Bone Marrow Transplant

What is Bone Marrow Transplant?

A bone marrow transplant is a procedure to replace damaged or destroyed bone marrow with healthy bone marrow stem cells.

What is Bone Marrow?

Bone marrow is the soft, fatty tissue inside your bones. The bone marrow produces blood cells. Stem cells are immature cells in the bone marrow that give rise to all of your different blood cells.

What is done before Bone Marrow Transplant?

Before the transplant, chemotherapy, radiation, or both may be given. This may be done in two ways:

• Ablative (myeloablative) treatment – High-dose chemotherapy, radiation, or both are given to kill any cancer cells. This also kills all healthy bone marrow that remains and allows new stem cells to grow in the bone marrow.
• Reduced-intensity treatment also called a mini transplant – Lower doses of chemotherapy and radiation are given before a transplant. This allows older people, and those with other health problems to have a transplant.

What are the types of Bone Marrow Transplant?

There are three kinds of bone marrow transplants:

• Autologous bone marrow transplant — The term auto means self. Stem cells are removed from you before you receive high-dose chemotherapy or radiation treatment. The stem cells are stored in a freezer. After high-dose chemotherapy or radiation treatments, your stems cells are put back in your body to make normal blood cells. This is called a rescue transplant.
• Allogeneic bone marrow transplant — The term allo means other. Stem cells are removed from another person, called a donor. Most times, the donor’s genes must at least partly match your genes. Special tests are done to see if a donor is a good match for you. A brother or sister is most likely to be a good match. Sometimes parents, children, and other relatives are good matches. Donors who are not related to you, yet still match, may be found through national bone marrow registries.
• Umbilical cord blood transplant — This is a type of allogeneic transplant. Stem cells are removed from a newborn baby’s umbilical cord right after birth. The stem cells are frozen and stored until they are needed for a transplant. Umbilical cord blood cells are very immature so there is less of a need for perfect matching. Due to the smaller number of stem cells, blood counts take much longer to recover.

A stem cell transplant is usually done after chemotherapy and radiation is complete. The stem cells are delivered into your bloodstream, usually through a tube called a central venous catheter. The process is similar to getting a blood transfusion. The stem cells travel through the blood into the bone marrow. Most times, no surgery is needed.

How Donor Stem Cells are collected?

Donor stem cells can be collected in two ways:

• Bone marrow harvest — This minor surgery is done under general anaesthesia. This means the donor will be asleep and pain-free during the procedure. The bone marrow is removed from the back of both hip bones. The amount of marrow removed depends on the weight of the person who is receiving it.
• Leukapheresis — First, the donor is given several days of shots to help stem cells move from the bone marrow into the blood. During leukapheresis, blood is removed from the donor through an IV line. The part of white blood cells that contains stem cells is then separated in a machine and removed to be later given to the recipient. The red blood cells are returned to the donor.

Why the Bone Marrow Transplant is done?

A bone marrow transplant replaces bone marrow that is either not working properly or has been destroyed (ablated) by chemotherapy or radiation. Doctors believe that for many cancers, the donor’s white blood cells may attack any remaining cancer cells, similar to when white cells attack bacteria or viruses when fighting an infection.

Your health care provider may recommend a bone marrow transplant if you have:

• Certain cancers, such as leukaemia, lymphoma, myelodysplasia, or multiple myeloma.
• A disease that affects the production of bone marrow cells, such as aplastic anaemia, congenital neutropenia, severe immune system illnesses, sickle cell anaemia, or thalassemia.

What are the risks and complications associated with Bone Marrow Transplant?

A bone marrow transplant may cause the following symptoms:

• Chest pain
• Drop in blood pressure
• Fever, chills, flushing
• Funny taste in the mouth
• Headache
• Hives
• Nausea
• Pain
• Shortness of breath

Possible complications of a bone marrow transplant depend on many things, including:

• Your age
• Your overall health
• How good of a match your donor was
• The type of bone marrow transplant you received (autologous, allogeneic, or umbilical cord blood)

Complications may include:

• Anaemia
• Bleeding in the lungs, intestines, brain, and other areas of the body
• Cataracts
• Clotting in the small veins of the liver
• Damage to the kidneys, liver, lungs, and heart
• Delayed growth in children who receive a bone marrow transplant
• Early menopause
• Graft failure, which means that the new cells do not settle into the body and start producing stem cells
• Graft-versus-host disease (GVHD), a condition in which the donor cells attack your own body
• Infections, which can be very serious
• Inflammation and soreness in the mouth, throat, oesophagus, and stomach, called mucositis
• Pain
• Stomach problems, including diarrhoea, nausea, and vomiting

What you have to do before the Procedure?

Your provider will ask about your medical history and do a physical exam. You will have many tests before treatment begins.

Before the transplant, you will have 1 or 2 tubes, called central venous catheters, inserted into a blood vessel in your neck or arms. This tube allows you to receive treatments, fluids, and sometimes nutrition. It is also used to draw blood.

Your provider will likely discuss the emotional stress of having a bone marrow transplant. You may want to meet with a counsellor. It is important to talk to your family and children to help them understand what to expect.

You will need to make plans to help you prepare for the procedure and handle tasks after your transplant:

• Complete an advance care directive
• Arrange medical leave from work
• Take care of bank or financial statements
• Arrange care of pets
• Arrange for someone to help with household chores
• Confirm health insurance coverage
• Pay bills
• Arrange for care of your children
• Find housing for yourself or your family near the hospital, if needed

What is done After the Procedure?

