To understand what a bone marrow transplant is really like, it might help to think of it like a blood transfusion: damaged or cancer-filled bone marrow is replaced with healthy bone marrow cells.
If the healthy cells come from your own bone marrow, it’s an autologous transplant. If they come from someone else (a donor), it’s an allogeneic one.
Either way, there are three basic steps:
- Collect healthy stem cells.
- Get your body ready to receive them (conditioning).
- Put the new cells into your body.
The steps may be done in a hospital, outpatient clinic, or mix of the two.
Collect Stem Cells
You can get healthy stem cells from three places:
Blood. This is the most common one. If you’re using your own cells, you first take a drug called growth factor to boost your stem cell count.
When it’s time to collect the cells, your medical team will take your blood out of one arm through a thin tube and flow it into a machine that filters out your stem cells. The rest of your blood goes out of the machine and back in through your other arm.
You’re awake the whole time, and it takes about 2 to 3 hours. It doesn’t hurt, and you won’t need to stay in the hospital. But you may need to do this a few times to get enough cells.
Your stem cells are then frozen and stored until you need them.
If you’re getting bone marrow from someone else, your donor goes through the same process. But these cells won’t be frozen because you’ll get them as soon as possible.
Bone marrow. For this, your doctor uses a needle to get bone marrow from different parts of your hipbone. It takes 1 to 2 hours, and you’ll take medicine to help you sleep through it. Afterward, you’ll have large bandages over your hips that will need to stay on for 24 hours, and you can expect to be a little sore for a few days.
Your doctor will also take some red blood cells in the process. You’ll get those back through an IV (a thin tube that goes into your arm or hand) as you recover.
Again, your own cells will be frozen until you’re ready for them. A donor goes through the same steps, but you get those cells within a day.
Cord blood. In some cases, the stem cells come from the placenta and umbilical cord of a newborn baby. The mother decides ahead of time if she wants to donate them, and the baby isn’t affected in any way. If so, they’re frozen until someone needs them.
When it’s almost time for you to get the new cells, you’ll have chemotherapy. You might also have radiation therapy, depending on the type of transplant you’re having, your illness, and your overall health.
This is called conditioning, and it’s done to:
- Clear out space in your bone marrow for new stem cells
- Turn your immune system way down to lower the chances that your body will reject the new cells
- Kill any cancer cells, if that’s what you’re being treated for
The process could take up to a week. If you need radiation, you might have only one session, or it might be split out over a few days.
Within a couple days of conditioning, you’re ready for the final step. You’ll get your new stem cells through a thin tube that goes into a vein in your chest, called a central line. It’ll take a couple of hours. You’ll be awake and won’t feel any pain.
The new stem cells find their way to your bone marrow. It will take several weeks for your blood cell counts to climb back to normal.
Stem cells that were frozen have a preservative in them that can cause side effects. If you use those, you’ll also get medicine to help with any problems, and you may get extra fluids to flush the preservative out of your body.
Generally, most side effects during the transplant are minor, and many come from the preservative. They may include:
- Chest pain
- Fever and chills
- Shortness of breath
- Taste of garlic or creamed corn in your mouth
Recovery: What to Expect Early On
While you’re in the hospital, you’ll be in a special room to help keep you from getting any infections. Anyone who visits you will have to wash their hands and wear a mask and gloves.
Side effects. These can start to show up in the first few days after the transplant, many of them from conditioning. Not only does it wipe out your bone marrow, but chemo and radiation also can be tough on your body.
Common issues include:
- Bleeding problems, such as nosebleeds
- Graft-versus-host disease (GVHD), where the new stem cells treat your body like a germ they need to attack. This can only happen if you get cells from a donor.
- Sores in your mouth
- Stomach upset and throwing up
- Feeling tired and rundown
Care and support. Your doctors and nurses will keep a close watch on you as you recover. You may need:
- Blood transfusions to boost your blood cell counts
- Drugs that dial down your immune system and help prevent GVHD
- Lab tests
- Medicine to fight infections
- Meds to help with side effects
From anger to joy, you might find that your emotions are all over the place. That’s normal but not necessarily easy to deal with. Talk to your doctor, family, and friends about getting support for your mental health, too.