Bone Marrow Transplantati on

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What is a bone marrow transplantation?

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Bone marrow transplantation (BMT) is a special therapy for patients with cancer or other diseases which affect the bone marrow. A bone marrow transplant involves taking cells that are normally found in the bone marrow (stem cells), filtering those cells, and giving them back either to the patient or to another person. The goal of BMT is to transfuse healthy bone 5/2/12 marrow cells into a person after

Bone marrow transplantation is not yet a standard treatment therapy, but has been used successfully to treat diseases such as leukemias, lymphomas, aplastic anemia, 5/2/12 immune

What is bone marrow?

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 Bone marrow is the

soft, spongy tissue found inside bones. It is the medium for development and storage of about 95 percent of the body's blood cells. produce other blood cells are called stem cells. The most primitive of the stem cells is called the pluripotent stem cell, which 5/2/12 is different than other blood cells with

The blood cells that

Why is a bone marrow transplant needed?

The goal of a bone marrow transplant is to cure many diseases and types of cancer. When a person's bone marrow has been damaged or destroyed due to a disease or intense treatments of radiation or chemotherapy for cancer, a marrow transplant may be needed.

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 What are some

diseases that may benefit from bone marrow transplantation?

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The following diseases are the ones that most commonly benefit from bone marrow transplantation:
leukemias aplastic anemia lymphomas multiple myeloma immune deficiency disorders solid-tumor cancers, such as breast or ovarian
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What are the different types of bone marrow transplants?

a.) Autologous bone marrow transplant b.) Allogeneic bone marrow transplant c.)Umbilical Cord Blood Transplant
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a.) Autologous bone marrow transplant

donor is the patient him/herself. Stem cells are taken from the patient either by bone marrow harvest or apheresis (peripheral blood stem cells) and then given back to the patient after intensive treatment. Often 5/2/12 the term "rescue" is used
The

b.) Allogeneic bone marrow transplant The donor shares the

same genetic type as the patient. Stem cells are taken either by bone marrow harvest or apheresis (peripheral blood stem cells) from a genetically-matched donor, usually a brother or sister.
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c.) Umbilical Cord Blood Transplant

Stem cells are taken from an umbilical cord immediately after delivery of an infant. These stem cells reproduce into mature, functioning blood cells quicker and more effectively than do stem cells taken from the bone marrow of another child or adult. The stem cells are tested, typed, counted, and frozen until they are ready to be transplanted.
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How are a donor and recipient matched?

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Matching

involves typing human leukocyte antigen (HLA) tissue. The antigens on the surface of these special white blood cells determine the genetic make-up of a person's immune system. There are at least 100 HLA antigens, however, it is believed that there are a few major antigens that determine whether a donor and recipient match. The others are considered "minor" and their effect on a successful transplant is not as well defined.

Medical research is still investigating

the role all antigens play in the process 5/2/12 of a bone marrow transplant. The more antigens that match, the better the

The bone marrow transplant team:

The group of specialists involved in the care of patients going through transplant is often referred to as the "transplant team." Each individual works together to 5/2/12 provide the best chance for a

The team consists of the following:

a. physicians B. bone marrow transplant nurse coordinator c. social workers d. dietitians e. physical therapists f. pastoral care g. other team members pharmacists respiratory therapists lab technicians infectious disease specialists dermatologists

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Preparation for the recipient:

1. For a patient receiving the transplant, the following will occur in advance of the procedure: 2. Prior to the transplant, an extensive evaluation is completed by the bone marrow transplant team. All other treatment options are discussed and evaluated for risk versus benefit. 3. A complete medical history and physical examination are performed, including multiple tests to evaluate the patient's blood and organ functions (i.e., heart, kidney, liver, lungs). 4. A patient will often come into the transplant center 5/2/12 up to 10 days prior to transplant for hydration,

1. Donor sources available include: self, sibling, parent or relative, non-related person, donor: Preparation for the or umbilical cord from a related or non-related person. There are national and international registries for non-related persons and cord blood. For family members, they may be typed because of the desire to help. These relatives may or may not elect to have their type registered for use with other recipients. 2. If the potential donor is notified that they may be a match for a patient needing a transplant, they will undergo additional tests. Tests related to their health, exposure to viruses, and complete genetic analysis 5/2/12 will be done to determine the extent of the match.

How are the stem cells collected? A bone marrow transplant is done by transferring stem cells from one person to another. Stem cells can either be collected from the circulating cells in the blood (the peripheral system) or from the bone marrow. 5/2/12

How are the stem cells collected? a.) Peripheral blood stem cells (PBSCs) b.) bone marrow harvest

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a.) peripheral blood stem cells (PBSCs)

