What Is a Bone Marrow Transplant?
A bone marrow transplant is a surgery that replaces damaged or diseased bone marrow with healthy marrow. Bone marrow is a spongy material inside your bones where your body makes and stores blood cells. Damaged bone marrow makes too few blood cells and not enough cells for your immune system.
Why Would You Need a Bone Marrow Transplant?
A bone marrow transplant can treat or cure certain diseases and some types of cancer. It does this by replacing damaged bone marrow with healthy marrow and helping rebuild your immune system.
You may need a transplant if you have:
- Acute or chronic leukemia
- Hodgkin’s or non-Hodgkin’s lymphoma
- Waldenström macroglobulinemia
- Multiple myeloma
- Aplastic anemia
- Amyloidosis
- Myelofibrosis
- Myeloproliferative disorders
- Germ cell tumors
- Sarcoma
- Some autoimmune diseases, such as lupus
- Cancer treatments, such as high doses of chemotherapy or radiation
Bone marrow transplant for cancer
Your doctor may suggest a bone marrow transplant if you have one of several types of cancer. Some forms of cancer begin in blood cells in the bone marrow, while others can travel from different parts of your body and attack the bone marrow. In both cases, bone marrow can’t make enough healthy blood cells, which you need to survive. A bone marrow transplant can replace bone marrow cells that were damaged by cancer or killed by cancer treatment (chemotherapy and/or radiation therapy).
You may need a bone marrow transplant if you have:
- Leukemia
- Lymphoma
- Multiple myeloma
- Germ cell tumors
- Waldenström’s macroglobulinemia
- Sarcoma
- Myeloproliferative neoplasm
- Myelofibrosis
Bone marrow transplant for autoimmune diseases
If you have an autoimmune disease, your immune cells attack healthy tissue in your body. Autoimmune diseases can often be controlled with medication, but some cases don’t respond well enough and become severe. Doctors have discovered that bone marrow transplants can help some patients with specific forms of severe autoimmune disease. In some cases, doctors remove healthy stem cells from your blood and use those to “reset” your immune system so that it behaves normally. In other cases, you may receive stem cells from a donor. Doctors are now using bone marrow transplants to treat some severe cases of:
- Crohn’s disease
- Multiple sclerosis
- Scleroderma
Researchers are studying whether bone marrow transplants might be an option for patients with several other autoimmune diseases.
Bone marrow transplant for aplastic anemia
Aplastic anemia is a rare disease that causes your bone marrow to stop producing blood cells, making it a very serious illness. A blood transfusion can be lifesaving if you have aplastic anemia, but it’s not a long-term solution. For some patients, a bone marrow transplant might be the answer. Doctors first remove your diseased bone marrow with drugs and/or radiation, then replace it with healthy bone marrow cells, ideally from a close relative to ensure that they’re a good match for your body.
Bone marrow transplant for amyloidosis
Amyloidosis is a disease in which your white blood cells don’t work properly and start producing clumps of protein that get deposited in your body’s organs, causing damage. If you have a form called AL amyloidosis, you may be able to undergo a bone marrow transplant. In this procedure, a doctor takes healthy cells from your marrow, uses drugs to destroy your damaged cells, and returns the healthy cells to your marrow where they can grow and multiply. If the operation is successful, amyloidosis can be cured.
Types of Bone Marrow Transplants
There are different types of bone marrow transplants:
Autologous bone marrow transplant
Your medical team collects stem cells from your own marrow or blood and stores them while you get cancer treatment. Then, they put the stem cells into your bloodstream. The cells travel to your bone marrow and multiply to help it make healthy stem cells again.
Allogeneic bone marrow transplant
After cancer treatment, you get stem cells from a person whose bone marrow closely matches yours. This may be a close family member, such as a parent or sibling, or someone from a national donor list. If the donor is an identical sibling whose tissue type is exactly the same as yours, it’s called a syngeneic transplant.
There are also two variations of allogeneic bone marrow transplants:
Umbilical cord blood transplant. This is a form of bone marrow transplant that uses stem cells from the blood in a newborn’s umbilical cord. The stem cells are harvested soon after birth and frozen until they’re needed. Because these stem cells are immature and not well developed, they don’t need to be a close match to your bone marrow.
Haploidentical transplant. If you need a bone marrow transplant but can’t find a donor who is a perfect match for your tissue, you may be able to have a haploidentical transplant. In this procedure, you receive stem cells from a donor whose bone marrow is similar, but not identical, to yours. Doctors can treat the stem cells to make this safe.
