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Bone Marrow Transplant - Complications, Types, and Prognosis

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Bone Marrow Transplant - Complications, Types, and Prognosis

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A bone marrow transplant is a procedure of introducing bone marrow cells in a patient with damaged bone marrow cells. This article explains bone marrow transplants in detail.

Medically reviewed by

Dr. Goswami Parth Rajendragiri

Published At June 22, 2021
Reviewed AtAugust 30, 2022

Introduction:

Bone marrow transplant is one of the commonly practiced transplant procedures. It is a procedure carried out to replace the damaged or destroyed bone marrow in the body. The damage could be due to disease, chemotherapy, or infection. There is the transplantation of stem cells from the blood, which migrate towards bone marrow and produce new cells that grow and function as bone marrow. This will help in the production of any desired type of blood cells like WBC, RBC, etc., to prevent anemia, bleeding disorders, or any infection.

Bone marrow is present within the bones and is spongy textured fatty tissue. It helps in the formation of red blood cells, white blood cells, and platelets which are the important constituents of the body. It also contains hematopoietic stem cells, which are immature cells that help in the formation of blood cells. The stem cells have the potential to differentiate into any type of desired and required tissue. The healthy stem cells can be obtained from a donor or the patient’s own body.

Why Is a Bone Marrow Transplant Required?

Bone marrow transplants are indicated in those individuals who have diseased, damaged, or infected bone marrow that does not perform its functions properly. This could be due to chronic infections, disease, or cancer treatments.

Following conditions can require the transplant:

  • Cancers affecting the bone marrow like leukemia.

  • Aplastic anemia affects the formation of new blood cells.

  • Chemotherapy-induced damage.

  • Congenital neutropenia.

  • Multiple myeloma.

  • Sickle cell anemia.

  • Thalassemia.

Are There Any Complications Associated With a Bone Marrow Transplant?

As beneficial it sounds to have a bone marrow transplant, it may lead to certain risks or complications as the following:

  • Headache.

  • Nausea.

  • Pain in the transplanted area.

  • A decrease in blood pressure.

  • Chills or shivering.

  • Fever.

  • Difficulty in breathing.

The abovementioned symptoms are for a short duration, but certain complications can be severe too. Moderate to serious complications are dependent on certain factors like the age and overall health condition of the patient, the causative disease, and the type of transplant done.

Following are some of the moderate to severe complications that may occur:

  • Graft-versus-host disease (GVHD) - In this, the donor cells start to attack the cells of the recipient's body.

  • Failure of the graft - This can occur if the transplanted cells fail to produce new cells.

  • The occurrence of bleeding in the organs like the brain, lungs, etc.

  • Cataracts.

  • Early occurring menopause.

  • Certain infections.

  • Chronic damage to vital organs of the body.

  • Anemia.

  • Nausea.

  • Diarrhea.

  • Vomiting.

  • Mucositis involving the mouth, the inner lining of the stomach, etc.

When you experience any of the signs and symptoms, you should consult your physician or specialist immediately to get medical assistance.

What Are the Types of Bone Marrow Transplant?

Bone marrow has been classified into types as follows:

1. Autologous Transplants:

This involves the usage of the individual’s stem cells. The collection of cells is done before the initiation of cell-damaging procedures like radiation or chemotherapy. Autologous transplants involve the use of a person’s stem cells. It is rarely available and is possible only if the patient has healthy bone marrow cells. But, it can present some serious complications like GVHD.

2. Allogeneic Transplants:

These types of transplants use cells from a donor person. For this, the donor has to be a close genetic match. This type of transplant is important in patients with damaged bone marrow cells. These types of patients have an increased risk of developing GVHD. You may also require certain medications to suppress your immune system so that the new bone marrow cells are not affected.

How Is It Performed?

When you visit your physician, you will be assessed for the need for a transplant and the type of transplant. The procedure is similar to blood transfusion. In case of an allogeneic transplant, the harvesting of bone marrow cells will be done from your donor within one or two days before your appointment for the procedure. If the patient’s cells are being used, then the cells will be obtained from a stem cell bank. Cell collection can occur in two ways. The bone marrow is obtained from both the hip bones using a needle. This procedure will be carried out under anesthesia.

What Is Leukapheresis?

Leukapheresis is a process in which five shots are given so that the stem cells can migrate from bone marrow to the bloodstream. Before this, the blood is drawn from the body using an intravenous (IV) line, and then a machine is used to separate the white blood cells from the blood which contains stem cells.

