Dr. Suraj Chiraniya Hematologist & BMT Physician

AUTOLOGUS BONE MARROW TRANSPLANT

What is a bone marrow transplant?

A bone marrow transplant is a procedure that replaces abnormal or missing cells in the bone marrow with healthy cells. The bone marrow is the tissue in the center of certain bones. Normally, the bone marrow makes blood cells, which the body needs to work normally. There are different types of blood cells, and all of them are made from cells in the bone marrow called “hematopoietic stem cells.”

If the bone marrow does not work normally, it can’t make the blood cells a person’s body needs. To treat this, a doctor can put healthy stem cells, called “donor” cells, into the bone marrow. The donor cells can then make normal blood cells. A bone marrow transplant is also called a “stem cell transplant” or “hematopoietic stem cell transplant.”

Why might I have a bone marrow transplant?

You might have a bone marrow transplant to help treat a cancer, such as leukemia or lymphoma, or another medical condition that affects your bone marrow.

What does “autologous” mean?

This means that the healthy stem cells come from your own body. (“Auto” means “self.”) If the donor cells come from another person, it is called an “allogeneic” bone marrow transplant.

The right type of bone marrow transplant for you depends on many different things, including:

• What kind of cancer or other medical problem you have
• Your other health conditions
• Your age
• Your preferences

Your doctor will do an exam and tests to make sure you can donate your own cells for transplant. The tests you get will depend on your medical condition, but will likely include:

• Blood tests
• Bone marrow biopsy – This involves taking a small sample of your bone marrow, then looking at it under a microscope.
• Imaging tests – Imaging tests create pictures of the inside of your body. They include chest X-ray, CT scan, and tests to check how well your heart is working.

An advantage of using your own stem cells is that they will recognize your body when they are transplanted back. When donor cells come from another person, they can sometimes attack your organs, which leads to problems.

How are the donor stem cells collected?

When it is time for the doctor to collect the “donor” stem cells from your body, you will go to the hospital or transplant center.

Most likely, the donor stem cells will come from your blood. To collect them, a needle will be inserted into a vein in each of your arms. Your blood will be taken from one arm and run through a special machine that collects the stem cells. After the stem cells are taken out, the rest of the blood goes back into your body through the other arm. This usually takes a few hours. Most people only need to do this once for enough stem cells to be collected, but some people need to go back a second time.

You will need to take a medicine to help your blood produce extra stem cells for several days before the collection. This medicine comes in a shot that may be given at the doctor’s office, or you might give yourself the shot at home each day. It causes temporary muscle or bone pain in most people. Acetaminophen (brand name: Tylenol) can help with this.

In some situations, it is possible to collect donor cells from your bone marrow instead of your blood. This is done through a different procedure. Your doctor will talk to you about your situation and how best to collect the cells from your body.

After the cells are collected, they will be frozen and stored until it is time to transplant them back into your bone marrow.

What else will happen before my transplant?

Your doctor will put a thin tube into a blood vessel in your upper chest. This tube, called a “central line,” will stay in place during your hospital stay. Your doctor will use it to give you treatments, as well as take blood for tests.

Just before your transplant, you will get “conditioning” treatment. This involves chemotherapy, radiation therapy, or both, usually given at high doses. Conditioning treatment kills cancer cells and prepares your bone marrow to receive the donor stem cells. Then when your stem cells are transplanted back into your bone marrow, called “stem cell rescue,” they can start making healthy blood cells again.

What will happen during my transplant?

Soon after the conditioning treatment, your doctor will put the donor cells into your body through your central line or another vein. The stem cells will find their way to your bone marrow. There, they can start making normal blood cells.

What will happen after my transplant?

Most people stay in the hospital for several days to weeks after an autologous bone marrow transplant.

Right after a bone marrow transplant, your body has a higher chance than usual of getting an infection. Because of this, you will need to stay in a special hospital room and get certain medicines.

Your doctor might give you other treatments, depending on your symptoms. He or she will also do blood tests regularly to check that your bone marrow transplant is working.

Once your bone marrow is working normally and you return home, you will need to see your doctor for regular follow-ups.

What are the side effects of a bone marrow transplant?

The side effects depend on where your donor cells came from, as well as which treatments you have before the transplant.

After an autologous bone marrow transplant, the most common short-term side effects include:

• Mouth sores and diarrhea
• Nausea and vomiting
• Hair loss (from the head, face, and body)
• Lung, liver, or bone problems

People can also have long-term side effects that include:

• Trouble getting pregnant – If you want to have a baby in the future, talk with your doctor before your bone marrow transplant.
• Other cancers that can happen years later

Donating bone marrow or blood stem cells

What are stem cells?

Blood or bone marrow stem cells are special cells that can become many different types of blood cells. They are found in the blood and in the bone marrow (the tissue in the center of certain bones).

A stem cell transplant is when healthy stem cells are put into a person’s body to replace stem cells that are diseased or damaged. This is also called a “hematopoietic stem cell transplant” or “bone marrow transplant.”

Why might someone need a stem cell transplant?

