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Bone Marrow Transplant Surgery


Introduction to Bone Marrow Transplant Surgery

Bone marrow transplantation is a special therapy for patients with certain cancers or other diseases with an aim to transfuse healthy bone marrow cells into a person after his or her own unhealthy bone marrow has been eliminated.

A bone marrow transplant is a surgery that involves taking cells that are normally found in the bone marrow (stem cells), filtering those cells, and giving them back either to the donor from whom they were taken from or to another person. It is a stem cell transplant that takes place in a hospital or outpatient facility in which the stem cells are collected (harvested) from bone marrow.

What Is a Bone Marrow Transplant?

A Bone Marrow Transplant is a medical procedure performed to replace bone marrow that is damaged or destroyed by a disease, infection or chemotherapy. This procedure involves transplanting of blood stem cells, which travel to the bone marrow to produce new blood cells and promote growth of new marrow.

Bone marrow is the spongy, fatty tissue inside your bones and creates the various parts of the blood such as red blood cells, which carry oxygen and nutrients throughout the body, white blood cells, which fight infection and platelets, which are responsible for the formation of clots.

A bone marrow transplant is done to replace your damaged stem cells with healthy cells so that your body can make enough white blood cells, platelets, or red blood cells to avoid infections, bleeding disorders, or anemia.

These Healthy stem cells can come from a donor, or they can produce from your own body. In such cases, stem cells can be harvested, or grown, before you start chemotherapy or radiation treatment and are then stored and used in transplantation.

Why Bone Marrow Transplant?

A person should undergo Bone Marrow Transplant when his marrow isn’t healthy enough to function properly. The following are the reasons for which an individual should undergo a bone marrow transplant

  • Aplastic anemia, a disorder where marrow stops making new blood cells
  • Cancers which can affect the marrow, such as leukemia, lymphoma, and multiple myeloma
  • Damaged bone marrow due to chemotherapy
  • Congenital neutropenia, an inherited disorder that causes recurring infections
  • Sickle cell anemia, an inherited blood disorder that causes misshapen red blood cells
  • Thalassemia, which is an inherited blood disorder where the body makes an abnormal form of hemoglobin, an integral part of red blood cells

Diet and nutrition to be taken After your bone marrow transplant

  • Eating plenty of fruits and vegetables each day
  • Eating lean meats, poultry and fish
  • Eating whole-grain breads, cereals and other products
  • Having enough fiber in your daily diet
  • Drinking low-fat milk or eating other low-fat dairy products, to help maintain enough calcium
  • Maintaining a low-salt and low-fat diet
  • Following food safety guidelines
  • Avoiding alcohol
  • Staying hydrated by drinking adequate water and other fluids each day
  • Avoiding grapefruit and grapefruit juice due to their effect on a group of immunosuppressive medications

Why is bone marrow transplant needed?

  • Replace diseased bone marrow with healthy, functioning marrow.
  • Treat a disease that affects the production of bone marrow cells or severe immune system illness.
  • Regenerate a new immune system that will fight existing or residual leukemia or other cancers not killed by the chemotherapy or radiation used in the transplant.
  • Replace the bone marrow and restore its normal function after high doses of chemotherapy and/or radiation are given to treat a malignancy.
  • Replace bone marrow with genetically healthy functioning bone marrow to prevent further damage.
  • The risks and benefits must be weighed in a thorough discussion with the doctors and the specialists in bone marrow transplants, prior to the procedure

Types of bone marrow transplants

  • Autologous bone marrow transplant
  • Allogeneic bone marrow transplant
  • Siblings (Matched related donor/ MRD)
  • Parent/Children (Haploidentical stem cell transplant)
  • Unrelated bone marrow transplants (UBMT) or matched unrelated donor (MUD)
  • Umbilical cord blood transplant

Process of bone marrow transplant

  • First, you are going to be assessed in a proper measure to as to see whether your body can handle this type of process
  • Once the donor has been accessed, the stem cells are retrieved either through the direct or the peripheral manner.
  • Now, these cells are preserved in a refrigerated ecosystem
  • As the refrigeration and preservation is going on, the patient is given immunosuppressant in order to make sure that once the stem cells are grafted, they remain.
  • Then the cells are retrieved from preservation unit and the transplantation takes place.
  • The transplant involves several processes like Leukapheresis where the cells will be injected into you using intravenous injections or any other process.
  • Once the transplant is over with, you will be kept under quarantine because your immune system is deliberately shot up as a precautionary measure to make sure that the new stem cells remain.
  • After the quarantine period, you will be sent home.
  • However, even after returning, it might take some time for you to get back to your normal life

