fromdisease, infection, chemotherapy,radiation, or antibiotics.

respiratory distress

Respiratory status is an important function


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organ damageThe liver and heart are important organs

that may be damaged during thetransplantation process. Temporary or

permanent damage to the liver and heartmay be caused by infection, graft-versus-host disease, high doses of chemotherapyand radiation, or fluid overload.

graft failureGraft failure is a potential complication.Graft failure may occur as a result ofinfection, recurrent disease, or if the stem

cell count of the donated marrow was


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graft-versus-host diseaseGraft-versus-host disease (GVHD) can be aserious and life-threatening complication ofa bone marrow transplant. GVHD occurs

when the donor's immune system reactsagainst the

recipient's tissue.

The new cells do not recognize the tissuesand organs of the recipient's body. Themost sites for GVHD are GI tract, liver,skin, and lungs.


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References:

http://www.umm.edu/blood/bonemarr.htm

http://www.cumc.columbia.edu/dept/medicine/
http://www.umm.edu/blood/bonemarr.htmhttp://www.cumc.columbia.edu/dept/medicine/bonemarrow/bmtinfo.htmlhttp://www.cumc.columbia.edu/dept/medicine/bonemarrow/bmtinfo.htmlhttp://www.umm.edu/blood/bonemarr.htm

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