7 Things You Need to Know About Bone Marrow Transplants

April 21, 2017 | by City of Hope

Despite these numbers, many people remain unaware of the facts behind this lifesaving procedure — and the global need for more stem cell donations.

In the weeks leading up to our 41st annual “Celebration of Life” reunion event — where bone marrow transplant survivors and their families will celebrate the victories they've attained in fighting cancer — we will be publishing a series of articles to answer these basic yet essential questions about bone marrow transplantations. 

Below, seven essential facts:

1. What is a bone marrow/stem cell transplant?

Bone marrow is a soft, spongy tissue within the bones that produces hematopoietic stem cells. These stem cells normally develop into healthy red blood cells, white blood cells and platelets. A bone marrow or stem cell transplant replaces stem cells that are cancerous, faulty or destroyed by chemotherapy or radiation.

2. What’s the difference between a bone marrow transplant and a stem cell transplant? 
 
The terms “bone marrow” and “stem cell” are sometimes used interchangeably, since bone marrow is the source of hematopoietic stem cells, and healthy stems cells are what patients need. However, there’s a technical difference regarding the donation procedures.  In a bone marrow transplant, these stem cells are collected from a donor’s bone marrow. While under general anesthesia, the donor’s bone marrow is harvested directly from the hip bones through a large needle.
 
In a  peripheral blood stem cell transplant, or PBST, stem cells are harvested from a donor’s blood through a process called apheresis. Donors receive a medication for five days that increases stem cell production. This process, which harvests stem cells from the bloodstream, is similar to a blood donation. 
 
Another type of stem cell transplant uses hematopoietic stem cells from umbilical cord blood, which parents agree to donate to a public cord blood bank for use by a matching patient in need. In all cases, the final product that the patient receives are stem cells.

3. Who needs a bone marrow/stem cell transplant?

Typically, patients diagnosed with leukemia, lymphoma, myelodysplasia, multiple myeloma, severe blood diseases and certain immune deficiency diseases may benefit from a transplant. A patient’s primary care doctor and an oncologist (cancer specialist) or hematologist (blood specialist) will recommend the best treatment options.

4. What’s the difference between allogeneic and autologous transplants?

An allogeneic transplant (“allo” means “other”) requires stem cells from a donor. A donor must have a similar HLA tissue type as the patient. There is a one in four chance that a patient’s biological sibling will be a good match. A match might also be found through a national registry such as Be The Match.

In an autologous transplant (“auto” means “self”), a patient’s own stem cells are collected from the blood and frozen, similar to the way a donor’s would be. Sometimes a patient may receive anti-cancer drugs first to reduce the possibility of cancer cells being picked up along with the stem cells.

In both types of transplants, the patient typically receives high doses of chemotherapy or radiation to destroy the cancer. Finally, the stem cells — either the donor’s or the patient’s own — are thawed and given to the patient, where over time they will grow and create healthy blood cells.

The type of transplant a patient receives will depend mostly on the disease being treated. Other important factors are the recipient’s age and health, the stage and status of the disease, the ability to collect and treat the patient’s stem cells, and/or the availability of a donor. Also, for older, more fragile patients, transplants that do not use high-dose chemotherapy and radiation (called “mini-transplants”) may be a viable option.

5. What are the risks and benefits of bone marrow/stem cell transplants?

In allogeneic transplants, the stem cells from healthy donors are cancer-free and can fight any remaining cancer cells (a phenomenon called “graft-versus-cancer”). However, there’s a risk that the donor’s immune cells might attack the patient’s healthy cells (“graft-versus-host disease”). To reduce this risk, patients are usually given drugs to suppress their immune system. However, a weakened immune system can lead to serious infection.

In autologous transplants, because a patient’s own stem cells are used, there is no risk of graft-versus-host disease. There is also a lesser risk of infection. However, there is a possibility that a patient’s cancer cells may contaminate the stem cells.

6. What can a patient expect after a bone marrow/stem cell transplant?

Most patients stay in the hospital for several weeks. They are carefully monitored for complications and treated for side effects from chemotherapy or radiation. Once patients are released, they face a long recovery process and need frequent follow-up care. During this time it’s important for them to closely follow their doctors’ instructions to ensure the best outcome. 

7. What makes City of Hope’s transplant center unique?

As one of the largest transplant centers in the world, City of Hope has performed over 13,000 bone marrow/stem cell transplant procedures since 1976. For 11 consecutive years, City of Hope has been ranked as an “overperforming” transplant center with better than expected survival outcomes. The program’s success is confirmed by the thousands of former patients who celebrate their survival and second chance at life at the annual Bone Marrow Transplant Reunion. City of Hope’s Hematologic Malignancies and Stem Cell Transplantation Institute is also leading the way in stem cell and cord blood transplants, as well as immunotherapy in treating blood cancers.

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On April 28, 2017, thousands of bone marrow and stem cell transplant recipients and their families will attend City of Hope’s 41st annual “Celebration of Life” reunion, where attendees will celebrate the victories they have attained in the fight against cancer, and where several patients will get the rare opportunity to meet their donors. Learn more about City of Hope's Hematopoietic Cell Transplantation Program.
 

 

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