Bone Marrow or Stem Cell Transplant

What is a bone marrow or stem cell transplant?

A bone marrow transplant (BMT) or peripheral blood stem cell transplant (PBSCT) is a treatment for certain types of cancer and bone marrow disorders. Bone marrow is spongy tissue in the center of many bones. It produces red blood cells, white blood cells, and platelets. Red blood cells carry oxygen from the lungs and distribute this oxygen to the rest of the body. White blood cells fight infections. Platelets are necessary for blood to clot.

Stem cells are young blood cells in the bone marrow that can become red blood cells, white blood cells, or platelets. Most bone marrow stem cells are in the marrow, but some circulate in the bloodstream. Blood in the human newborn umbilical cord also contains stem cells. Stem cells can be obtained from any of these sources for use in transplants.

When is it used?

A bone marrow or stem cell transplant may be done to:

• help your body make more blood cells
• help your body fight disease
• replace diseased or destroyed bone marrow with normal bone marrow.

A common reason for the use of stem cell transplants in cancer treatment is to make it possible for you to have very high doses of chemotherapy or total-body radiation therapy. These treatments destroy cancer cells throughout the body, but they also destroy normal bone marrow and stem cells. A stem cell transplant right after high-dose chemotherapy and radiation helps your body have healthy bone marrow again. The transplanted cells go to the bone marrow and become the new stem cells, replacing the stem cells that were destroyed by treatment. Your body can then make the blood cells you need.

Stem cell transplants are most often used in the treatment of 3 types of cancer: leukemia, myeloma, and lymphoma. Stem cell transplants are also used to treat other cancers, such as testicular cancer. Researchers are studying stem cell transplants to see if they will help with other diseases.

How do I prepare for this procedure?

Follow all of the instructions provided by your healthcare provider. If you need to take a medicine before donating stem cells, take the medicine exactly as prescribed. If you are to have general anesthesia for the collection of bone marrow cells, eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

Plan for your care and recovery after the procedure, especially if you are to have general anesthesia. Arrange to have someone take you home and stay with you for a while after the procedure. Allow for time to rest. Try to find people to help you with your daily duties for 24 hours after the procedure

What happens during the procedure?

First the bone marrow or stem cells must be collected, which is called harvesting. You may be able to donate your own bone marrow or stem cells; in this case, you are your own donor. Or someone else may donate cells that you will then receive as a transplant.

If you are going to use your own marrow as a transplant, the marrow is harvested before you have chemotherapy or radiation treatment. The marrow is usually collected from the hipbones with a needle. This is done under regional or general anesthesia at the hospital. A regional anesthetic numbs part of your body, preventing you from feeling pain while you remain awake. A general anesthetic puts you to sleep and prevents you from feeling pain while some of the marrow is removed. The procedure for harvesting the marrow takes about an hour.

Stem cells may be harvested from the blood rather than the hipbone. This is called a peripheral blood stem cell transplant. The stem cells can be collected from a donor or from your own blood before you have chemotherapy or radiation therapy. Before the stem cells are collected from your blood, you may be given medicine for a few days to stimulate the production and release of stem cells from the marrow into the bloodstream. This increases the number of stem cells that can be harvested from the blood. The blood is obtained through a large vein in your arm or through a tube placed in a vein in your neck, chest, or groin. The blood goes through a machine that removes the stem cells. The blood is then returned to the donor and the cells that were removed from the blood are stored. The collection of the stem cells from the blood takes about 4 to 6 hours. It can be done at an outpatient clinic. Stem cells can be frozen until they are needed.

When it is time for the transplant, the bone marrow or stem cells are given through a vein (IV), like a blood transfusion. The transplant takes 1 to 5 hours.

What happens after the procedure?

After you donate bone marrow, the area where the marrow was taken out may feel stiff or sore for a few days, and you may feel tired. Within a few weeks, your body will replace the donated marrow. Some people are back to their usual routine within 2 or 3 days, but others may need 3 to 4 weeks to fully recover their strength.

