Bone marrow transplantation (BMT) is a highly advanced medical procedure being used to treat diseases once thought to be incurable. Since its first successful use in 1968, BMTs have been used to treat patients diagnosed with leukaemia, aplastic anaemia, lymphomas such as Hodgkin’s disease, multiple myeloma, immune deficiency disorders and some solid tumours such as breast and ovarian cancer.
Bone marrow transplant is needed to cure many diseases and types of cancer. Bone marrow transplants may also be needed if the bone marrow has been destroyed by a disease. Damaged or diseased stem cells can make too few blood cells or immune cells, or too many abnormal cells resulting, not to have enough normal red blood cells, white blood cells, or platelets which are essential for survival. A bone marrow transplant may help cure these problems.
In some cancers, such as certain leukemias, multiple myeloma, and some lymphomas, a bone marrow transplant can be an important part of treatment. High doses of chemo, which is sometimes given with radiation, work better than standard doses to kill cancer cells. But high doses can also cause the bone marrow to completely stop making blood cells, so bone marrow transplant is required. This transplant lets doctors use much higher doses of chemo to try to kill all of the cancer cells.
There are three kinds of bone marrow transplants:
1. Autologous bone marrow transplant: In autologous transplants the donor is the patient himself. The doctors remove the stem cells from the patient, store them, and then put these cells back after destroying the cancer or diseased cells with conditioning .Stem cells are taken from the patient either by bone marrow harvest or apheresis (a process of collecting peripheral blood stem cells), and then given back to the patient after intensive treatment.
2. Allogeneic bone marrow transplant: In allogenic transplant, the transplanted stem cells come from another person, called a donor. Donor transplants are called allogeneic transplants.
In serious conditions, allogeneic transplants can boost the chances of the patient’s long-term recovery. However, allogeneic transplants can be riskier than autologous transplants. Finding a donor who is related to the child, a brother or sister can reduce some of this risk. The closer the match, the greater the chances for a positive outcome. If the child does not have a closely matched relative who can donate bone marrow, then international registries are used to find an unrelated donor.
3. Umbilical cord blood transplant: Another option for those without a matched donor is Umbilical cord blood transplant. In this process 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 stem cells taken from the bone marrow of another child or adult. The stem cells are tested, typed, counted, and frozen until they are needed for a transplant.
1. Physical examination: A thorough physical examination before a bone marrow transplant is conducted to assess the general level of health. Physical examination checks the condition of internal organs, such as the liver, heart and lungs to know how well they’re functioning.
2. Harvesting stem cells: After the physical examination, the stem cells will need to be harvested. The most common method used for harvesting involves removing blood from the body then separating stem cells from the other cells in the blood and then returning the blood to the body.
An alternative method used by the doctors to collect the bone marrow is by removing stem cells from the hip bone using a special needle and syringe. This may be recommended for certain conditions.
3. Conditioning: The conditioning process involves using high doses of chemotherapy and sometimes radiation therapy. It’s carried out to destroy the existing bone marrow cells to make room for the transplanted cells. It also destroys any existing cancer cells. The conditioning process usually takes between four and seven days.
4. The Transplant: Transplant is carried out one or two days after conditioning has finished. The donated stem cells will be passed into the body through the central line. This process takes around half an hour to several hours to complete, depending on the type of blood cells being used. The transplant isn’t painful and one can stay awake throughout the procedure.
5. Recovery: Patient may feel weak after the transplant and may experience vomiting, diarrhoea or a loss of appetite. Transplanted stem cells begin to create new blood cells. Doctors conduct blood tests and other tests to monitor the patient’s condition to check if the transplanted cells are producing new blood cells.
Patients require medications daily after the bone marrow transplant. Many patients are discharged from hospital between one and three months after undergoing a bone marrow transplant.
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