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The Risk of Neutropenia Due to Bone Marrow Replacement

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Graft rejections after bone marrow transplants can cause reduced white blood cells. Read the below article to learn more about bone marrow replacement.

Medically reviewed by

Dr. Abdul Aziz Khan

Published At May 29, 2023
Reviewed AtFebruary 6, 2024

Introduction:

A bone marrow transplant is a process that introduces healthy blood-forming stem cells into the body. A bone marrow transplant replaces damaged stem cells with healthy cells. A bone marrow transplant is required if the bone marrow stops working and does not produce enough healthy blood cells.

What Is a Bone Marrow Transplant or Replacement?

Bone marrow is a spongy, fatty tissue inside the bones. It produces red blood cells (RBCs carry oxygen and nutrients to the body), white blood cells, and platelets (help form blood clots). Bone marrow contains immature blood-forming stem cells called hematopoietic precursor cells. These cells are differentiated and can only make copies of themselves. However, these stem cells are unspecialized and immature. These cells can multiply through cell division which will remain as stem cells or differentiate and mature into many blood cells. The hematopoietic precursor cells in the bone marrow will make new blood cells throughout the lifespan.

Healthy stem cells are from a donor or can come from their own body. Stem cells can be harvested or grown before chemotherapy or radiation treatment. Those healthy cells are then stored and used in transplantation. Bone marrow transplants use cells from their own body (autologous transplant) or a donor, called an allogeneic transplant.

What Are the Types of Bone Marrow Transplants?

  1. Allogenic stem cell transplant (uses healthy stem cells from a donor to replace the bone marrow).

  2. Autologous stem cell transplant.

What Are the Uses of Bone Marrow Transplants?

A bone marrow transplant is used to:

  • Replace bone marrow with new stem cells.

  • Provide new stem cells that can help kill cancer cells directly and produce new blood cells to resume normal functions of the body.

Bone marrow transplant is a procedure for the following conditions:

  • Acute leukemia (a type of cancer of blood and bone marrow that affects white blood cells).

  • Aplastic anemia (a condition in which the body stops producing enough new blood cells).

  • Bone marrow failure syndromes.

  • Chronic leukemia.

  • Hodgkin's lymphoma (cancer of the lymphatic system).

  • Immune deficiencies.

  • Multiple myeloma (a cancer of plasma cells).

  • Neuroblastoma.

  • Non-Hodgkin's lymphoma.

  • Plasma cell disorders.

People with bone marrow transplants may experience minimal problems or may lead to serious complications requiring treatment or hospitalization. The complications can be life-threatening.

Possible complications from a bone marrow transplant include:

  • Graft-versus-host disease (a complication that occurs in allogeneic transplants only).

  • Stem cell (graft) failure.

  • Organ damage.

  • Infections.

  • Infertility.

  • Death.

What Is Graft-Versus-Host Disease?

A potential risk occurs when stem cells come from donors. A transplant that uses stem cells from an allogenic transplant causes a risk of developing graft-versus-host disease (GVHD). It occurs when the donor stem cells that make up new immune cells see the body's tissues and organs as foreign and attack them. Acute GVHD happens during the first months after the transplant. It typically affects the skin, digestive tract, and liver. Chronic GVHD develops later and can affect many organs. GVHD may happen at any time after the transplant. People with have an allogeneic transplant get GVHD. The risk of GVHD is higher if the precursor is derived from an unrelated donor. GVHD happens to anyone who has a bone marrow transplant from the donor.

The two kinds of GVHD are acute and chronic GVHD. Chronic GVHD signs and symptoms include:

  • Joint or muscle pain.

  • Shortness of breath.

  • Persistent cough.

  • Dry eyes and blurred vision.

  • Skin changes.

  • Rash.

  • Dry mouth.

  • Mouth sores.

  • Diarrhea.

  • Nausea.

  • Vomiting.

What Is Neutropenia?

Neutropenia is a condition characterized by low levels of neutrophils. They are white blood cells that protect the body from infection. It increases the risk of many infections.

What Are the Types of Neutropenia?

The four types of neutropenia are:

Congenital:

  • Congenital neutropenia occurs at birth. Neutropenia causes very low neutrophil levels and, in some cases, a complete lack of neutrophils. This causes serious infections in infants and young children.

