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Bone Marrow Transplantation

What is bone marrow?

Bone marrow is a spongy tissue in the bones and contains cells defined hematopoietic stem cells or blood-forming stem cells. Bone marrow forms blood cells by multiplying and differentiating to form blood cells when necessary.

What are blood cells?

Blood cells have vital tasks. Red blood cells (erythrocytes), which give the blood its red color, are responsible for carrying oxygen to the tissues. Blood platelets (platelets) function to stop bleeding by providing clotting. White blood cells (leukocytes) are responsible for fighting with microbes and protecting our body from all kinds of infections. White blood cells also perform the function of attacking and killing tumor cells. Numerical or functional disorders of these cells result in very different number of life-threatening diseases.

Most of hemopoietic stem cells are present in the bone marrow, but there are also hemopoietic stem cells in blood that is present in umbilical cord.

What is bone marrow transplantation?

Bone marrow transplantation (stem cell transplant) is a procedure in which stem cells are transplanted to the patient from the patient himself/herself or from someone else. In general, there are 2 types of bone marrow transplantation. Transplanting from patient's own stem cells is called 'autologous' bone marrow transplantation; and transplanting from own stem cells of another one is called 'allogeneic bone marrow transplantation'. Allogeneic transplantation can be performed from an identical twin (syngeneic), as well as from fully compatible mother, father, brother, or fully compatible unrelated people. In recent years, transplantations have also been performed from semi-compatible family members. These transplantations from parents, half-compatible siblings or children are also called haploidentical transplantations.

In what diseases is bone marrow transplantation performed?

 

  • Acute leukemia
  • Adrenoleukodystrophy
  • Aplastic anemia
  • Syndromes of bone marrow failure
  • Chronic leukemia
  • Hemoglobinopathy
  • Hodgkin's lymphoma
  • Immunodeficiencies
  • Congenital errors of metabolism
  • Multiple myeloma
  • Myelodysplastic syndromes
  • Neuroblastoma
  • Non-Hodgkin's lymphoma
  • Plasma cell disorders
  • POEMS syndrome
  • Primary amyloidosis
  • Solid organ tumors refractory or relapse to the treatment

 

What is done before a bone marrow transplantation?

How is the donor preparation done?

Collection methods of peripheral stem cells and bone marrow-derived stem cell are described. The patient's physician decides on the method of collecting stem cells. After conducting a physical examination of the donor, the following examinations are performed;

 

  • ECHO, ECG, lung radiography, upper abdominal USG
  • Hematological examinations
  • Microbiological examinations
  • Biochemical tests

After examinations stated above are completed, the physician evaluates the tests, and a donor is examined again. After all this is completed, planning of the stem cell collection process is carried out.

 

How is the transplantation patient prepared?

After physical examination of the patient who will undergo transplantation is conducted by a physician who is specialist of this field, execution of following tests are requested;

  • ECHO, ECG, lung radiography, total abdomen USG, neck USG
  • Respiratory function test
  • 6-minute walking test
  • Hematological examinations
  • Microbiological examinations
  • Biochemical tests
  • Consultation to Cardiologist
  • Consultation to Chest Diseases
  • Consultation to Otorhinolaryngologist
  • Consultation to Dental Practitioner
  • Consultation to Psychiatrist

After examinations stated above are completed, the physician evaluates the tests and examines the patient again. After all this is completed, hospitalization of the patient in the Bone Marrow Transplantation Unit is decided. In addition, there is a possibility that the patient who will undergone transplantation will become infertile. Therefore, the patient is informed during the preparation. Male patients are directed to freeze sperm before transplantation, and female patients are directed to freeze their eggs to appropriate unit.

How is bone marrow transplantation performed?

Bone marrow produces blood cells. Stem cells are immature cells that are in the bone marrow and form all different blood cells. Stem cells, which form the origin of all structures in the human body and have the ability to rapidly regenerate themselves, are a hope in the treatment of many diseases, including some types of cancer. Bone marrow stem cell transplantation comes up with quite successful results in the treatments of lymphoma that can be seen at any age, in blood cancers such as leukemia, various genetic disorders, inherited blood disorders, solid organ tumors refractory and relapse to the treatment, immune system diseases, and autoimmune diseases such as multiple sclerosis.

Hematopoietic stem cells are used in bone marrow transplantations. Stem cells are intravascularly transferred to the patient who is the recipient. For this, devices, that are called central venous catheters and are inserted intravenously, are mostly used. After transplantation, immature cells begin to live in the bone marrow and turn into various mature blood cells, including those:

 

  • Red blood cells carrying oxygen
  • Platelets helping blood clotting
  • White blood cells that help to fight with infection

 

Via bone marrow transplantation, damaged stem cells are replaced with healthy cells. This condition also helps the body to make enough white blood cells, platelets, or red blood cells to avoid infections, bleeding disorders, or anemia. There are different types of blood stem cell transplantation. The type of transplantation vary depending on the source of blood stem cells. In bone marrow transplantations (BMT), blood stem cells collected from the bone marrow are used. In peripheral blood stem cell transplantations (PBSCT), blood stem cells collected from blood circulation are used. In umbilical cord blood transplantations (CBT), blood stem cells collected from the placenta and umbilical cord of a newborn baby are used. Bone marrow transplantation is performed when person's bone marrow is not healthy enough to function properly. The reason for this may be chronic infections, various diseases, or cancer treatments. Bone marrow transplantations can benefit for people with following diseases:

 

  • Acute leukemia
  • Adrenoleukodystrophy
  • Aplastic anemia
  • Syndromes of bone marrow failure
  • Chronic leukemia
  • Hemoglobinopathy
  • Hodgkin's lymphoma
  • Immunodeficiencies
  • Congenital errors of metabolism
  • Multiple myeloma
  • Myelodysplastic syndromes
  • Neuroblastoma
  • Non-Hodgkin's lymphoma
  • Plasma cell disorders
  • POEMS syndrome
  • Primary amyloidosis
  • Solid organ tumors refractory or relapse to the treatment

 

There are two types of bone marrow transplantation (stem cell transplantation), which are autologous or allogeneic. Stem cell transplantation performed to treat malignant diseases can be autologous or allogeneic. Allogeneic source is often used for malignant diseases such as leukemia or myelodysplastic syndrome, which retain bone marrow. Autologous source is mainly used in solid tumors and some types of relapse or refractory lymphomas.

