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BONE MARROW TRANSPLANT or BLOOD STEM CELL TRANSPLANT

What are bone marrow and stem cells?

Bone marrow is the soft, sponge-like material found inside bones. It contains immature cells known as hematopoietic or blood-forming stem cells. (Hematopoietic stem cells are different from embryonic stem cells. Embryonic stem cells can develop into every type of cell in the body.) Hematopoietic stem cells divide to form more blood-forming stem cells, or they mature into one of three types of blood cells: White blood cells, which fight infection; red blood cells, which carry oxygen; and platelets, which help the blood to clot. Most hematopoietic stem cells are found in the bone marrow, but some cells, called peripheral blood stem cells (PBSCs), are found in the bloodstream. Blood in the umbilical cord also contains hematopoietic stem cells. Cells from any of these sources can be used in transplants.

Bone marrow transplantation (BMT) and peripheral blood stem cell transplantation (PBSCT)

 

Bone-marrow transplants prolong the life of patients. A bone marrow transplant delivers healthy bone marrow stem cells into the patient. It replaces bone marrow that is either not working properly or has been destroyed (ablated) by chemotherapy or radiation. The healthy, transplanted stem cells can restore the bone marrow`s ability to produce the blood cells the patient needs.

There are three types of transplants:

  • In autologous transplants, patients receive their own stem cells.
  • In syngeneic transplants, patients receive stem cells from their identical twin.
  • In allogeneic transplants, patients receive stem cells from their brother, sister, or parent. A person who is not related to the patient (an unrelated donor) also may be used.

Bone-marrow transplants are performed for:

  • Deficiencies in red blood cells (aplastic anemia) and white blood cells (leukemia or lymphoma)
  • Aggressive cancer treatments (chemotherapy or radiation therapy)
  • Inherited (genetic) diseases (such as thalassemia)
  • Immune-system disorders (such as congenital neutropenia and severe-combined immunodeficiency syndrome)

Procedure details for harvesting bone marrow for transplantation

Using either general anesthesia or local/regional anesthesia, needles are inserted through the skin over the pelvic (hip) bone and into the bone marrow of the donor to draw the marrow out of the bone. The bone marrow is filtered, treated, and transplanted immediately. Other times it`s frozen and stored for later use (cryopreservation). The bone marrow is then transfused through a vein (IV line). It naturally transports itself back into the intended bone cavities, where it grows quickly to replace the old bone marrow.

Procedure details for obtaining PBSCTs for transplantation

The stem cells used in PBSCT come from the bloodstream. A process called apheresis or leukapheresis is used to obtain PBSCs for transplantation. For 4 or 5 days before apheresis, the donor may be given a medication to increase the number of stem cells released into the bloodstream. In apheresis, blood is removed through a large vein in the arm or a central venous catheter (a flexible tube that is placed in a large vein in the neck, chest, or groin area). The blood goes through a machine that removes the stem cells. The blood is then returned to the donor and the collected cells are stored. Apheresis typically takes 4 to 6 hours. The stem cells are then frozen until they are given to the recipient. After being treated with high-dose anticancer drugs and/or radiation, the patient receives the stem cells through an intravenous (IV) line just like a blood transfusion. This part of the transplant takes 1 to 5 hours.

Use of BMT and PBSCT in cancer treatment

  • BMT and PBSCT make it possible for cancer patients to receive very high doses of chemotherapy and/or radiation therapy which can severely damage or destroy the patient`s bone marrow. BMT and PBSCT replace stem cells destroyed by treatment.
  • BMT and PBSCT are most commonly used in the treatment of leukemia and lymphoma.
  • BMT and PBSCT are also used to treat other cancers such as neuroblastoma (cancer that arises in immature nerve cells and affects mostly infants and children) and multiple myeloma.

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