  • Cyclic neutropenia is present at birth.

  • Neutrophil counts vary in a 21 day cycle.

  • A period of neutropenia lasts a few days, followed by normal levels for the rest of the cycle. The cycle begins again.

Autoimmune:

  • With autoimmune neutropenia, the body makes antibodies that fight neutrophils. These antibodies kill the neutrophils, causing neutropenia.

Idiopathic:

  • This neutropenia develops at any time in life and can affect anyone. The cause is unknown.

What Are the Symptoms of Neutropenia?

The symptoms are mild to severe. The symptoms are very severe when the neutrophils are very less. Typical symptoms include fever, pneumonia, gum infection, or inflammation. Severe congenital neutropenia causes serious symptoms. It often includes bacterial infections. Bacterial infections grow on the skin, respiratory tract, and digestive tract.

What Causes Neutropenia?

The following factors can trigger neutropenia:

  • Chemotherapy.

  • Radiation therapy.

  • Certain drugs.

  • Conditions that affect the bone marrow.

  • Severe aplastic anemia.

How Can Graft Failure Cause Neutropenia?

  • Graft failure is extremely unusual in autologous stem cell transplantation. Graft failure occurs when the bone marrow does not function well.

  • The graft may fail to grow in the patient resulting in bone marrow failure with the absence of red blood cells, white blood cells, and platelet production.

  • This results in infection, anemia, and bleeding. Graft failure may also occur in patients with extensive marrow fibrosis before transplantation, a viral illness, or from the use of some drugs (such as Methotrexate).

  • In leukemia patients, graft failure is often associated with cancer recurrence; the leukemic cells may inhibit the growth of the transplanted cells.

  • In some cases, the reasons for graft failure are unknown. The body makes enough white blood cells, platelets, or red blood cells to avoid infections, bleeding disorders, or anemia. But the bone marrow stops working and does not produce enough healthy blood cells.

  • Stem cells can be harvested or grown before they are infused into the donor. Graft failure occurs when the patient results in bone marrow failure with the absence of red blood cells, white blood cells, and platelet production. This results in infection, anemia, and bleeding.

  • Graft failure may also occur in patients with extensive marrow fibrosis before transplantation, a viral illness, or from the use of some drugs (such as Methotrexate).

  • In leukemia patients (cancer of white blood cells), graft failure in the leukemic cells may inhibit the growth of the transplanted cells.

  • Unexpected neutropenia after bone marrow transplantation can be caused by graft rejection.

  • Thrombocytopenia is a condition that causes low platelet count and anemia (low hemoglobin or red cell count) that leads to nonfunctional bone marrow.

  • Thrombocytopenia causes bleeding in the gastrointestinal (GI) tract, brain, lungs, and other body parts.

  • Anemia causes fatigue, lack of appetite, irritability, rapid heart rate, and other symptoms.

  • The infused bone marrow may fail to produce blood cells for the host's body.

  • This complication is called graft failure. It occurs because of infection, recurrent disease, or if the stem cell count of the donated marrow is insufficient to cause engraftment.

  • It is treated by giving a second infusion. In this case, the infused stem cells may be from a different donor and a different source than was used for the first infusion.

Conclusion:

Graft rejections can cause serious problems in the body that lead to a collapse in total blood count. Graft failure is treated with another transplant, including a conditioning regimen and an infusion of bone marrow or blood stem cells. During the period between the destruction of the old bone marrow and the production of new blood cells by the transplanted stem cells, the patient may experience neutropenia. Bone marrow replacement can cause neutropenia as a side effect due to the destruction of existing bone marrow and the time it takes for transplanted stem cells to begin producing new blood cells.

Frequently Asked Questions

1.

Is a Bone Marrow Transplant a Serious Procedure?

A bone marrow transplant is a very difficult and dangerous medical operation. It is widely used to treat leukemia and other life-threatening diseases. However, serious hazards such as immune system problems and graft-versus-host disease are associated with the procedure. Specialized care and close observation are essential during the transplant process.

2.

How Long Will a Person Live After Receiving a Bone Marrow Transplant?

