Bone Marrow Transplant

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About Bone Marrow Transplant

A bone marrow transplant is basically a treatment that replaces insalubrious marrow with a healthy one. It’s also known as a blood or marrow transplant (BMT).

Bone marrow refers to the soft, spongy tissue inside your bones that makes blood-forming cells (blood stem cells). These cells turn into blood cells including:

  • White blood cells to combat infections.
  • Red blood cells to transport oxygen throughout the body.
  • Platelets to manage bleeding.
  • Blood-forming cells are also found in the blood stream and the umbilical cord blood.

Before transplant, patients undergo chemotherapy (chemo) with or without radiation to eliminate the diseased blood-forming cells and marrow. After this, healthy cells are given to you (it’s not surgery). The new cells are inserted into the bloodstream using an intravenous (IV) line, or tube. It’s more like getting blood or medicine through an IV. The cells find their way into your marrow, where they nurture and start making healthy red blood cells, white blood cells and platelets.

Bone marrow transplants are done to manage:

  • Blood cancers such as leukemia or lymphoma
  • Bone marrow diseases like aplastic anemia
  • Other immune system or genetic diseases like sickle cell disease

There three primary types of Bone Marrow Transplant such as

  1. Autologous transplant – uses one’s own blood-forming cells
  2. Allogeneic transplant – uses blood-forming cells donated by another person
  3. Haploidentical transplant – a kind of allogeneic transplant

Autologous transplant

In case of an autologous transplant, one’s own blood-forming cells are gathered, frozen and stored. Then, they’re given back to the patient after chemotherapy (chemo) and most likely radiation. Your doctor will decide the best time to assemble your cells. Once the collection is done, the cells can be frozen for months or years until the need for transplant arises.

How cells are collected?

There are two ways to do this:

1.  Peripheral blood stem cell (PBSC) collection: The cells are collected from your bloodstream. This process is known as apheresis. Before apheresis, patient receives shots for a few days to augment the number of blood-forming cells in your bloodstream. During apheresis, blood is eliminated from your vein through an intravenous (IV) line, passed through a machine, and put back into your vein. The machine takes out the blood-forming cells that will be used for your transplant. Most patients who have an autologous transplant collect their cells this way.

2.  Bone marrow collection: The cells are collected from the pelvic (hip) bone during surgery. You get anaesthesia so you don’t feel pain. A doctor uses a special needle to take out the blood-forming cells from your bone marrow.

Allogeneic transplant

In case of allogeneic transplant, patient tends to get healthy blood-forming cells given by someone else. The donor can be a family member or someone unrelated to you. Sometimes, people get donated blood-forming cells from umbilical cord blood. This is the blood collected from the umbilical cord and placenta after a baby is born and made available through Be The Match Registry.

The best transplant outcomes (results) is said when a patient’s HLA closely matches the donor’s HLA. A close HLA match also helps lower the risk for problems after transplant. Matching HLA markers is much more complex than matching blood types.

Haploidentical transplant

A haploidentical transplant is a kind of allogeneic transplant. It employs healthy, blood-forming cells from a half- matched donor to replace the unhealthy ones. The donor is basically a family member.

For allogeneic transplants, the doctor examines the patient’s blood to find out your human leukocyte antigen (HLA) type. HLA is a protein — or marker — found on most cells in your body. Doctors look for a donor or umbilical cord blood that closely matches the HLA.

A haploidentical, or half-matched, donor is generally your mom, your dad or your child. Parents are always a half-match for their children. Siblings (brothers or sisters) have a 50% (1 out of 2) chance of being a half-match for each other. It’s very unlikely that other family members (like cousins, aunts or uncles) would be a half-match.

A haploidentical transplant is relatively a newer kind of transplant. This means:

  • Patient may have the option to be a part of clinical trial (research study).
  • Not all transplant centres will do this type of transplant.

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