Bone Marrow Transplant and The Important Things In It

A bone marrow transplant is a procedure to renew bone marrow that is damaged and no longer able to produce healthy blood cells. Bone marrow transplant is also known as stem cell or stem cell transplant.stem cells).

Bone marrow is tissue that is found in some bones, such as the pelvis and femur. Bone marrow functions to produce red blood cells (erythrocytes), white blood cells (leukocytes), and platelets (platelets).

Bone marrow can be damaged by disease, such as cancer and infections, or by cancer treatments, such as chemotherapy and radiotherapy. Damaged bone marrow can interfere with the production of blood cells. The blood cells produced by damaged bone marrow may also be unhealthy or not functioning normally.

Bone marrow transplantation aims to restore the function of damaged bone marrow. This procedure is done by inserting healthy stem cells into the patient's body. These healthy stem cells will then develop and produce healthy blood cells.

Bone Marrow Transplant Indications

Bone marrow transplantation is performed to treat disorders of bone marrow function that can be caused by the following diseases:

  • Adrenoleukodystrophy
  • aplastic anemia
  • Primary amyloidosis
  • Sickle cell anemia
  • Congenital neutropenia
  • Metabolic disorders
  • Immune system disorders
  • Leukemia
  • Lymphoma
  • Multiple myeloma
  • Neuroblastoma
  • Osteopetrosis
  • POEMS syndrome
  • Myelodysplastic syndrome
  • Wiskott-Aldrich . syndrome
  • Thalassemia

In addition to the consequences of the above conditions, bone marrow transplantation can also be done to replace bone marrow damaged by chemotherapy and radiotherapy.

Before Bone Marrow Transplant

Before undergoing a bone marrow transplant, there are several things that patients need to know and live by, namely:

Procedure before transplant

The doctor will explain about the process, side effects, and risks that may occur after a bone marrow transplant. After that, the doctor will perform a series of tests to assess whether the patient is healthy and suitable for the bone marrow transplant procedure. This series of tests includes:

  • Overall medical history and physical examination
  • Examination of the patient's emotional and psychological condition
  • Cardiac examinations, such as ECG (electrocardiography) and echocardiography
  • Lung examination, such as chest X-ray and spirometry
  • Blood tests, which include a complete blood count, blood chemistry, and screening for viruses in the blood
  • Scan with CT scan or MRI
  • HLA (human leukocyte antigen) tissue typing, which is an examination to find out whether the donor's bone marrow will match the prospective donor recipient
  • Bone marrow biopsy

After all the above examinations are complete and the patient is declared ready for a bone marrow transplant, the doctor will continue the preparation process by inserting a catheter into a vein in the neck or chest.

The catheter is used to insert blood stem cells and drugs. During treatment, the catheter will remain in the patient's body.

Blood stem cell collection

Stem cell collection can be done by autologous (from the patient's own body) or allogeneic (from the donor's body). Here is the explanation:

  • Bone marrow transplant autologous

    In bone marrow transplant autologous, the doctor will perform the apheresis procedure.

    The filtered stem cells will be frozen for use in the transplant procedure, while the separated blood will flow back into the patient's body.

  • Bone marrow transplant allogeneic

    In bone marrow transplant allogeneic, the doctor will take stem cells from the blood or bone marrow of a donor.

    Before taking stem cells, donors must first undergo tests to determine whether their stem cells match the patient's. Usually, the preferred donor is from the patient's family or close relatives.

    Apart from blood or bone marrow, doctors can also take stem cells from a newborn's umbilical cord. Blood from the umbilical cord is generally still immature, so the risk of incompatibility with the patient is less.

Customization process

In this process, the patient will undergo chemotherapy or radiotherapy. Depending on the patient's condition, the doctor may only run one or perhaps both types of therapy at once.

The adjustment process to chemotherapy and radiotherapy aims to:

  • Prepares bone marrow for new stem cells
  • Suppress the immune system
  • Destroy cancer cells

This process takes 5-10 days. During this stage, patients may experience side effects, such as hair loss, diarrhea, nausea, and vomiting. However, the doctor will give medication to relieve these side effects.

After the adjustment process is complete, the patient will be asked to rest for a few days before undergoing the transplant process.

Bone Marrow Transplant Procedure

Before starting the bone marrow transplant process, the doctor will give the patient drugs through an IV. This drug is useful for reducing the risk of side effects from preservatives used in the stem cell clotting process.

Next, the frozen stem cells will be thawed by heating. After the stem cells are liquid, the doctor will insert the stem cells through a catheter in the vein that was previously installed.

During the transplant process, the patient remains conscious and does not feel pain.

The new stem cells that enter the patient's body will go to the bone marrow and will begin to multiply to produce healthy blood cells. This process can take place 10–28 days after transplantation, which is characterized by an increase in the number of white blood cells.

The time it takes for the blood cell count to return to normal depends on the patient's condition and the type of transplant being undertaken. However, the blood cell count will usually return to normal in 2–6 weeks.

After Bone Marrow Transplant

After the bone marrow transplant is complete, the doctor will monitor the patient's condition. If infection or other complications occur, the patient must be hospitalized in the hospital, until the patient's condition is confirmed to improve.

During the first few weeks after the transplant, the doctor will periodically transfuse red blood cells and platelets, until the new bone marrow can produce enough blood cells. Doctors may also prescribe medications, such as:

  • Antibiotics, antivirals, or antifungals, to prevent infection
  • Immune system suppressant drugs, to prevent graft-versus-host disease

After undergoing the recovery process at the hospital, patients are allowed to go home if they meet the following conditions:

  • No fever for 48 hours
  • Can eat and drink by mouth for at least 48 hours
  • Nausea, vomiting and diarrhea can be controlled with medication
  • The number of blood cells has increased and is considered no longer dangerous
  • Having family or other people to help the patient's needs at home

The recovery process after a bone marrow transplant can take up to 3 months. However, the patient may take up to 1 year to fully recover. Several factors that affect the length of the patient's recovery process are:

  • Genetic match between donor and recipient
  • The intensity of radiotherapy or chemotherapy the patient received
  • General health condition of the patient

Complications of Bone Marrow Transplant

Each patient can experience different side effects after undergoing a bone marrow transplant. Some patients may experience only fever, nausea, pain, and headache. However, in some cases, patients can also experience serious complications, such as:

  • Infection
  • Cataract
  • Early menopause
  • infertility
  • Internal organ bleeding
  • The growth of new cancer cells
  • Graft-versus-host disease
  • Transplant failure
  • Organ damage