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Bone Marrow Transplantation

What is a bone marrow transplantation?

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 they were taken from or to another person. The goal of BMT is to transfuse healthy bone marrow cells into a person after their own unhealthy bone marrow has been eliminated.

Anatomy of a bone, showing blood cells
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What is bone marrow?

The bone marrow is a soft, spongy tissue found inside the bones. The bone marrow in the hips, breast bone, spine, ribs, and skull contain cells that produce the body's blood cells. The bone marrow is responsible for the development and storage of about 95 percent of the body's blood cells. The three main types of blood cells produced in the bone marrow include:

Each of these cells carries a life-maintaining function. The bone marrow is a vital part of the human body.

What are stem cells?

Every type of blood cell in the bone marrow begins as a stem cell. Stem cells are immature cells that are able to produce other blood cells that mature and function as needed.

Stem cells are the most important cells needed in a bone marrow transplant. Stem cells, when transplanted, find their way to the recipient's marrow and begin to differentiate and produce all types of blood cells that are needed by the body.

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 child's bone marrow has been damaged or destroyed due to a disease or intense treatments of radiation or chemotherapy for cancer, a bone marrow transplant may be needed.

A bone marrow transplant can be used to:

Bone marrow transplantation has risks involved, some of which are life threatening. The risks and benefits must be weighed in a thorough discussion with the bone marrow transplant team prior to the procedure.

Each child experiences diseases differently and a bone marrow transplantation may not be appropriate for everyone who suffers from these diseases. Some of the diseases that have been treated with bone marrow transplant include the following:

What are the different types of bone marrow transplants?

There are different types of bone marrow transplants depending on who the donor is. The different types of bone marrow transplant include the following:

The bone marrow transplant team:

The group of specialists involved in the care of children who are undergoing a transplant procedure is often referred to as the "transplant team." Each individual works together to provide the best chance for a successful transplant. The bone marrow transplant team consists of:

An extensive evaluation is completed by the bone marrow transplant team. The decision for your child to undergo a bone marrow transplant will be based on many factors including:

Preparation for the recipient:

For the child receiving the transplant, the following will occur in advance of the procedure:

Preparation for the donor:

How are a donor and recipient matched?

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 of a bone marrow transplant. The more antigens that match, the better the engraftment of donated marrow. Engraftment of the stem cells occurs when the donated cells make their way to the marrow and begin reproducing new blood cells.

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.

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 child's tolerance for certain medications. Consider the following:

The days before transplant are counted as minus days. The day of transplant is considered day 0. Engraftment and recovery following the transplant are counted as plus days. For example, a child may enter the hospital on day -8 for preparative regimen. Days +1, +2, etc., will follow. There are specific events, complications, and risks associated with each day before, during, and after transplant. The days are numbered to help the child and family understand where they are in terms of risks and discharge planning.

During infusion of bone marrow, your child may experience any, or all, of the following symptoms:

After infusion, your child may:

Your child's physical and mental health are important in the success of a transplant. Every measure is taken to minimize complications and promote a healthy, happy, safe environment for your child.

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.

Engraftment can be delayed because of infection, medications, low donated stem cell count, or graft failure. Although the new bone marrow may begin making cells in the first 30 days following transplant, it may take months, even years, for the entire immune system to fully recover.

What complications and side effects may occur following BMT?

The following are complications that may occur with a bone marrow transplantation. However, each child may experience symptoms differently. Complications may vary depending on the following:

Possible complications may include, but are not limited to, the following. These complications may also occur alone, or in combination:

When will my child be discharged?

When your child is discharged following a bone marrow transplant depends on many factors, including the following:

Frequent visits to your child's transplant team will be required to determine effectiveness of treatment, detect complications, detect recurrent disease, and to manage the late effects associated with a bone marrow transplant. The frequency and duration of visits will be determined by your child's transplant team.

Long-term outlook for a bone marrow transplantation:

Prognosis greatly depends on the following:

As with any procedure, such as bone marrow transplant, prognosis, and long-term survival can vary greatly from child to child. The amount of transplants occurring for an increased number of diseases and medical developments has greatly improved the outcome for bone marrow transplant in children and adults. Continuous follow-up care is essential for the child following a bone marrow transplant. New methods to improve treatment and to decrease complications and side effects of a bone marrow transplant are continually being discovered.

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Online Resources of Transplantation


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