The needle used is called a central venous catheter or a port that is installed on the upper right side of the chest. This will help the stem cells to go into the heart and grow. The port is not removed and left in place as the bone marrow transplant procedure is done in many sessions and is completed in a few days.

When multiple sessions are done, it improves the chances of integration of stem cells in the body. This is called engraftment. This port is also used for blood transfusions, nutrients, liquids, etc. Post-procedure, certain medications are given to improve the success rate and prevent any complications. Also, you will be monitored for any complications.

What Is the Prognosis?

The prognosis depends on the individual, their disease, and the type of graft used. You may have some minor symptoms, which will get better in a few days. You will be regularly monitored for any complications, and usually, it is from 10 to 28 days. Some people may develop moderate to severe complications that need immediate medical attention.

Conclusion:

Bone marrow transplant is very useful in individuals with damaged bone marrow. It helps them to develop blood cells. Online medical platforms have made it easy for patients to talk to a physician or specialist when required. You can contact a specialist online to know more about bone marrow transplants, the procedure, and the possible complications.

Frequently Asked Questions

1.

What Is the Prognosis of Bone Marrow Transplantation?

A better prognosis following bone marrow transplants is seen in younger patients. Increasing age has proven to cause a poor prognosis and decrease the survival rate after bone marrow transplantation. Recipients with good clinical status and are at the initial stages of the disease also show better prognoses.

2.

What Are the Types of Bone Marrow Transplants?

Depending on the donor type, there are two types of bone marrow transplants. They are, namely, autologous and allogeneic transplants. The hematopoietic stem cells in autologous transplants are taken from the same individual who is about to undergo the bone marrow transplant (self-donation). In allogeneic transplants, the stem cells are collected from a healthy donor and matched (for tissue compatibility) with the recipient.

3.

What Are the Most Common Complications After Stem Cell Transplantation?

The most common complications reported following stem cell transplants are immune reactions against the donor tissue (graft-versus-host disease), bone marrow (graft) failure, organ damage due to inflammatory reactions, infections, cataracts, infertility, and developing other new types of cancers.

4.

What Is the Success Percentage of Bone Marrow Transplants?

The success rate was 62%  in the first year following bone marrow transplantation. The survival rate decreases to 15 %  after three years. Long-term survival is seen in younger individuals with autologous transplants.

5.

What Are the Side Effects of a Bone Marrow Transplant?

The most common side effect following the bone marrow transplant is a greater risk of developing infection due to the reduced levels of white blood cells. Therapies like chemotherapy and radiation treatments weaken the immune system. Other side effects include fatigue, breathing problems, hair loss, decreased levels of platelets, bleeding tendencies, and decreased levels of red blood cells leading to anemia.

6.

What Are the Treatment Options in a Bone Marrow Transplant Failure?

In cases of bone marrow failure, doctors would suggest retransplantation with different donor stem cells (with more compatibility) after assessing the patient's clinical conditions.  Other therapeutic options include chemotherapy, clinical trials, donor lymphocyte infusions, and supportive care.

7.

Who Can Donate Stem Cells for Bone Marrow Transplants?

Healthy individuals are screened for stem cell donation donors, preferably between 18 to 35 years of age.  The upper limit to be included in the national marrow donor program is 40 years of age. Apart from age criteria, stem cells from siblings and self show better compatibility in bone marrow transplantations.

8.

How Long Is the Duration of Hospitalization After Bone Marrow Transplantation?

Following bone marrow transplantation, the recipients are hospitalized for a duration ranging from 1 to 3 months.  Developing complications such as infections or immune reactions prolongs the hospital stay.

9.

Which Is an Ideal Tissue for a Bone Marrow Transplant?

Healthy blood-forming cells that are needed for bone marrow transplants are collected from three sources, namely, bone marrow (spongy tissue inside the bones), peripheral blood-forming stem cells (PBSC), and cord blood that is collected from the placenta or the umbilical cord following childbirth.

10.

What Are the Advantages of Bone Marrow Transplants?

Bone marrow transplants help replace the affected person's bone marrow cancer cells. The highly toxic doses of chemotherapy and radiation could be avoided. New stem cells produce normal, noncancerous blood cells. It is the most effective treatment to eradicate cancer cells directly.
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Dr. Goswami Parth Rajendragiri
Dr. Goswami Parth Rajendragiri

Pathology

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