The receiver's age, general health, kind of transplant, and underlying ailment being treated are among the variables that affect the survival rate following a bone marrow transplant. After receiving a transplant, the majority of patients go on to spend long, healthy lives. Some achieve long-term remission or even recovery, while others may encounter difficulties and complications that shorten their lives. In recent years, donor matching and medical treatment improvements have led to a notable increase in survival rates. Patients must communicate with their healthcare team about their prognosis and long-term outlook.

3.

Does Cancer Require a Bone Marrow Transplant Only?

A bone marrow transplant is not just used to treat cancer. Although leukemia, lymphoma, and myeloma are among the significant ailments for which it is used, severe aplastic anemia, hereditary immunological abnormalities, and certain metabolic disorders are examples of non-cancerous diseases for which it might be used. The transplant aims to restore normal blood cell production and immunological function by substituting healthy donor cells for damaged or dysfunctional bone marrow.

4.

What Is the Bone Marrow Transplant Success Rate?

The type of transplant, the underlying ailment, the patient's age and health, and the donor's compatibility all significantly impact the success rate of a bone marrow transplant. Success rates for leukemia, lymphoma, and several non-cancerous disorders typically vary from 40 percent to 90 percent; however, recent breakthroughs in supportive care and transplantation techniques have led to improved outcomes. It is crucial to speak with a medical team about each patient's prognosis and success rate in light of their unique situation. 

5.

Is Receiving a Bone Marrow Transplant Worth It?

A person's decision to receive a bone marrow transplant is complicated and unique. It is usually advised when there is the greatest possibility of a cure or a notable improvement in the patient's state, particularly in cases of life-threatening illnesses. The possible benefits must be carefully assessed against the dangers and potential problems, and patients should engage in detailed talks with their healthcare team to make an informed decision.

6.

A Bone Marrow Transplant: How Painful Is It?

Since a bone marrow transplant is usually done under anesthetic, the process itself is not painful. However, during the healing and therapy phases, patients may feel pain, nausea, and exhaustion, among other side effects. The severity of these effects varies based on the patient and the type of transplant. 

7.

What Things Should Patients With Neutropenia Avoid?

Individuals suffering from neutropenia, a disorder marked by reduced white blood cell counts, should steer clear of potentially infectious environments, such as congested areas and ill people. To lower their risk of infection, they should also wash their hands frequently and refrain from eating undercooked or uncooked since these could contain dangerous bacteria or pathogens.

8.

What Precautionary Measures to Be Taken for Neutropenic WBC?

Neutropenic patients should take precautions such as avoiding sick people's company, keeping a clean, sterile environment to lower exposure to pathogens, and maintaining strict hand cleanliness to lessen the chance of infection. To strengthen their immune systems, neutropenic people should also heed the advice of their medical professionals on vaccinations and preventative antibiotics. 

9.

What Are Neutropenia's Primary Causes?

The leading causes of neutropenia are autoimmune diseases that attack white blood cells, such as autoimmune neutropenia, underlying medical problems like leukemia or aplastic anemia, and side effects from certain treatments like chemotherapy. Neutropenia can occasionally be congenital, the product of inherited genetic mutations.

10.

What Risks Are Associated with Severe Neutropenia?

Because the body's defenses against infections are severely weakened, severe neutropenia increases the risk of infection. When neutrophil numbers are extremely low, even relatively simple infections can turn potentially fatal. Therefore, to control and avoid serious infections in individuals suffering from severe neutropenia, hospitalization, and antibiotic treatment may be required.

11.

Is There a Cure for Mild Neutropenia?

Since mild neutropenia can be a transient condition brought on by things like infections or adverse drug reactions, there may not always be a solution for it. If there is an underlying cause, it must be addressed. Mild neutropenia frequently goes away as the body heals from the triggering cause, necessitating no special therapies or interventions. To rule out any underlying problems or concerns, a healthcare physician should complete an evaluation of any chronic or inexplicable neutropenia.

12.

Does Neutropenia Cause No Harm?

Neutropenia that is mild or temporary may not be harmful and may be a typical reaction to a number of conditions, including infections or some drugs. On the other hand, because severe or persistent neutropenia raises the risk of potentially fatal infections, it is a serious medical problem. Diagnosing and treating neutropenia is imperative to avoid potential injury, mainly if it is persistent or recurrent.
Source Article IclonSourcesSource Article Arrow
Dr. Abdul Aziz Khan
Dr. Abdul Aziz Khan

Medical oncology

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