Description

Bone Marrow Transplantation

What is bone marrow transplantation?

Bone marrow is the tissue responsible for the
production of blood cells in our body. Blood has three types of cells; red
blood cells that transport oxygen into organs and tissues, white blood cells
that act in defense of the body against external factors, and platelets for
clotting the blood. Cells responsible for the production of blood cells in the
bone marrow are referred to as hematopoietic progenitor cells. In other words,
the purpose of bone marrow transplantation is to transfer the stem cell, which
is responsible for the production of other cells.

Bone marrow is not the only source of stem cells used
for the bone marrow transplantation. The stem cells can also be derived from
the blood and the umbilical cord.

When a disease develops in the bone marrow or when
bone marrow is damaged, the body cannot produce healthy blood cell.

Bone marrow transplantation involves harvesting
healthy stem cells from the person or tissue-matched healthy donor, processing
the stem cells and infusing them to or back to the patient. The autologous bone
marrow transplant uses the cells harvested from the patient. When the bone
marrow is collected from another donor, the process is called allogeneic
transplant.

Autologous bone marrow transplantation has some
advantages. Since the patient’s own cells are used, tissue compatibility is not
a prerequisite. However, the patient must now have healthy bone marrow cells.
In the autologous transplantation, the bone marrow of the patient is processed
quickly and infused back without any delay. However, autologous bone marrow
transplantation is also a part of the treatment for patients who will receive
chemotherapy and/or radiotherapy in the future. The collected bone marrow cells
are specially processed, frozen and stored for the future use. Since
chemotherapy and/or radiotherapy damages the bone marrow, autologous
transplantation is performed to replace the damaged marrow.

In allogeneic transplantation, bone marrow, taken from
the tissue-compatible healthy donor, is used.  This donor may be either
your relative or any other foreign person. Irrespective of donor (whether
related or not), the tissue compatibility is the prerequisite of the allogeneic
transplantation.

Why is  bone marrow transplantation procedure done?

Bone marrow transplantation can be done to ensure
healthy and adequate blood cell production, because the patient’s bone marrow
cannot properly produce blood cells.

Bone marrow transplantation is also an option for
congenital blood diseases. Abnormal or inadequate functioning of the bone
marrow may result in insufficient production of blood cells, or the abnormal
cells may not function properly.

Bone marrow transplantation is the only treatment
option for blood cancer (leukemia) and lymph cancer (lymphoma) that are
unresponsive to other treatments or develop after the treatment.

Finally, if cancer develops in other organs and
tissues of the body, the patient will require treatments that damage the bone
marrow, such as chemotherapy and radiotherapy. After such treatments are
completed, bone marrow/stem cell is transplanted to sustain proper production
of blood cells.

Bone marrow transplantation helps below listed diseases:

• Leukemia
• Lymphoma
• Multiple Myeloma
• Aplastic Anemia
• Myelodysplasia
• Myelofibrosis
• Neuroblastoma
• Hodgkin lymphoma.
• Non-Hodgkin Lymphoma
• Hemoglobinopathies

Following a series of comprehensive evaluations and
examinations, your doctor will decide whether bone marrow transplant is the
treatment of choice for your condition or not.

Risks

Almost all diseases treated with bone marrow
transplant are life-threatening diseases.  For this reason, bone marrow
transplantation can lead to very serious complications. In autologous bone
marrow transplantation, the risk of such complications is very low, as
patient’s own bone marrow and/or stem cells are transplanted. Since the
likelihood of these complications depends on a number of factors, very
comprehensive assessments are needed to determine the complications that may be
present and to take the necessary precautions and you often need to be examined
by doctors rather than the doctor who treats your illness.

The complications associated with bone marrow
transplantation are listed below:

• Infection
• Fever
• Reaction against the bone marrow graft (Graft
  versus Host Disease)
• Recurrence
• Failure of the bone marrow or the stem cell to
  function in the recipient
• Side effects of chemotherapy given during the
  preparation phase before the bone marrow transplantation (diarrhea,
  vomiting, nausea, fever, mouth sores, serious infections, etc.)