Preparing for a Bone Marrow Transplant
Your doctor will decide whether a bone marrow transplant would work for you. They’ll give you a physical exam and tests to check your blood and how well your heart, lungs, liver, and other organs are working.
If a transplant seems like a good option, they’ll talk with you about what type of procedure you’ll have and what you can expect.
In some cases, you may need to have a tube called a central venous catheter put into a vein in your chest. This is usually done as outpatient surgery before the transplant. Your medical team will use it to take blood and give you medicine. It will stay there until after your treatment.
Collecting cells for an autologous bone marrow transplant
Your doctor might use a long needle to take stem cells from your marrow, usually in your hip bone or sternum. It’s done in an operating room under general anesthesia, which means you’re asleep and don’t feel anything. The procedure takes 1 to 2 hours. You can go home that day or the next morning. You might feel sore and weak for a few days.
They can also take cells directly from your blood with a procedure called apheresis. You’ll need to get a drug called filgrastim, which triggers your bone marrow to make and release a lot of stem cells, for a few days beforehand. Your doctor may also give you another drug, called plerixafor, to help with this process. Then, your medical team will take blood from a vein in your arm and run it through a machine that separates the stem cells, returning the other cells to your bloodstream. Apheresis is an outpatient procedure, which means you won’t have to stay in the hospital. It usually takes 2 to 4 hours.
Collecting cells for an allogeneic bone marrow transplant
Your doctor will match you with someone who has the same human leukocyte antigen (HLA), which is a protein found in most cells in your body. Your HLA type is something that runs in your family. If you have a sibling who has the same parents as you, there’s a 25% chance that she or he is an HLA match.
Whether they’re a relative or a stranger, the donor will go through the same process to collect their stem cells. If parents choose to donate cells from an infant’s umbilical cord blood, the cells will be collected at birth, after the cord is clamped and cut.
Who can donate bone marrow?
You may be able to donate bone marrow if you’re healthy, not pregnant, and between the ages of 18 and 60. However, some organizations that recruit bone marrow donors only accept donors between the ages of 18 and 40. That’s because stem cells donated by younger people have a greater likelihood of resulting in a successful transplant.
Bone Marrow Transplant Procedure
Your bone marrow transplant will take place in several steps.
Bone marrow transplant conditioning
You’ll start with a process called conditioning. This usually involves a high dose of chemotherapy, often with radiation, for about 5-10 days. It’s different for everyone and is based on your overall health and the condition being treated.
Conditioning makes room for new cells to grow in your bone marrow. It also briefly weakens your immune system to keep your body from fighting the new cells.
Bone marrow transplant conditioning side effects
Side effects may include:
- Mouth sores
- Nausea and vomiting
- Diarrhea
- Trouble eating
- Increased risk for infections
- Fatigue
- Hair loss
- Cataracts
- Heart, liver, or kidney failure
- Lung or breathing problems
- Premature menopause
- Fertility problems
After a few days of rest, you’ll get new blood stem cells through the central venous catheter. You’ll probably be awake for this, but it shouldn’t hurt.
Engraftment
Once the new cells reach your marrow, they’ll grow into red blood cells, white blood cells, and platelets. This process, called engraftment, can take 2-4 weeks.
Bone Marrow Transplant Recovery
After you receive donor bone marrow, your doctors will want to monitor you closely. Living with your new bone marrow requires some lifestyle changes to help the transplant succeed.
Recovery time
The recovery process is different for everyone, but you’ll probably spend several weeks in the hospital. Your immune system will be weak, so you’ll take medicines to prevent infections. You may also need blood transfusions.
For the first few weeks, your doctors will test your blood often to check for engraftment. They might also take a small sample of your bone marrow for this.
You can usually leave the hospital after you meet certain criteria, including specific blood cell counts and no fever for 2 days. You’ll also have to have someone at home who can help take care of you.
Your immune system can take a year or longer to recover after your transplant. You’ll need to see your doctor often and keep taking medications to prevent infections and graft vs. host disease (GVHD). This is when the new cells attack your own.
Lifestyle changes
Your medical team may recommend that you see a specialist called a dietitian. They can work with you to create a diet plan that will help prevent infections and keep you healthy. They may tell you to:
- Avoid foods and drinks that carry a higher risk of foodborne illness.
- Choose foods that give your body the nutrients it needs.
