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Bone marrow transplant

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Definition:

A bone marrow transplant is a procedure that transplant healthy bone marrow into a patient whose bone marrow is not working properly. A bone marrow transplant may be done for several conditions including hereditary blood diseases, hereditary metabolic diseases, hereditary immune deficiencies, and various forms of cancer.

The healthy bone marrow may be taken from the patient prior to chemotherapy or radiation treatment (autograft), or it may be taken from a donor (allograft).

Alternative Names:

Transplant - bone marrow

Description:

Bone marrow is a soft, fatty tissue inside the bones. This is where blood cells (red blood cells, platelets, and white blood cells) are produced, and where they develop. In a disease of the blood cells -- especially cancers such as leukemia -- high doses of chemotherapy may be required to destroy the cancer. However, this also destroys normal blood cells.

In other cases in which hereditary or acquired disorders cause abnormal blood cell production, transplantation of healthy bone marrow may correct these problems. Transplanted bone marrow will restore production of white blood cells, red blood cells, and platelets.

Bone marrow transplant patients are usually treated in specialized centers. The patient stays in a special nursing unit -- a bone marrow transplant unit, or BMT -- to limit exposure to infections.

Donated bone marrow must match the patient's tissue type. It can be taken from the patient, a living relative (usually a brother or a sister), or from an unrelated donor (found through the national marrow donor program). Donors are matched through special blood tests called HLA tissue typing. (See HLA antigens .)

Bone marrow is taken from the donor in the operating room while the donor is unconscious and pain-free (under general anesthesia). Some of the donor's bone marrow is removed from the top of the hip bone. The bone marrow is filtered, treated, and transplanted immediately or frozen and stored for later use. Transplant marrow is transfused into the patient through a vein (IV) and is naturally carried into the bone cavities where it grows to replace the old bone marrow.

Alternatively, blood cell precursors, called stem cells, can be made to move from the bone marrow to the blood stream using special medications. These stem cells can then be taken from the bloodstream through a procedure called leukapheresis.

The patient is prepared for transplant by administering high doses of chemotherapy or radiation (conditioning). This serves 2 purposes. First, it destroys the patient's abnormal blood cells or cancer. Second, it slows the patient's immune response against the donor bone marrow (graft rejection).

Following conditioning, the patient is ready for bone marrow infusion. After infusion, it takes 10 - 20 days for the bone marrow to establish itself. During this time, the patient requires support with blood cell transfusions.

Indications:

Bone marrow transplant may be recommended for:

• Bone marrow deficiency disease caused by:
  • Abnormal red blood cell production, such as thalassemia or sickle cell disease
  • Aggressive cancer treatments ( chemotherapy , radiation therapy ), especially for leukemia or lymphoma
  • Lack of normal blood cell production (aplastic anemia)
• Immune system disorders (immunodeficiencies) such as:
  • Congenital neutropenia
  • Severe combined immunodeficiency syndrome
• Specific forms of cancer:
  • Leukemias
  • Lymphomas
  • Myeloma

Bone marrow transplant is not recommended for:

• Patients with heart, kidney, lungs, or liver disorders
• Patients with other diseases that may limit survival

• Review Date: 10/30/2006
• Reviewed By: William Matsui, MD, Assistant Professor of Oncology, Division of Hematologic Malignancies, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD. Review provided by VeriMed Healthcare Network.

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