Bone Marrow Transplants

Bone marrow is a spongy material inside your bones where your body makes and stores blood cells. When it’s damaged, it makes too few blood cells and not enough cells for your immune system.

A transplant replaces damaged bone marrow with healthy marrow cells. It can cure certain diseases or some types of cancer. It also means a long recovery process and a risk of serious side effects. If you’re thinking about having one, talk with your doctor about all the pros and cons of the transplant.

Who Needs a Bone Marrow Transplant?

Your bone marrow holds your body’s blood stem cells. They grow to become:

  • Red blood cells, which carry oxygen throughout your body
  • White blood cells, which help your immune system
  • Platelets, which let your blood clot

Certain types of cancer, such as leukemia, lymphoma, and multiple myeloma, can destroy your bone marrow. So can some cancer treatments, like high doses of chemotherapy or radiation.

A bone marrow transplant can help you if you have a severe form of aplastic anemia, a disease in which your body does not make enough red blood cells. It might also help with certain kinds of autoimmune diseases, in which your immune system attacks your body’s healthy tissues.

Before the Transplant

Your doctor will need to decide if a bone marrow transplant would work well for you. She’ll give you a physical exam and run tests to check your blood and how well your heart, lungs, liver, and other organs are working.

If a transplant seems like a good option, you’ll need a source of new blood stem cells that match yours. Doctors can get them from your body (called an autologous transplant), an identical twin or triplet (syngeneic transplant), or a donor (allogeneic transplant). Family members are usually good bone marrow matches, but doctors can also look for a donor in a national registry.

Donor registries match people who have the same type of protein on their white blood cells, called a human leukocyte antigen (HLA). Your HLA type is something that runs in your family. The chances of finding a match are better if two people are the same race or ethnicity.

Whether the blood stem cells for your transplant are coming from your body or a donor, doctors can take them in one of three ways:

  • Directly from the bone marrow with a needle, usually placed in the hip bone or breastbone
  • From your or your donor’s blood
  • From the blood in the umbilical cord after a baby is born

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The Transplant Process

A few days before your transplant, you’ll visit the hospital and get a tube called a central venous catheter placed into a vein in your chest. You may also get a high dose of chemotherapy, maybe with radiation, for about 10 days. The process treats your cancer (if you have it) and makes room for new cells to grow in the marrow. It also briefly weakens your immune system to keep your body from fighting the new cells.

During the transplant, you’ll get new blood stem cells through the central venous catheter. You’ll probably be awake for this, but it shouldn’t hurt.

Once the new cells are in your blood, they’ll travel to your bone marrow. There, they’ll grow into red and white blood cells and platelets. This process, called engraftment, can take 2 to 4 weeks.

After Your Transplant

The recovery process is different for everyone, but you’ll probably spend several weeks or months in the hospital after a bone marrow transplant. Your immune system will be weak, so you’ll take medicines to prevent infections. You may also need blood transfusions.

For the first few weeks, your doctors will test your blood often to check for engraftment. They might also take a small sample of your bone marrow for this.

If you get a transplant from a donor, you’ll have to look for symptoms of graft-vs-host disease, when the new cells attack your own. Symptoms include:

Graft-vs-host disease can become a long-lasting condition. If it does, you may have:

Your immune system can take a year or longer to recover after your transplant. You’ll need to keep taking medications and make a lot of visits to the doctor. You probably won’t be able to return to work or other activities for a while.

The success of a bone marrow transplant depends on a lot of things, like the type of procedure you had, how it affects your disease, your age, and how healthy you are overall. Still, the therapy has cured thousands of people of cancer. Doctors are also finding new ways to make it better.

WebMD Medical Reference Reviewed by David T. Derrer, MD on August 25, 2014

Sources

SOURCES:

Health Resources and Services Administration: “Understanding Transplantation as a Treatment Option.”

American Cancer Society: “Why Would Someone Need a Stem Cell Transplant?” “The Transplant Process,” “What Are Stem Cells and Why Are They Transplanted?”

Johns Hopkins Medicine: “Bone Marrow Transplantation.”

Be the Match: “How A Bone Marrow Transplant Works,” “HLA Matching,” “Graft-Versus-Host Disease,” “Infection Prevention.”

National Cancer Institute: “Bone Marrow Transplantation and Peripheral Blood Stem Cell Transplantation.”

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