Bone Marrow & Stem Cell Transplantion About
Below you will find information about bone marrow and stem cell transplantation, including bone marrow and stem cell transplant types , the role of the donor, the potential of cord blood, the transplant process, and other resources and support.
Bone Marrow and Stem Cell Transplantation
What is it?
Bone marrow or stem cell transplantation gives patients new marrow in a process similar to blood transfusion. Bone marrow is a liquid tissue found inside the bones which produces blood cells. Stem cells are the immature blood-producing cells found mostly in the marrow, but some are in the bloodstream (peripheral blood stem cells). The blood cells they produce include oxygen-carrying red blood cells, the infection-fighting white blood cells, and the platelets which enable the blood to clot.
When is it used?
Bone marrow transplantation has been used as therapy for several potentially fatal blood disorders since 1968. It has been used to treat patients with:
- blood-related cancers (leukemia and lymphomas such as Hodgkin's disease and multiple myeloma),
- solid tumors (such as breast or testicular cancer),
- lack of normal blood cell production (aplastic anemia),
- inherited (genetic) diseases,
- and immune system (immunodeficiency) disorders.
Traditionally, it was used only after other therapies had failed. Chemotherapy alone or combined with a high dose of radiation was used to treat these diseases. These methods did more than destroy illness; they also killed essential cells, including those in the bone marrow, and stopped them from dividing and growing. Transplantation was often necessary to restore some of these essential cells.
Currently, bone marrow and stem cell transplantation is often used as a first line of treatment. Transplantation may offer better results than conventional treatments, potentially saving thousands of lives.
Bone Marrow and Stem Cell Transplant Types
Autologous
Using the recipient's own stem cells, this method is used for:
- blood-related cancers (lymphomas, Hodgkin's disease, and leukemia),
- connective tissue cancers (sarcomas),
- nervous system cancers (neuroblastoma),
- and certain solid tumor cancers (breast, testicular and ovarian cancer).
Stem cells are harvested or collected at a certain point in therapy; then frozen, stored, and given after high dose chemotherapy to rescue patients from the toxic effects of chemotherapy on one's bone marrow.
Allogeneic
Using stem cells from a donor, this method is used most often for:
- blood-related cancers (leukemia and lymphomas),
- bone marrow disorders (myelodysplastic syndrome and aplastic anemia),
- immune system disorders (reduce body's ability to fight disease),
- metabolic diseases (disrupt body's ability to produce materials needed for life),
- and other inherited (genetic) diseases.
If stem cells are taken from the bone marrow, the procedure is done under either general anesthesia, which puts the person to sleep, or local anesthesia, which causes loss of feeling. Only the bone marrow is collected or harvested from the hips. The bones are not removed or opened during the procedure. The amount of marrow needed is based on the weight of the transplant recipient, but it is usually one to two pints.
About 10 percent of the donor's total bone marrow is harvested. Within a short time, the bone marrow will replenish itself. Side effects from the bone marrow harvest may be sore hips and mild anemia. Overall, there are few side effects. The surgery can be done as an outpatient procedure.
Stem cells taken from the bloodstream (peripheral blood stem cell transplant) is a less invasive option than bone marrow transplantation. The parent (or progenitor) cells are harvested via a collection catheter from the circulating blood instead of from the bone marrow. This procedure, called apheresis, is completed as an outpatient. The stem cells are collected, frozen, and stored for later use.
The Role of the Donor
Another important aspect of bone marrow transplantation is finding a suitable donor. The donor in allogenic bone marrow transplant is an important person, and great care is taken to identify a suitable donor.
- Donors are educated so they understand what will happen when marrow is harvested.
- Donors must undergo several tests and procedures to ensure that they are physically able to safely donate marrow.
- Immediate family members are tissue or DNA typed first to see if a matched donor can be found within the family. A matched donor in the recipient's family is the best donor to have. Many of the donor's and recipient's genes are similar, and there are potentially fewer side effects from treatment.
- If no one in the recipient's family is a match, then the transplant coordinator will begin a search for a donor. There are three additional sources for donors in stem cell transplantation:
- Unrelated Marrow Donors Through the National Marrow Donor Program and similar registries, about three million volunteers worldwide are available to donate marrow. For more information about being a volunteer through the National Marrow Donor Program call 1-800-Marrow-2.
- Unrelated Cord Blood Donors The cord blood is obtained from the umbilical cord at birth and is rich in stem cells. For more information about storing cord blood, contact our Pediatric Transplant Coordinator at (317) 278-0619.
- Haploidentical Donors Parents are half-matched to their children and may be a suitable donor.
The Potential of Cord Blood
Cord blood transplantation is an exciting area of research and a major focus of study in both pediatric and adult settings. When a baby is born, the umbilical cord is cut, and the placenta is discarded. Recently, it has been discovered that the blood inside the umbilical cord is rich in stem cells. The stem cells can be removed from the cord and frozen to use in transplantation.
Collecting, storing, testing, and transplanting cord blood requires the expertise of highly qualified physicians. Indiana University Bone Marrow and Stem Cell Transplantation Program uses cord blood from donor banks that are approved by the Federal Drug Administration.
In searching for a match, a tiny DNA sample from the blood cord is tested to verify a DNA match with the recipient. If the DNA matches, the cord blood is shipped to Indiana University and is used as a source for transplantation.
The Transplant Process
The transplant process differs by type of transplant which is determined following referral to the Bone Marrow and Stem Cell Transplant Team. The transplant team, patient education, and follow-up care are all important components of the process.
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Resources and Support
The Blood Marrow Tranplant Information Network:
- connects patients with survivors who have been through the transplant experience and can serve as a resource and source of support for new patients.
- publishes the Blood Marrow Tranpslant Newsletter which contains timely information about bone marrow, stem cell and cord blood transplants, as well as stories of survival.
- maintains databases of information resources, transplant centers and drugs used during and after transplants.
The National Marrow Donor Program (NMDP) facilitates unrelated marrow and blood stem cell transplantation for patients with life-threatening diseases who do not have matching donors in their families. The NMPD Web site provides access to resources for patients and professionals on topics related to bone marrow and stem cell transplantation. The site also provides information for donors and inspirational stories for donors and patients.
The National Bone Marrow Transplant Link operates a 24-hour, toll-free number and provides peer support to bone marrow transplant (BMT) patients and their families. It serves as an information center for prospective BMT. Educational publications, brochures, and videos are available.