Table of contents:
- Indications for Bone Marrow Transplant
- Before Bone Marrow Transplant
- Bone Marrow Transplant Procedure
- After Bone Marrow Transplant
- Bone Marrow Transplant Complications
Bone marrow transplant is a procedure to renew bone marrow that is damaged and no longer able to produce he althy blood cells. Bone marrow transplant is also known as stem cell or stem cell transplant
Bone marrow is a tissue found in some bones, such as the pelvis and femur. This bone marrow functions to produce red blood cells (erythrocytes), white blood cells (leukocytes), and platelets (platelets).
Bone marrow can be damaged by diseases, such as cancer and infections, or by cancer treatments, such as chemotherapy and radiotherapy. Damaged bone marrow can interfere with the production of blood cells. The blood cells produced by the damaged bone marrow may also be unhe althy or not functioning normally.
Bone marrow transplant aims to restore the function of damaged bone marrow. This procedure is done by inserting he althy stem cells into the patient's body. These he althy stem cells will then develop and produce he althy blood cells.
Indications for Bone Marrow Transplant
Bone marrow transplantation is performed to treat disorders in bone marrow function that can be caused by the following diseases:
- Aplastic anemia
- Primary amyloidosis
- Sickle cell anemia
- Congenital neutropenia
- metabolic disorders
- Immune system disorders
- Multiple myeloma
- POEMS syndrome
- myelodysplastic syndrome
- Wiskott-Aldrich Syndrome
In addition to the above conditions, bone marrow transplantation can also be performed to replace bone marrow damaged by chemotherapy and radiotherapy.
Before Bone Marrow Transplant
Before undergoing a bone marrow transplant, there are several things that patients need to know and live by, namely:
Procedures before transplant
The doctor will explain about the process, side effects, and risks that may occur after a bone marrow transplant. After that, the doctor will perform a series of tests to assess whether the patient is he althy and suitable for a bone marrow transplant procedure. The series of tests include:
- Overall medical history and physical examination
- Checking the patient's emotional and psychological condition
- Cardiac examination, such as ECG (electrocardiography) and echocardiography
- Lung examination, such as chest X-ray and spirometry
- Blood test, which includes complete blood count, blood chemistry, and screening for viruses in the blood
- Scan with CT scan or MRI
- HLA (human leukocyte antigen) tissue typing, which is an examination to determine whether the donor's bone marrow will match the prospective donor recipient
- Bone marrow biopsy
After all the above examinations are completed and the patient is declared ready for a bone marrow transplant, the doctor will continue the preparation process by inserting a catheter into a vein in the neck or chest.
The catheter is used to insert blood stem cells and drugs. During treatment, the catheter will remain in the patient's body.
Blood stem cell collection
Stem cell collection can be done autologous (from the patient's own body) or allogeneic (from the donor's body). Here is the explanation:
Autologous bone marrow transplant
In autologous bone marrow transplant, the doctor will perform the apheresis procedure.
The apheresis procedure is done by giving stem cell production stimulant drugs. After the number of stem cells is sufficient, the patient's blood vessels will be connected to a machine that will filter and separate the stem cells from other blood components.The filtered stem cells will be frozen for use in the transplant procedure, while the separated blood will flow back into the patient's body.
Allogeneic bone marrow transplant
In an allogeneic bone marrow transplant, the doctor will take stem cells from donor blood or bone marrow.
Before the stem cell collection is carried out, the donor must first undergo a test to determine whether his stem cells match the patient's. Usually, the preferred donor is from the patient's family or close relatives.
In addition to blood or bone marrow, doctors can also take stem cells from the umbilical cord of newborns. Blood from the umbilical cord is generally still immature, so the risk of incompatibility with the patient is smaller.
In this process, the patient will undergo chemotherapy or radiotherapy. Depending on the patient's condition, the doctor may only administer one or both types of therapy at the same time.
The adjustment process with chemotherapy and radiotherapy aims to:
- Preparing bone marrow for new stem cells
- Suppress the immune system
- Destroy cancer cells
This process takes 5-10 days. During this stage, patients may experience side effects, such as hair loss, diarrhea, nausea, and vomiting. However, the doctor will give medicine to relieve these side effects.
After the adjustment process is complete, the patient will be asked to rest for a few days before undergoing the transplant process.
Bone Marrow Transplant Procedure
Before starting the bone marrow transplant process, the doctor will give the patient medicines through an IV. This drug is useful for reducing the risk of side effects from preservatives used in the stem cell clotting process.
Furthermore, the frozen stem cells will be thawed by heating. After the stem cells are liquid, the doctor will insert the stem cells through the catheter in the vein that was previously installed.
During the transplant process, the patient remains conscious and does not feel pain.
New stem cells that enter the patient's body will go to the bone marrow and will begin to multiply to produce he althy blood cells. This process can take 10–28 days after transplantation, which is characterized by an increase in the white blood cell count.
The time it takes for the blood cell count to return to normal depends on the patient's condition and the type of transplant being undertaken. However, the blood cell count will usually return to normal in 2–6 weeks.
After Bone Marrow Transplant
After the bone marrow transplant is complete, the doctor will monitor the patient's condition. If infection or other complications occur, the patient must be hospitalized in the hospital, until the patient's condition is confirmed to improve.
During the first few weeks after the transplant, the doctor will periodically transfuse red blood cells and platelets, until the new bone marrow can produce enough blood cells. Doctors can also prescribe medicines, such as:
- Antibiotics, antivirals or antifungals, to prevent infection
- Immune system-suppressing drugs, to prevent graft-versus-host disease
After undergoing the recovery process at the hospital, patients are allowed to go home if they meet the following conditions:
- No fever for 48 hours
- Can eat and drink by mouth for at least 48 hours
- Nausea, vomiting and diarrhea can be controlled with medication
- The number of blood cells has increased and is considered no longer dangerous
- Having family or other people to help the patient's needs at home
The recovery process after a bone marrow transplant can take up to 3 months. However, the patient may take up to 1 year to fully recover. Several factors that affect the length of the patient's recovery process are:
- Genetic match between donor and recipient
- Intensity of radiotherapy or chemotherapy received by the patient
- General he alth condition of the patient
Bone Marrow Transplant Complications
Each patient may experience different side effects after undergoing a bone marrow transplant. Some patients may experience only fever, nausea, pain, and headache. However, in some cases, patients can also experience serious complications, such as:
- Early menopause
- Internal organ bleeding
- The growth of new cancer cells
- Graft-versus-host disease
- Transplant failure
- Organ damage