Peripheral blood stem cells (PBSCs)
are collected by a apheresis, a process in which the donor is connected to a special cell separation machine via a needle inserted in the vein. Blood is taken from one vein and is circulated though the machine which removes the stem cells and returns the remaining blood and plasma back to the donor through another needle inserted into the opposite arm. Several sessions may be required to collect enough stem cells to ensure a chance of successful engraftment in the recipient. A medication may be given to the donor for about 5/2/12 one week prior to apheresis that will stimulate the bone marrow to increase production of new stem cells. These

b.) bone marrow harvest

Bone marrow harvesting

involves collecting stem cells with a needle

placed into the soft center of the bone, the marrow. Most sites used for bone marrow harvesting are located in the hip bones and the sternum. The procedure takes place in the operating room. The donor will be anesthetized during the harvest and will not feel the needle. In recovery, the donor may experience some pain in the areas where the needle was inserted.
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The bone marrow transplant procedure:

The preparations for a bone marrow transplant vary depending on the type of transplant, the disease requiring transplant, and your tolerance for certain medications. Consider the following:
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a.) Most often, high doses of chemotherapy and/or radiation are included in the preparations. This intense therapy is required to effectively treat the malignancy and make room in the bone marrow for the new cells to grow. This therapy is often called ablative, or myeloablative, because of the effect on the bone marrow. The bone marrow produces all the blood cells in our body. Ablative therapy prevents this process f cell production and the marrow becomes empty. An empty marrow is needed to make room for the new stem cells to grow and establish a new production system.

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b.) After the chemotherapy and/or radiation is administered, the marrow transplant is given through the central venous catheter into the bloodstream. It is not a surgical procedure to place the marrow into the bone, but is similar to receiving a blood transfusion. The stem cells find their way into the bone marrow and begin reproducing and establishing new, healthy blood cells.

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c.) Supportive care is given to prevent and treat infections, side effects of treatments, and complications. This includes frequent blood tests, close monitoring of vital signs, strict measurement of input and output, daily weigh-ins, and providing a protected and sterile environment. 5/2/12

During infusion of bone marrow, the patient may experience the following:

pain chills fever hives chest pain

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After infusion, the patient may: spend several weeks in the hospital. be very susceptible to infection. Experience excessive bleeding. have blood transfusions. be confined to a sterile environment. take multiple antibiotics and other medications. be given medication to prevent graft-versus-host disease - if the transplantation was allogeneic. The transplanted new cells (the graft), tend to attack the patient's tissues (the host), even though the donor is a relative, such as a brother, sister, or parent. undergo continual laboratory testing. experience nausea, vomiting, diarrhea, mouth sores, and extreme weakness. experience 5/2/12 temporary mental confusion and emotional or psychological distress.

. When does engraftment occur?

Engraftment of the stem cells occurs when

the donated cells make their way to the marrow and begin reproducing new blood cells. Depending on the type of transplant and the disease being treated, engraftment usually occurs around day +15 or +30. Blood counts will be performed frequently during the days following transplant to evaluate initiation and progress of engraftment. Platelets are generally the last blood cell to recover.
5/2/12 infection, medications, low donated stem

Engraftment can be delayed because of

M. What complications and side effects may occur following depending on the BMT? Complications may vary,
following:
type of marrow transplant type of disease requiring transplant preparative regimen age and overall health of the recipient variance of tissue matching between donor

and recipient
presence of severe complications
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The following are complications that may occur with a bone marrow transplantation. However, each individual may experience symptoms differently. These complications may also occur alone, or in combination:

infections

Infections are likely in the patient with severe bone marrow suppression. Bacterial infections are the most common. Viral and fungal infections can be life threatening. Any infection can cause an extended hospital stay, prevent or delay engraftment, and/or cause permanent organ damage. Antibiotics, anti-fungal medications, and anti-viral medications are often given to prevent serious infection in the immunosuppressed patient.
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low platelets and low red blood cells

Thrombocytopenia (low platelets) and anemia (low red blood cells), as a result of a non-functioning bone marrow, can be dangerous and even life threatening. Low platelets can cause dangerous bleeding in the lungs, gastrointestinal (GI), and brain. Pain related to mouth sores and gastrointestinal (GI) irritation is common. High doses of chemotherapy and radiation can cause severe mucositis (inflammation 5/2/12 of the mouth and GI tract).

pain

fluid overload

Fluid overload is a complication that can lead to pneumonia, liver damage, and high blood pressure. The primary reason for fluid overload is because the kidneys cannot keep up with the large amount of fluid being given in the form of intravenous (IV) medications, nutrition, and blood products. The kidneys may also be damaged from disease, infection, chemotherapy, radiation, or antibiotics.
5/2/12 Respiratory status is an important function

respiratory distress

organ damage

The liver and heart are important organs that may be damaged during the transplantation process. Temporary or permanent damage to the liver and heart may be caused by infection, graft-versushost disease, high doses of chemotherapy and radiation, or fluid overload. Graft failure is a potential complication. Graft failure may occur as a result of infection, recurrent disease, or if the stem 5/2/12 cell count of the donated marrow was

graft failure

graft-versus-host disease

Graft-versus-host disease (GVHD) can be a serious and life-threatening complication of a bone marrow transplant. GVHD occurs when the donor's immune system reacts against the

recipient's tissue. The new cells do not recognize the tissues

and organs of the recipient's body. The most sites for GVHD are GI tract, liver, skin, and lungs.
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References:
http://www.umm.edu/blood/bonemarr.htm

http://www.cumc.columbia.edu/dept/medicine/b

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