Tests that are to be performed before Bone Transplant Surgery

  • Human Leukocytic Antigens (HLA) test
  • Blood tests to check ferritin, complete metabolism, haemoglobin solubility, blood type, blood count and platelet count, frequency of bleeding and the amount of immunoglobulins
  • Physical examination
  • Imaging test
  • Electrocardiogram (ECG) to check your heart’s rhythm and electrical activity
  • X-ray and/or computerized tomography (CT) scan to check lungs and liver condition
  • Pulmonary function test to determine how much air is taken into the lungs when the patient inhales and how quickly breath is exhaled
  • Tests of small pieces of bone marrow (biopsy) to examine the patient and donor condition
  • Tests to evaluate the medical conditions like Hepatitis, HIV, immunodeficiency diseases and certain viruses of Donor

What is the purpose of the tests?

  • Confirm a blood cancer diagnosis or a bone marrow disorder
  • Determine the cause of severe anemia or thrombocytopenia (low platelet count)
  • Detect abnormal chromosomes to determine your risk and to plan treatment
  • Evaluate your response to therapy
  • Help track your progress during treatment

Risks involved in Bone Marrow Biopsy

  • Infections
  • Graft Versus Host Disease
  • Graft failure
  • Anemia
  • Bleeding in the lungs, intestines, brain, and other areas of the body
  • Cataracts
  • Clotting in the small veins of the liver
  • Damage to the kidneys, liver, lungs, and heart
  • Delayed growth in children who receive a bone marrow transplant
  • Early menopause
  • Inflammation and soreness in the mouth, throat, esophagus, and stomach, called mucositis
  • Pain
  • Stomach problems, including diarrhea, nausea, and vomiting
  • Cancer relapse

What happens during a bone marrow biopsy?

Now-a-days Bone Marrow Transplant is done on outpatient basis that means you can go home on the same day. However the procedure may vary depending on your condition and your provider’s practices.

  • You will be asked to remove clothing and may be given a gown to wear
  • Your position may vary depending on the bone that is used
  • You may be asked to lie on your side or your stomach if the pelvis bone is used
  • During the procedure, you will need to lie as still as possible
  • The skin over the biopsy site will be cleaned with a sterile (antiseptic) solution.
  • You will feel a needle stick as the provider injects a local anesthetic to numb the area
  • A small cut (incision) may be made over the biopsy site
  • The biopsy needle will be inserted through the bone and into the bone marrow.
  • A bone marrow aspiration is usually done first
  • The provider will use a syringe to pull a small liquid sample of the bone marrow cells through the needle which may cause you feel pain
  • You will have a pulling feeling when the marrow is removed
  • The provider performs a core biopsy where he will remove a small, solid piece of bone marrow using a special hollow needle
  • The biopsy needle will be removed and the firm pressure will be applied to the biopsy site for a few minutes, until the bleeding has stopped.
  • A sterile bandage or dressing will be applied.
  • The bone marrow samples will be sent to the lab for exam

Growing demand for bone marrow transplant surgery

The medical science has developed various treatments for a number of diseases that are known as deadly and find some of the best solutions for them. A bone marrow transplant is a surgery that gets people out of the dangers suffering from deadly diseases like cancer and gives them a long and healthy life. But, the procedure is backing out because of the insufficient numbers of donors like all the other transplants. The bone marrow makes red blood cells or erythrocytes and white blood cells or leukocytes and blood platelets or thrombocytes.

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Generally, these cells go through renewal through stored stem cells in the bone marrow otherwise known as the virgin cells. The bone marrow is situated in the middle of the long bones such as the humerus bone of the arm, the pelvic bone in the pelvis, etc. The bone marrows are way too different from that of the spinal cord which is a part of the nervous system stocked in the form of the channel by vertebrae.

How is the bone marrow transplant conducted?