A bone marrow transplant is usually done in a hospital or medical center that specializes in such treatment. Most of the time, you stay in a special bone marrow transplant unit in the center. This is to limit your chance of getting an infection.

Depending on the treatment and where it is done, all or part of an autologous or allogeneic transplant may be done as an outpatient. This means you do not have to stay in the hospital overnight.

How long you stay in the hospital depends on:

• Whether you developed any complications related to the transplant
• The type of transplant
• Your medical center’s procedures

While you are in the hospital:

• The health care team will closely monitor your blood count and vital signs.
• You will receive medicines to prevent GVHD and prevent or treat infections, including antibiotics, antifungals, and antiviral medicine.
• You will likely need many blood transfusions.
• Feeding will be done through a vein (IV) until you can eat by mouth, and stomach side effects and mouth sores have gone away.

After you leave the hospital, be sure to follow instructions on how to care for yourself at home.

How well you do after the Bone Marrow Transplant?

depends on:

• The type of bone marrow transplant
• How well the donor’s cells match yours
• What type of cancer or illness you have
• Your age and overall health
• The type and dosage of chemotherapy or radiation therapy you had before your transplant
• Any complications you may have

A bone marrow transplant may completely or partially cure your illness. If the transplant is a success, you can go back to most of your normal activities as soon as you feel well enough. Usually, it takes up to 1 year to recover fully, depending on what complications occur.

Complications or failure of the bone marrow transplant can lead to death.

What to Expect at Home?

It will take 6 months or more for your blood counts and immune system to fully recover. During this time, your risk for infection, bleeding, and skin problems are higher.

Your body is still weak. It may take up to a year to feel like you did before your transplant. You will likely get tired very easily. You may also have a poor appetite.

If you received bone marrow from someone else, you may develop signs of graft-versus-host disease (GVHD). Ask your health care provider to tell you what signs of GVHD you should watch for.

Mouth Care

Take good care of your mouth. Dry mouth or sores from medicines you need to take for the bone marrow transplant can lead to an increase in bacteria in your mouth. The bacteria can cause mouth infection, which can spread to other parts of your body.

• Brush your teeth and gums 2 to 3 times a day for 2 to 3 minutes each time. Use a toothbrush with soft bristles.
• Let your toothbrush air dry between brushings.
• Use a toothpaste with fluoride.
• Floss gently once a day.

Rinse your mouth 4 times a day with a salt and baking soda solution. (Mix one-half teaspoon, or 2.5 grams, of salt and one-half teaspoon or 2.5 grams, of baking soda in 8 ounces or 240 millilitres of water.)

Your doctor may prescribe a mouth rinse. DO NOT use mouth rinses with alcohol in them.

Use your regular lip care products to keep your lips from drying and cracking. Tell your doctor if you develop new mouth sores or pain.

Avoid foods and drinks that have a lot of sugar in them. Chew sugarless gums or suck on sugar-free popsicles or sugar-free hard candies.

Take care of your dentures, braces, or other dental products.

• If you wear dentures, put them in only when you are eating. Do this for the first 3 to 4 weeks after your transplant. DO NOT wear them at other times during the first 3 to 4 weeks.
• Brush your dentures 2 times a day. Rinse them well.
• To kill germs, soak your dentures in an antibacterial solution when you are not wearing them.

Preventing Infections

Take care not to get infections for up to 1 year or more after your transplant.

Practice safe eating and drinking during cancer treatment.

• DO NOT eat or drink anything that may be undercooked or spoiled.
• Make sure your water is safe.
• Know how to cook and store foods safely.
• Be careful when you eat out. DO NOT eat raw vegetables, meat, fish, or anything else you are not sure is safe.

Wash your hands with soap and water often, including after:

• being outdoors
• touching body fluids, such as mucus or blood
• changing a diaper
• Before handling food
• using the telephone
• doing housework
• going to the bathroom

Keep your house clean. Stay away from crowds. Ask visitors who have a cold to wear a mask, or not to visit. DO NOT do yard work or handle flowers and plants.

Be careful with pets and animals.

• If you have a cat, keep it inside.
• Have someone else change your cat’s litter box every day.
• DO NOT play rough with cats. Scratches and bites can get infected.
• Stay away from puppies, kittens, and other very young animals.

Ask your doctor what vaccines you may need and when to get them.

Other Self-care

Other things you can do to stay healthy include:

• If you have a central venous line or PICC (peripherally inserted central catheter) line, know how to take care of it.
• If your provider tells you your platelet count is low, learn how to prevent bleeding during cancer treatment.
• Stay active by walking. Slowly increase how far you go based on how much energy you have.
• Eat enough protein and calories to keep your weight up.
• Ask your provider about liquid food supplements that can help you get enough calories and nutrients.
• Be careful when you are in the sun. Wear a hat with a wide brim. Use sunscreen with SPF 50 or higher on any exposed skin.
• DO NOT smoke.

Follow-up

You will need close follow-up care from your transplant doctor and nurse for at least 3 months. Be sure to keep all your appointments.

When to Call the Doctor?

Call your doctor if you have any of these symptoms:

• Diarrhoea that does not go away or is bloody.
• Severe nausea, vomiting, or loss of appetite.
• Cannot eat or drink.
• Extreme weakness.
• Redness, swelling, or draining from any place where you have an IV line inserted.
• Pain in your abdomen.
• Fever, chills, or sweats. These may be signs of infection.
• A new skin rash or blisters.
• Jaundice (your skin or the white part of your eyes looks yellow).
• A very bad headache or a headache that does not go away.
• A cough that is getting worse.
• Trouble breathing when you are at rest or when you are doing simple tasks.
• Burning when you urinate.