Although all possible measures that modern medicine
allows are taken to prevent occurrence of risks, it is no means possible to
warrant that the risks will be completely eliminated.

Our expert transplant team will employ all practices
to minimize the risk of complications and your primary physician, the
transplant team and doctors of other departments will inform you, before the
transplantation, about risks listed above and all other potential complications
and will address all your concerns.

Preparation

After it is decided that bone marrow transplantation
can work in the treatment of your condition, you will need to have a series of
comprehensive examinations and examinations. The first goal of this preparation
phase is to determine whether your general health will allow the bone marrow
transplantation.  If any health problem is identified that may pose a risk
on the bone marrow transplantation, they will be treated to make you more and
better prepared for bone marrow transplantation.

The second goal of the preparations is to facilitate
bone marrow transplantation and to minimize the complications that may occur
afterwards.

In the case of autologous bone marrow or, more
generally, stem cell transplantation, some drugs should be used, first in order
to increase production of stem cells and then to ensure the increase the number
of stem cells to be collected for the period that your doctor will instruct. A
long and thin tube, known as central venous catheter, is placed into one of the
great veins of the body. This catheter allows both administration of medicines
that stimulate production of stem cells and infusion thereof.

Your doctor will decide on the source of the bone
marrow source to be used to treat your condition. You may be transferred your
own stem cells or stem cells can be harvested from a relative or a from a
person you have never met.

If your own stem cells are used, your blood is
processed in an apheresis device to collect blood stem cells from the blood.

In the case of allogeneic transplantation, your doctor
will determine the most appropriate source (bone marrow, blood, umbilical cord)
to harvest the stem cell.

If the bone marrow transplant is required to replace
the bone marrow damaged by anti-cancer treatment, you will be placed on
high-dose chemotherapy and/or radiotherapy.  At this stage, you may
experience complications of chemotherapy and radiotherapy and these
complications must be treated to continue with the bone marrow transplant.
 Possible complications include, but not limited to hair loss, nausea,
vomiting, diarrhea, mouth sores, infection, fatigue, malaise, infertility and
bleeding.

After the complications are eliminated or alleviated
enough to allow bone marrow transplantation, your immune system is suppressed
so that your body does not reject the bone marrow. At this stage, you will be
significantly prone to infections and therefore, you need to follow the
measures very strictly.

Surgery and early postoperative period

The stem cells that are already collected from you or
any other donor and prepared properly are infused through the central venous
catheter. At this stage, you feel no pain and local anesthesia or sedation is
not required.

All your vital signs are closely monitored throughout
the infusion of stem cells. If a risk is encountered, the process is paused and
sustained after the problem is treated.

The stem cells infused to your body distribute in your
body and eventually reach your bone marrow.  If no complication is faced,
your stem cells will settle in your bone marrow and start producing new,
healthy blood cells. The stage that transplanted stem cells can produce new
blood cells is referred to as engraftment. You may need blood transfusion
(erythrocyte suspension and platelet solution) before the production of new
blood cells takes place.

Production of new blood cells will be monitored in the
light of blood tests. In addition, blood and urine tests, imaging studies and
close observation will be sustained to assess your general health and manage
complications, if any.

Even if you are healthy enough to be discharged from
the hospital after bone marrow transplantation, you should be closely followed
up by your doctor for the time interval that may, sometimes, take many years.

Results

Bone marrow can be transplanted to treat your
condition (leukemia, lymphoma, etc.) or to manage adverse effects of other
diseases (bone marrow damage secondary to hyigh-dose chemotherapy in tissue and
organ cancers).

Bone marrow transplant requires patience, close
observation and strict compliance to instructions of your doctor.

It is always possible to face complication at pre-transplant
preparation phase, during transplantation and in the short- and long-term after
the after transplantation. All of them will be assessed and treated one by one
and you will eventually have to follow a long way to resume a healthy normal
life.

The multidisciplinary team of Medicana Health Group
has the experience, knowledge and medical equipment necessary to restore your
general health.