A bone marrow transplant consists of taking a small bone marrow sample from the donor and infusing it into the patient. Some deadly diseases can be treated undergoing this procedure, and it is highly effective in the cases of leukemia because the cancer cells in this disease invade the bone marrow and make it function improperly. This condition also goes with the case of aplasia where the bone marrow does not function properly and is unable to produce white and red blood cells.

The bone marrow transplant can also be done by the bone marrow transplant doctors in India when a harmful treatment procedure accidentally destroys the bone marrow completely or partially, and that stops the production of red blood cells risking the patient with anaemia. When your white blood cell count falls, your body stops fighting to foreign germs and infections, and when your platelet count is reduced than normal, you experience bleeding.

What is the HLA system?

The major problem with bone marrow transplant surgeries is the graft rejection which means that when the recipient is unable to accept the bone marrow of the donor. You need to know that every individual has his bone marrow characteristics and the tissues are genetically inherited, and the immune system is programmed in such a way that it can eliminate all the foreign elements from the body. These tissue properties are also known as the “HLA system”.

When the bone marrow transplant doctors in India opt for an organ transplant that meets all the criteria of HLA system, it is termed to be compatible. In such cases, the recipient body accepts the donor cells, and the immune system does not damage the transplanted organ in any way, and it is identified as an organ that is belonging to the body. There is a procedure known as autologous bone marrow transplant that uses the patient’s bone marrow, and it is collected first and then frozen to be used later in life.

What to Expect After a Bone Marrow Transplant?

The success of a Bone Marrow Transplant depends on how closely the donor and recipient genetically match and it can be very difficult to find a good match among unrelated donors. Your engraftment state is regularly monitored and it generally complete between 10 and 28 days after the initial transplant.

The first engraftment sign is a rising white blood cell count which shows that transplant has started producing new blood cells.

The recovery time for a Bone Marrow Transplant is 3 months. However it may take a year for you to recover fully. There is a possibility that the symptoms that are experienced before the surgery would remain same even after the surgery. Bone Marrow Transplant recovery depends upon various factors such as

  • the condition being treated
  • chemotherapy
  • radiation
  • donor match
  • where the transplant is performed

Diseases that can be treated:

  • Multiple myeloma
  • Relapsed Hodgkins Disease
  • Relapsed Non Hodgkins Lymphoma (NHL)
  • Neuroblastoma
  • Relapsed Ewings Sarcoma
  • Metastatic Ewings Sarcoma
  • Metastatic Germ cell tumors
  • Medulloblastoma, other brain tumors
  • Other solid malignancy
  • MDS
  • AML
  • High Risk ALL
  • Relapsed or Refractory AML/ALL
  • CML
  • Refractory Lymphomas
  • Myeloproliferative Neoplasms (MPN)
  • Severe Autoimmune Diseases
  • Multiple Sclerosis
  • Aplastic Anemia
  • Thalassemia
  • Severe Immunodeficiency disorders
  • Inherited Metabolic disorders

What are the side effects Associated with a Bone Marrow Transplant?

  • A drop in blood pressure
  • A headache
  • Nausea
  • Pain
  • Shortness of breath
  • Chills
  • A fever
  • Graft-versus-host disease (GVHD)
  • Graft failure
  • Bleeding in the lungs, brain, and other parts of the body
  • Cataracts, which is characterized by clouding in the lens of the eye
  • Damage to vital organs
  • Early menopause
  • Anemia, which occurs when the body doesn’t produce enough red blood cells
  • Infections
  • Nausea, diarrhea, or vomiting
  • Mucositis
  • Soreness in the mouth, throat and stomach

Transplant problems that may show up later

  • Organ damage
  • Relapse (the cancer comes back)
  • Secondary (new) cancers
  • Abnormal growth of lymph tissues
  • Infertility (the inability to produce children)
  • Hormone changes, such as changes in the thyroid or pituitary gland
  • Cataracts

Questions to ask the health care team

Before you undergo Bone Marrow transplant, please consider asking your health care team the following questions:

  • Who will perform the procedure?
  • What will happen during the procedure?
  • How long will the procedure take?
  • What are the risks and benefits of having the procedure?
  • Will I be awake or asleep during the procedure?
  • Will I feel any pain during the procedure? If so, for how long? What can be done to reduce the pain?
  • How soon can I return to my normal activities after the procedure?
  • Can you give me instructions on how to care for the wound?
  • When will I learn the results?
  • Who will explain the results to me?