- Take multivitamins or supplements to fill gaps in nutrition.
- Limit sodium.
- Avoid alcohol.
- Avoid grapefruit and grapefruit juice, which could interfere with your medications.
- Follow general food safety guidelines.
You probably won’t be able to return to work or other activities for a while. And your doctor might tell you to make a few lifestyle changes, such as:
- Limit your time in direct sunlight, as your skin may be more sensitive.
- Don’t get a body piercing or tattoo.
- Take extra care to prevent cavities.
- Keep your home clean and free of mold.
- Don’t smoke tobacco.
Risks of Bone Marrow Transplants
A bone marrow transplant can have complications, such as:
- Bleeding
- Infections
- Low blood cell counts
- Skin rash
- Diarrhea
- Fertility problems
- Cataracts
- Muscle spasms or leg cramps
- Painful inflammation in your mouth and digestive tract
- Liver or kidney problems
- Trouble breathing
- Organ damage
A transplant also makes it more likely that you’ll have another cancer later on.
It’s rare, but some of these problems can be deadly.
Graft vs. host disease
If you get a transplant from a donor, your doctor will monitor you closely for a potential complication called graft vs. hostdisease (GVHD). GVHD happens when the donor cells received by you consider your tissue as a foreign body and attack it. This complication can occur as soon as 10 days after a transplant (acute GVHD) or up to a year and a half later (chronic GVHD). Report any of these symptoms immediately:
- Nausea and vomiting
- Stomach cramps and pain
- Diarrhea, which may be bloody
- Loss of appetite
- Yellowing of your skin and eyes
- Weight loss
- Joint or muscle pain
- Shortness of breath
- Persistent cough
- Vision changes
- Dry eyes
- Skin changes, such as a rash on your palms or soles of your feet
- Dry mouth and mouth sores
Bone Marrow Transplant Outlook
Your doctor will tell you what they’re looking for in order to declare a transplant a success. This might include blood counts that are back to safe levels and a disease that’s under control.
The success of a bone marrow transplant depends on a lot of things, including:
- Your age
- Your overall health
- The type of procedure you had
- How it affects your disease
- How well you tolerate certain procedures or treatments
- Whether you have any complications
Transplants have cured thousands of people of their diseases. Doctors are also finding new ways to make them better.
If you find yourself struggling with stress or emotional issues after your transplant, talk with your doctor or a social worker. They can help you find resources such as support groups with people who know what you’re going through.
Takeaways
A bone marrow transplant is an important treatment option you may need to consider if you have cancer that affects your blood, though these procedures are increasingly used for other medical conditions. Scientists have developed techniques that allow you to donate your own cells to treat diseased bone marrow, though you may need a donor to provide healthy cells. The process of preparing for, receiving, and recovering from a bone marrow transplant is difficult and can take months, but it can be lifesaving.
Bone Marrow Transplant FAQs
How does a bone marrow transplant work?
In a bone marrow transplant, your diseased bone marrow is replaced by healthy stem cells, which can become any kind of tissue. A doctor removes your diseased bone marrow by treating it with chemotherapy and sometimes radiation. This process is called conditioning and it quiets your immune system for a short time, preventing it from attacking the new stem cells when they’re infused. These stem cells may come from your own body or a donor. Over time, they form healthy new bone marrow tissue.
What is the survival rate of a bone marrow transplant?
How long someone survives after a bone marrow transplant depends on many factors, including the type and severity of the disease, the type of transplant used, and others. According to one estimate, nearly 80% of people who have allogeneic bone marrow transplants (meaning the healthy cells received from a donor) survive at least 10 years. Another study found that 70% of patients with multiple myeloma who receive their own cells, known as an autologous transplant, survive at least 5 years.
What is life like after a bone marrow transplant?
You can live a fulfilling life after a bone marrow transplant, but you must also be prepared to take on some new responsibilities and make some lifestyle changes. Your doctor will want to see you on a routine basis to monitor you for complications, so attending every appointment is essential. Depending on the type of transplant you had, you will also need to take medication regularly to prevent it from failing. You may experience side effects from the treatment that can last the rest of your life. And making certain lifestyle changes, such as adjusting your diet, can help ensure that your transplant is a success.
Can I live without a bone marrow transplant?
If your doctor has recommended a bone marrow transplant, it’s likely because other treatment options aren’t working to control your disease. If you’re unsure about having this procedure, get a second opinion from another doctor.