If you donated stem cells from your blood, you may have some side effects from the medicine used to stimulate the release of stem cells from the marrow into the bloodstream. Possible side effects include bone and muscle aches, headaches, fatigue, nausea, vomiting, and trouble sleeping. These side effects generally go away in 2 to 3 days after the last dose of the medicine.

When you are given a transplant, the stem cells will travel to the bone marrow inside your bones. The cells will begin to make new, healthy blood cells in 2 to 4 weeks. Until the stem cells start to produce new blood cells, you will have a higher risk for infection and bleeding. You may also have a reaction to the transplanted cells. During this time, precautions are taken to prevent infections until your bone marrow can produce enough white blood cells. You may be given platelets to control any bleeding and antibiotics to prevent or treat infection. You may also be given transfusions of red blood cells to treat anemia.

After the transplant, you will have frequent blood tests to see how well your bone marrow is making new blood cells. You may also have a test called bone marrow aspiration, which is the removal of a small sample of bone marrow through a needle for examination under a microscope. This helps your provider see how well your bone marrow is producing new cells and platelets.

Although your body will start making new blood cells in 2 to 4 weeks, it will take much longer for your immune system to completely recover. It could take up to several months if your own stem cells are used and 1 to 2 years if the stem cells were donated by someone else.

What are the benefits of this procedure?

When used as a part of the treatment for cancer or other diseases, a stem cell transplant makes it possible for you to receive very high doses of chemotherapy or radiation therapy. The transplant can restore your ability to make new, healthy blood cells and to fight disease.

What are the risks associated with this procedure?

When you donate bone marrow, there are usually no serious risks other than the risks of the general or regional anesthesia used during the procedure. You should discuss the risks of anesthesia with your healthcare provider. There is no risk from anesthesia when stem cells are harvested from the blood because anesthesia is not needed.

When you receive a stem cell transplant:

• It may be harder for your body to fight infections and bleeding because of chemotherapy or radiation treatments you may have had just before the transplant. You may have short-term side effects such as nausea, vomiting, fatigue, loss of appetite, mouth sores, hair loss, and skin reactions.
• When you receive cells from another person, a complication known as graft-versus-host disease (GVHD) sometimes develops. GVHD occurs when white blood cells from the donor attack your cells. This can damage some parts of your body, such as the skin, liver, and intestines. It may happen within a few weeks of the transplant or much later. To help prevent this complication, the tissue type of cells from a donor need to closely match your tissue type. You may be given medicines that suppress the immune system to help prevent GVHD. Also, before the transplant, the donated stem cells can be treated to remove the white blood cells that cause GVHD. GVHD can be hard to treat, but some studies suggest that people who have leukemia and develop GVHD are less likely to have the disease come back.
• When you receive cells from another person, the stem cells may die or be destroyed by your immune system before they can settle into your bone marrow.
• When you receive cells from another person, there is a small risk of infection from the donated cells.
• If you use your own cells for the transplant after treatment for cancer, there may be cancer cells among the transplanted stem cells. Sometimes the harvested cells can be treated first to reduce the number of cancerous cells that may be present. This is called purging.

You should ask your healthcare provider how these risks apply to you.

When should I call my healthcare provider?

Call your provider right away if:

• You have any signs of infection, such as fever, chills, or sweats.
• You have any bleeding.

For more information about bone marrow transplants, contact:

• The Leukemia & Lymphoma Society
  Phone: 800-955-4572
  Web site: http://www.leukemia-lymphoma.org.
• The National Cancer Institute
  Phone: 800-4-CANCER
  Web site: http://www.cancer.gov.
• The American Cancer Society
  Phone: 800-ACS-2345
  Web site: http://www.cancer.org.
• The National Marrow Donor Program (NMDP)
  - Phone: 800-627-7692 (800-MARROW2)
  - Web site: http://www.marrow.org

  The National Marrow Donor Program is a federally funded nonprofit organization that was created to improve the effectiveness of the search for donors.