WHAT IS BONE MARROW?
Bone marrow is a spongy tissue found inside bones. The bone marrow in the breast bone, skull, hips, ribs and spine contains stem cells that produce the body’s blood cells. This is where the blood cells (RBC’s, platelets and WBC’s) are produced where they develop. These blood cells include white blood cells (leukocytes), which fight infection; red blood cells (erythrocytes), which carry oxygen, to and remove waste products from organs and tissues; and platelets, which enable the blood to clot. Each of these carries a life maintaining function. The bone marrow is a vital part of the human body.
Every type of blood cell in the bone marrow begins as a stem cell. Stem cells are immature cells that are able to produce other blood cells that mature and function as needed.
Stem cells are the most important cells needed in a bone marrow transplant. Stem cells, when transplanted, find their way to the recipient’s marrow and begin to differentiate and produce all types of blood cells that are needed by the body.
Bone marrow transplantation is used in a treatment of hereditary blood disease, hereditary metabolic disease, hereditary immune deficiencies and various forms of cancer such as leukemia, lymphomas and myelomas that affect the bone marrow.
You may have a bone marrow transplant if:
- Cancer is in remission(the symptoms go away and the disease is under control but not necessarily cured)
- Cancer relapses(returns)after initial treatment
- Cancer has not responded to other treatment
TYPES OF BONE MARROW TRANSPLANT
The stem cells are collected from the blood or bone marrow of a related (brother or sister) or unrelated donor.
The stem cells are collected from the blood or bone marrow of the patient prior to high-dose therapy and are stored until time of transplant.
The stem cells are collected from the blood or bone marrow of an identical twin.
PROCEDURE OF BONE MARROW TRANSPLANT
Bone marrow transplant patients are usually treated in specialized centers and the patient stays in a special nursing unit (a bone marrow transplant unit) to limit exposure to infections. The hospitalisation period is from 4 to 6 weeks, during which time the patient is isolated and under strict monitoring because of the increased risk of infection and/or bleeding.
Donated bone marrow must match the patient’s tissue type. It can be taken from the patient, a living relative (usually a brother or a sister), or from an unrelated donor. Donors are matched through special blood tests called HLA tissue typing.
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Bone marrow is taken from the donor in the operating room while one is unconscious and pain-free (under general anaesthesia). Some of the donor’s bone marrow is removed from the top of the hip bone. The bone marrow is filtered, treated, and transplanted immediately or frozen and stored for later use. Then, transplant material is transfused into the patient through a vein and is naturally transported back into the bone cavities where it grows to replace the old bone marrow.
Alternatively, blood cell precursors, called stem cells, can be induced to move from the bone marrow to the blood stream using special medications. These stem cells can then be taken from the bloodstream through a procedure called leukapheresis.
The patient is prepared for transplantation by administering high doses of chemotherapy or radiation (conditioning). This serves two purposes. First, it destroys the patient’s abnormal blood cells or cancer. Second, it inhibits the patient’s immune response against the donor bone marrow (graft rejection).
Following conditioning, the patient is ready for bone marrow infusion. After infusion, it takes 10 to 20 days for the bone marrow to establish itself. During this time, the patient requires support with blood cell transfusions.
RISKS OF BONE MARROW TRANSPLANTATION
There are many very serious risks and side effects to a bone marrow transplant. These include:
- Serious bleeding
- Liver problems
- Skin rash
- Infertility or sterility
- Muscle spasms
- Leg cramps
- Numbness in your arms and legs
- Secondary cancers — the transplant procedure increases the risk of developing another cancer.
Another possible problem is that cells from a donor might not match your cells well enough and the new cells can begin attacking your cells. This is called graft versus host disease. This can be a serious problem, but it also can help to cure the cancer because the new cells also will attack any cancer cells that are left.
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