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Alternative Names Return to topTransplant - bone marrow; Stem cell transplant; Hematopoietic stem cell transplant; Reduced intensity, non-myeloablative transplant; Mini transplant; Allogenic bone marrow transplant; Autologous bone marrow transplant; Umbilical cord blood transplant
Definition Return to top
A bone marrow transplant delivers healthy bone marrow stem cells into the patient. It replaces bone marrow that is either not working properly or has been destroyed (ablated) by chemotherapy or radiation.
Description Return to top
Bone marrow is the soft, fatty tissue inside your bones. Stem cells are immature cells in the bone marrow. Some stem cells grow into different parts of your blood. These parts are:
In a bone marrow transplant, you will receive healthy stem cells after your own bone marrow has been destroyed.
There are three kinds of bone marrow transplants:
Most patients get high doses of chemotherapy, radiation, or both, before the bone marrow transplant. This is called ablative (or myeloablative) treatment. It kills any cancer cells that might remain, and it makes room in the bone marrow for the new stem cells to grow.
Today, some patients are getting less chemotherapy and radiation before their transplant. This is called a reduced intensity (non-myeloablative) or "mini" transplant.
After the patient gets chemotherapy and radiation, a doctor will do the stem cell transplant. The patient gets the stem cells through a tube called a central venous catheter. The cells go right into the bloodstream.
This delivery of cells is called an infusion. It may take up to several hours. It is not surgery. It is similar to a blood transfusion. The stem cells find their way into the bone marrow, where they may begin reproducing and making healthy new blood cells.
Donors must have minor surgery to collect their bone marrow and stem cells. They will be unconscious and pain-free (under general anesthesia) while their bone marrow is removed from their hip bone.
When receiving stem cells, a patient may have these symptoms:
Why the Procedure is Performed Return to top
Bone marrow or stem cell transplant may be recommended for:
Risks Return to top
All bone marrow transplants have risks. The risk is higher or lower depending on many factors. Some of these factors are:
Complications you may have are:
Before the Procedure Return to top
Your health care provider will ask you about your health record and do aphysical exam. You will also have many tests before your treatment begins.
Your doctor or nurse should discuss the emotional stress of having a bone marrow transplant. You may want to meet with a mental health counselor talk. Talking with your family and children to help them understand and prepare is important.
You will need to make plans for when you have the transplant. Items to consider are:
You may need to find housing for yourself or your family near the hospital.
Before the transplant, one or two catheters are inserted into larger blood vessels, usually in the neck, for you to receive treatments, fluids, and sometimes nutrition.
After the Procedure Return to top
Bone marrow transplant patients usually go to medical centers, or hospitals, that specialize in this treatment. Most times the patient will stay in a bone marrow transplant unit in the center to limit their chance of getting an infection.
Some patients who get autologous transplants do not have to stay in the hospital or medical center. They can get the transplant as an outpatient.
Some patients may have part of their autologous or allogeneic transplant done as an outpatient.
Most patients will be in the hospital for 4 to 6 weeks. During this time, you will be isolated and watched closely because of the increased risk of infection.
While you are in the hospital, these things may happen:
Outlook (Prognosis) Return to top
How well you do after transplant greatly depends on these things:
Possible results of a bone marrow transplant are complete cure of the illness being treated, a partial cure, or death. Death may be caused by complications of the bone marrow transplant or because the transplant did not work to treat the illness.
If the transplant works, you can go back to most of your normal activities as soon as you feel well enough. Most times it takes up to 12 months to recover fully.
References Return to top
Bishop MR, Pavletic SZ. Hematopoietic stem cell transplantation. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG, eds. Clinical Oncology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 32.
Vose JM, Pavletic SZ. Hematopoietic stem cell transplantation. In: Goldman L, Ausiello D. Goldman: Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 184.Update Date: 10/30/2008 Updated by: Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.