A person might have a stem cell transplant to help treat a cancer, such as leukemia or lymphoma, or another medical condition. The healthy stem cells can come from a few different sources:

• The person’s own body
• A relative, such as a brother or sister
• A person who is not related
• Blood from a newborn baby’s umbilical cord

A person who gives stem cells to another person is called a “donor.”

What does it mean to be a “match”?

To donate stem cells to another person, your blood needs to closely match theirs. To check this, doctors can do special tests to look at certain proteins on your body’s cells. This is called “HLA typing.” HLA type is not the same as blood type (A, B, AB, or O).

Donated stem cells can come from:

• A sibling – When a person needs a stem cell transplant, siblings (brothers and sisters) might be tested to find out if any of them is a “match.” There is about a 1 in 4 chance that a brother or sister will be a match for HLA type. If there is a match, a sibling donor is usually the best option. That’s because siblings share similar genes, so the stem cells are more likely to work well with the body of the person who gets them. If tests show that a sibling is an HLA match, the person is called a “matched related donor.”
• An unrelated person – If no sibling is a good match, it is sometimes possible to find a donor who is not related to the person. This is often done by searching registries, which are lists of people all over the world who have volunteered to donate stem cells. The chances of finding a match from a registry partly depend on the person’s race and background. When a person who is not a relative is an HLA match, they are called a “matched unrelated donor.”
• A parent or child – Sometimes, a person’s parent or child can donate stem cells for transplant. When this happens, it is called a “haploidentical” transplant. With a parent or child donor, only half of the genes will be a good match, while siblings share more similar genes.
• Umbilical cord blood from a newborn baby – In some cases, stem cells from a newborn baby’s umbilical cord can be used. This is called an “umbilical cord blood transplant.” Not all centers perform haploidentical transplants or umbilical cord transplants.

Are there other requirements for donating stem cells?

Yes. If you are found to be a “match” for someone who needs stem cells, that’s the first step. But there are other requirements, too.

To donate stem cells, you must be in generally good health. You will have a physical exam and blood tests before you are allowed to donate. You will also need to answer questions about your health and behavior. These usually include questions about:

• The medicines you take, or took in the past
• Any recent vaccines that you have gotten
• Whether you have had certain diseases
• Countries you have lived in or traveled to
• Sex partners you have had
• Drug use
• Past pregnancies

You will get information about the donation procedure and risks. You will also be asked to sign forms saying that you agree to be a donor. It’s important that you are making the choice to be a donor for yourself, and no one is pressuring you to do it.

What is the procedure like?

It depends on how your stem cells are collected. They can be taken from either the bone marrow or the blood. Your doctor will talk to you about each option, and help you decide which is best for your situation.

• Blood collection– If you are going to donate stem cells from your blood, a needle will be inserted into a vein in each of your arms. Your blood will be taken from one arm and run through a special machine that collects the stem cells. After the stem cells are taken out, the rest of the blood goes back into your body through the other arm. This usually takes a few hours. Most donors only need to do this once for enough stem cells to be collected, but some people need to go back a second time.

You will need to take a medicine to help your blood produce extra stem cells for several days before the collection. This medicine comes in a shot that may be given at the doctor’s office, or you might give yourself the shot at home each day. It causes temporary muscle or bone pain in most people. Acetaminophen (brand name: Tylenol) can help with this.

• Bone marrow collection– If you are going to donate bone marrow, right before the procedure you will be given medicine (called anesthesia). The medicine prevents you from feeling pain. A doctor will insert a special needle into the back of your hip bone, and take out some of your bone marrow. The doctor will need to insert the needle more than once to get enough bone marrow. After the procedure, the area will be covered with a bandage.

If you are a bone marrow donor, you will need to avoid alcohol for about 2 weeks before the procedure. You will also be asked to avoid medicines known as “nonsteroidal antiinflammatory drugs,” or NSAIDs, for 24 hours before. These medicines include ibuprofen (sample brand names: Advil, Motrin) and naproxen (sample brand name: Aleve). Some people need to take iron pills before and after donating bone marrow.

What are the risks to me?

Both ways of donating stem cells involve some pain. For bone marrow donation, you are more likely to have pain after the procedure, in the hip area where the needles went in. There are also risks that go along with any surgery, including infection or problems with anesthesia. For blood stem cell donation, you are more likely to have pain in the days before the procedure. This is related to the medicine you take to help your body make more stem cells.

Most people who donate stem cells feel good about being able to help someone. You might have some stress, especially if you are donating to a family member. Keep in mind that by donating stem cells, you are improving someone’s chances at a healthy life. A stem cell transplant does not always lead to recovery, and it’s not your fault if the person does not get better.

What will my recovery be like?

If you donated bone marrow, you will likely have some pain after the procedure. You might also be more tired than usual. But you should feel back to normal in a month or so. You should avoid heavy lifting and intense exercise for about 6 weeks, to allow your body to heal.

If you donated blood stem cells, you might feel fine right after the procedure. Your doctor might tell you to rest for a few days, but you should be able to get back to normal activities soon. No matter which way your stem cells were collected, your body will create more to replace the ones that were removed. You will be back to having the normal amount of stem cells within a few weeks or months.