What is Bone Marrow?

Bone marrow is a spongy tissue found inside the bones and contains cells defined as hematopoietic or blood-forming stem cells. Bone marrow stem cells multiply and differentiate when necessary to form blood cells.

What is Bone Marrow Transplantation?

The cells responsible for blood production in the human organism are stem cells in the bone marrow. Transplantation of cells with these highly specialized functions is generally referred to as 'bone marrow transplant'.

How is Bone Marrow Transplantation performed?

A bone marrow transplant is a procedure that implants healthy blood-making stem cells into the body to replace damaged or diseased bone marrow. In cases where the bone marrow is not functioning or cannot produce enough healthy blood cells, a bone marrow transplant is required. Bone marrow transplants are of two types, autologous and allogeneic. Transplants using cells from the patient’s body itself are called autologous, and transplants from a donor are called allogeneic transplants.

Autologous Bone Marrow Transplant

Autologous bone marrow transplant uses healthy blood stem cells in the body to replace diseased or damaged bone marrow. During a stem cell transplant, using cells from one's own body has some advantages over using stem cells from someone else. For example; In autologous stem cell transplants, there is no incompatibility problem between the transplanted cells and the body's own cells.

Autologous bone marrow transplant may be an option only if the body is producing enough healthy bone marrow cells. These cells can be harvested, frozen and stored for later use. Autologous stem cell transplants are often used in people who need high doses of chemotherapy and radiation. Autologous stem cell transplant helps replace damaged bone marrow.

Autologous stem cell transplants are mostly used to treat the following conditions:

· Hodgkin lymphoma

· Myeloma

· Non-Hodgkin lymphoma

· Plasma cell disorders

Allogeneic Bone Marrow Transplant

Allogeneic bone marrow transplant uses healthy “blood stem cells” from a donor to replace diseased or damaged bone marrow. Allogeneic stem cell transplant is also called allogeneic bone marrow transplant.

Donor; It could be a family member, acquaintance or stranger. Cells used in allogeneic stem cell transplantation can be collected from different sites such as:

· From the donor's blood

· From the bone marrow in the donor's hip bone

· From donated umbilical cord blood

Before an allogeneic stem cell transplant is performed, high doses of chemotherapy or radiation therapy are taken to destroy diseased cells and prepare the body for donor cells. An allogeneic stem cell transplant may be an option for people with a variety of diseases, including:

· Acute leukemia

· Adrenoleukodystrophy

· Extreme anemia

· Bone marrow failure syndromes

· Chronic leukemia

· Hemoglobinopathies

· Hodgkin lymphoma

· Immune deficiencies

· Inborn errors of metabolism

· Multiple myeloma

· Myelodysplastic syndromes

· Neuroblastoma

· Non-Hodgkin lymphoma

· Plasma cell disorders

· POEMS syndrome

· Primary amyloidosis

What are the risks of Bone Marrow Transplantation?

Bone marrow (stem cell) transplantation may take a long time for the immune system to be in order and for the production of healthy new blood cells. Immune recovery after transplantation depends on many variables. For example, immune recovery may take up to five years, depending on the stem cell source used, immune suppressive interventions, various problems that develop, and cell subtypes that can recover at different times. Patients who have had a bone marrow transplant are at risk of infection during this time and should take precautions. Also a decrease in the number of blood cells may cause anemia, excessive bleeding, bruising on the body and an increased risk of infection. Some patients may require a blood transfusion for a period of time.

Possible complications associated with a bone marrow transplant include:

· Graft-versus-host disease (allogeneic transplant only)

· Stem cell (graft) error

· Organ damage

· Infections

· Cataract

· Infertility

· New cancers

What happens during a bone marrow transplant?

On the day of transplantation, stem cells are given to the body through the catheter. The transplant is painless and the patient is not put to sleep during the procedure.

What is done before Bone Marrow Transplantation?

You will undergo a series of tests and procedures to assess your overall health and condition, and to ensure that you are physically ready for the transplant. Evaluation may take several days or longer. In addition to these, a surgeon or radiologist inserts a long thin tube (intravenous catheter) into a large vein in your chest or neck. The catheter, often called the central line, stays in place for the duration of your treatment in most cases. Your transplant team will use the centerline to infuse transplanted stem cells, drugs, and blood products into your body.

What should be considered after Bone Marrow Transplantation?

If the bone marrow transplant uses stem cells from a donor (allogeneic transplant), doctors may prescribe drugs that reduce the immune system's reaction (immunosuppressive drugs) to prevent Graft-versus-Host Disease (GVHD). It takes time for the immune system to recover after a transplant. During this time, medications may also be given to prevent infections.

After a bone marrow transplant, dietary adjustments may be necessary to stay healthy and prevent excessive weight gain. The nutritionist (dietician) and other members of the transplant team work with the patient to create a healthy eating plan that meets their needs and complements their lifestyle. Some of the recommendations may include:

· Following food safety instructions to prevent foodborne infections

· Eating a wide variety of healthy foods, including vegetables; fruits; whole grains; lean meat, poultry and fish; legumes; and healthy fats such as olive oil

· Limiting salt intake

· Limiting alcohol

· Avoiding grapefruit and grapefruit juice because of their effects on a group of immunosuppressive drugs (calcineurin inhibitors)

· Regular physical activity after bone marrow transplant; It helps control weight, strengthen bones, increase endurance, strengthen muscles and keep the heart healthy.

· It is even more important to take steps to prevent cancer after a transplant. It is necessary not to smoke, to use sunscreen when outside and to have cancer screenings recommended by the doctor.