Bone marrow transplant

Alternative names:

transplant of the bone marrow

Definition:

Surgical procedure to transplant healthy bone marrow to a patient with deficient bone marrow function, usually due to chemical treatment (chemotherapy) or radiation treatment for cancer. The healthy bone marrow may be taken from the patient prior to chemotherapy or radiation treatment (autograft) or it may be taken from a donor (homograft).

Description:

Bone marrow is a soft fatty tissue found inside bones. It produces blood cells (red blood cells, platelets, and white blood cells). When the patient develops disease of the blood cells (anemias, leukemias, or lymphomas) or when cancer treatment (chemotherapy and radiation therapy) damages or destroys the bone marrow, a transplant with healthy bone marrow can save the patient's life. Patients need bone marrow transplants because they have dangerously low white blood cells (which are needed to fight infection) as a result of cancer treatments or have cancer of the blood cells.

Bone marrow transplant patients are usually treated in specialized centers and the patient stays in a special nursing unit (bone marrow transplant unit: BMT) to limit exposure to infections.

Donated bone marrow must match the patient's tissue type. It can be taken from the patient, a living relative (usually a brother or a sister: allogeneic), or from an unrelated donor (found through the national marrow donor program which lists more than 700,000 potential donors). Donors are matched through special blood tests called HLA tissue typing (see HLA antigens).

Bone marrow is taken from the donor in the operating room while the patient is deep asleep and pain-free (under general anesthesia). Some of patient's bone marrow is removed from the top of the hip bone (iliac crest). The bone marrow is filtered, treated, and transplanted immediately or frozen and stored for later use. Bone marrow transplant is transfused into the patient through a vein (IV line) and is naturally transported back into the bone cavities where it grows quickly to replace the old bone marrow.

Indications:

Bone marrow transplant may be recommended for:

• bone marrow deficiency disease caused by:
  • red blood cells (aplastic anemia)
  • white blood cells (leukemia or lymphoma)
  • aggressive cancer treatments (chemotherapy, radiation therapy)
  • inherited (genetic) diseases (such as thalassemia)

• immune system disorders (immunodeficiency) such as:
  • congenital neutropenia
  • severe combined immunodeficiency syndrome

Bone marrow transplant surgery is not recommended for:

• patients with heart, kidney, lungs, or liver disorders
• patients with insulin-dependent diabetes mellitus (IDDM)
• patients with other diseases that may limit survival.