Will My Insurance Pay for Bone Marrow Transplants?

Every health insurance policy is different. Some plans pay for transplant and some don’t. Probably the insurance company may pay for the cost of expenses incurred for transplant but not for the cost to find a donor or cord blood unit. You need the permission of insurance company before talking to someone else about your case.

Questions for your insurance company:

These are the questions you need to ask your insurance company so that you can plan for the expenses of transplantation.

  1. What are my deductible and out-of-pocket maximum for medical benefits?
  2. What is the maximum on my insurance coverage? What happens if my financial coverage runs out?
  3. Do I have a transplant maximum separate from my lifetime max?
  4. How does my plan determine transplant approval?
  5. If transplant coverage is denied, am I able to appeal? What is the process?
  6. If I have a question regarding my Explanation of Benefits (EOB), whom should I call?
  7. How will a change in my job status affect my insurance? What would the increase be in my deductible?
  8. What pre- and post-transplant tests are covered?
  9. Does my plan cover donor-searching expenses?
  10. Does my plan cover the expenses incurred by my bone marrow donor?
  11. Are expenses for meals, lodging, and transportation covered while I wait for my transplant? Are there maximums placed on the reimbursement for these items?
  12. Do I report to you if I have secondary insurance?
  13. What are my possible out-of-pocket expenses for prescriptions?
  14. At which participating pharmacies can I fill my prescriptions?
  15. Does my insurance provide coverage for home health services? Is there a maximum on my home health service coverage?
  16. Is there a co-pay for a specialist office visit?

Bone Marrow Transplant Surgery – FAQs

Do donor required to have same blood group of a patient?

No, donor and patient need not have the same blood group as a patient. There are some 6-10 major markers in the DNA that need to match up perfectly in order to consider a match.

Will pieces of bone are removed during this process?

No, bone pieces are removed during Bone Transplant Surgery. Only the stem cells which have ability produce other blood cells that mature and function as needed are collected.

Is donation bad for the donor’s health?

Bone marrow donation is no exception to risk and complications as every medical procedure involves some risk. Five percent of the donor’s marrow is harvested which does not cause any problems and these harvested cells replace themselves within four to six weeks.

What are the diagnostic tests are to be performed before a bone marrow transplant?

  • Physical Examination
  • Imaging Tests
  • Bone Marrow Biopsy
  • Blood Test

Which medical conditions require a bone marrow transplant?

  • Leukemia
  • Aplastic Anemia
  • Sickle Cell Anemia
  • Lymphoma
  • Thalassemia
  • Multiple myeloma
  • Immune deficiency disorders
  • Neuroblastoma
  • Hurler’s Syndrome
  • Adrenoleukodystrophy

When is a bone marrow transplant necessary?

A bone marrow transplant is used as a treatment for certain blood cancers, blood disorders such as aplastic anemia, thalassemia and sickle cell anemia and in rare cases for certain solid tumors (germ cell tumors).

What are stem cells?

Stem cells are the immature and most important cells needed in a bone marrow transplant as they produce other blood cells that mature and function as needed.

These stem cells after transplanting find their way to the recipient’s marrow and begin to differentiate (mature) and produce all types of blood cells that are needed by the body.

Who can benefit from Bone Marrow and Stem Cell Transplantation?

  • Acute and chronic leukemias
  • Aplastic anemia
  • Non-Hodgkin and Hodgkin lymphoma
  • Multiple myeloma
  • Myelodysplastic syndromes
  • Primary amyloidosis

What are the chronic GVHD signs and symptoms?

  • Joint or muscle pain
  • Shortness of breath
  • Persistent cough
  • Vision changes, such as dry eyes
  • Skin changes, including scarring under the skin or skin stiffness
  • Rash
  • Yellow tint to your skin or the whites of your eyes (jaundice)
  • Dry mouth
  • Mouth sores
  • Abdominal pain
  • Diarrhea
  • Nausea
  • Vomiting

What are the other names for Bone Marrow Transplant?

  • Stem cell transplant
  • Peripheral blood stem cell transplant
  • Blood cell transplant
  • Hematopoietic stem cell transplant (HSCT)
  • A high-dose therapy with stem cell rescue.

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