What is autologous bone marrow transplantation?

Purpose of autologous transplantation is to provide an opportunity for hematological recovery after high-dose therapy. Cells are taken from the patient's own bone marrow before chemotherapy and replaced with a new one after cancer treatment. In other words, in some cases, high-dose intensive chemotherapy or radiotherapy is applied to treat cancer. As a matter of fact, cancer treatment can damage our stem cells and immune system.

Physicians collect and store person's own stem cells and keep them as freezed before starting cancer treatment. These stem cells stored after cancer treatment are returned to the person. This process is called stem cell recovery. Autologous stem cell transplantation is most often used to treat diseases such as lymphoma and myeloma. In autologous stem cell transplantation, the recipient has very low risk of rejecting stem cells and very low risk of graft versus host disease (GvHD). For this reason, Autologous stem cell transplantation is safer than allogeneic transplantation.

What is an allogeneic bone marrow transplantation?

The procedure in which ‘bone marrow’ or 'peripheral blood' is taken from sibling and relatives of person who will undergo stem cell transplantation or from unrelated donor, is called allogeneic stem cell transplantation. These cells can also come from umbilical cord blood that is taken from the placenta after birth and stored in special banks for cord blood for future use.

After transplantation, cells settle in the patient's bone marrow and begin to produce blood cells. Now, blood cells produced in the patient are the cells that the donor produces his/her stem cells. Unlike autologous transplantations, allogeneic transplantations, create a new immune system response to fight cancer. In other words, during transplantation process, immune system (immune system) cells are also transplanted along with the donor's stem cells. If the donor's lymphocytes transferred to the patient during allogeneic transplantation perceive some cells that they sees differently as foreign, it starts a war against them, and this situation may lead to ‘graft versus host’ disease that causes severe damage to the recipient's organs. In this context, it is intended that there should be nearly total tissue compatibility between the patient and donor as much as possible so that battle does not start due to tissue differences after allogeneic stem cell transplantation. There are two commonly used terms for this type of transplantation. One of them is match-sibling-donor (MSD), and the other is Match-unrelated-donor. (MUD) is used to identify the process in which the MSD stem cell donor is the patient's sibling. MUD is a term used for transplantations that are performed with unrelated donors. In addition, human Leukocyte Antigens (HLA; human leukocyte antigens) are used to assess compatibility between the recipient of stem cells and donor of stem cells.

In order to reduce the risk caused by allogeneic stem cell transplantation, the patient is given drugs that suppress the immune system immediately after the transplantation for the purpose of suppressing the fighting capacities of the donor's lymphocytes. Although it is undesirable for the donor's lymphocytes to harm the patient, these warrior lymphocytes can also have a beneficial effect on cancer patients. These lymphocytes can detect cancer cells in the patient as foreign and kill them.

After a bone marrow (Stem cell) transplantation, it takes 10-15 days for stem cells to start producing blood cells again. During this period, blood cell supplement is transfused to the patient externally. This is because the bone marrow will need red blood cells and platelet transfusions during the period of time that is until it begins to produce enough healthy cells on its own. In order to assess the response of patients to the graft, they are required to come for follow-up visits in which blood tests are made. After the transplantation, patients may need to be followed up for many years to avoid serious problems.

What is considered after a bone marrow transplantation?

People who have bone marrow transplantation should be more attention to their health. This is because health problems such as high blood pressure (hypertension), high cholesterol after transplantation can worsen and delay your recovery.

Some of the ways to ensure that you stay healthy are to eat a healthy and balanced diet, to pay attention to your body mass index, and to stay away from stress. A dietitian can be consulted about eating healthy and balanced diet. Some things that can be considered regarding proper nutrition are as follows:

 

  • Alcohol consumption can cause complications
  • Prefer whole grain crispy and/or bread
  • Adopt a diet program with a low salt content.
  • Include fruits in your diet. However, avoid drinking grapefruit juice or grapefruit
  • Prefer low-fat milk and low-fat dairy products
  • Include plants of the cruciferae family, namely cruciferae in your diet
  • Consume fibrous products.

 

Why must I undergo bone marrow transplantation at Memorial Health Group?

With a vision of becoming a center of reference in many areas in Turkey, Memorial Bone Marrow Transplantation Center has all opportunities that current technology provides, for the purpose of meeting bone marrow requirements of the patients who live not also in İstanbul and Turkey but also in geographical region where we live in. In addition to ensuring international standards for bone marrow transplantation, our center provides all the services that patients need. In the center that will carry out treatment processes within multidisciplinary structure, people with lymphoma (Hematologic lymph node cancer), myeloma (hematologic bone cancer created by plasma cells), acute leukemia (Blood cancer) and chronic leukemia, and blood diseases such as aplastic anemia can undergo bone marrow transplantation.

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