What Is a Bone Marrow Transplant?

A Bone Marrow Transplant Provides Healthy Stem Cells to Cancer Patients

Bone marrow is the spongy tissue found in the center (medullary cavities) of bones that is responsible for producing red blood cells, white blood cells and platelets. As such, healthy bone marrow is necessary to sustain life. Sometimes, diseases such as cancer can affect the bone marrow, preventing it from making these essential cells. In other cases, a cancer patient’s chemotherapy or radiation treatment may damage or destroy healthy bone marrow so that it no longer generates the blood cells the patient needs. In these instances, a bone marrow transplant (BMT) may be necessary.

What are the types of bone marrow transplants?

There are three types of blood and bone marrow transplants: autologous, in which the stem cells are taken from the patient’s own blood; allogeneic, in which the stem cells are collected from a donor; and syngeneic, in which the stem cells are obtained from an identical twin.

Autologous transplants

Autologous stem cell transplants are commonly used to treat several kinds of blood cancer. In an autologous transplant, the donor is the patient himself or herself. The stem cells, which are harvested from the bone marrow and/or bloodstream, are typically collected from the patient when his or her disease is in remission, or at least in a more stable condition. Approximately one week before the BMT is to take place, the patient is given high-dose chemotherapy and sometimes radiation therapy to prepare his or her body for the transplant and destroy any lingering cancer cells (conditioning therapy). Finally, the stem cells are reintroduced to the patient via a central line.

Allogeneic transplants

Often recommended for patients with leukemia, allogeneic stem cell transplants involve collecting healthy stem cells from a donor who is a genetic match to the patient (often a sibling). This is similar to a syngeneic transplant, though the donor does not have to be an identical twin. Extensive DNA testing with any potential donor is required to ensure that the donor’s stem cells and white blood cells will be an appropriate match for the patient. With siblings, the chance is higher that the human leukocyte antigen (HLA) will match than with unrelated donors. However, if the transplant recipient does not have a sibling (or does not match with his or her siblings), stem cells from an unrelated donor may be utilized.

Sometimes, a patient and donor are not an identical match, but a transplant is still the best treatment option for the patient. To prepare for the transplant, the patient will first receive high doses of chemotherapy and radiation therapy. Then, the donor’s stem cells and white blood cells are infused through a vein, similar to a blood transfusion.

Syngeneic transplants

A BMT for which the donor is the patient’s identical twin is the least complicated bone marrow transplantation because there’s no risk of rejection, graft-versus-host disease or tumor in the marrow.

How does a bone marrow transplant work?

The idea behind BMT treatment is to re-introduce healthy blood-forming cells into the patient’s bloodstream, where they will start making healthy red blood cells, white blood cells and platelets. The healthy cells for transplantation will be collected from the patient or a donor that has been screened and determined to be an appropriate match. When it’s time for the transplant, the patient receives the donated cells through an intravenous (IV) catheter, or tube. 

What does a bone marrow transplant treat?

Bone marrow transplants are a common form of treatment for patients with a number of different conditions. For instance, patients with the following conditions may benefit from a stem cell transplant:

  • Leukemia (acute or chronic)
  • Lymphoma (Hodgkin or non-Hodgkin)
  • Lupus
  • Multiple myeloma
  • Multiple sclerosis
  • Myelodysplastic syndromes
  • Myelofibrosis
  • Myeloproliferative neoplasms
  • Paroxysmal nocturnal hemoglobinuria (PNH)
  • Primary amyloidosis
  • Severe anaplastic anemia (SAA)
  • Testicular cancer
  • Waldenstrom’s macroglobulinemia
  • Essential thrombocytosis (ET)
  • Ewing’s sarcoma

While a blood and bone marrow transplant is commonly used to treat individuals with these conditions, this procedure is not right for everyone. To determine if a transplant is the best option for any particular patient, the specifics of his or her case will be closely reviewed by the patient’s treatment team.

How do you prepare for a bone marrow transplant?

Intravenous blood transfusion

There are a number of steps that must be taken to prepare a patient for a bone marrow transplant. First, a series of tests must be administered to determine if the patient is healthy enough to undergo the transplant. A catheter (central line) may also be inserted into a vein in the chest, where it will remain for the duration of the transplant. After these initial procedures are completed, conditioning will begin. This involves receiving high doses of chemotherapy and possibly radiation therapy to destroy lingering cancer cells and suppress the immune system to prepare the body for the transplant. This process typically takes several days, though the dosage and duration of the conditioning therapies will depend on several factors unique to the patient. After conditioning has been completed, the patient is ready to receive the stem cell transplant.

What’s involved in bone marrow donation?

For patients who don’t have their own healthy cells to donate for their BMT, doctors look for a donor whose tissue type matches the patient’s for a certain protein, or marker, known as human leukocyte antigen (HLA). The body’s immune system uses HLA markers to distinguish between cells that ought to be present in the blood and those that shouldn’t. Therefore, incompatible HLAs can trigger an immune response, and the patient faces a higher risk of rejecting the transplanted cells.

Blood marrow donors are in high demand, as only about 30% of people who need a donor can find an HLA-matched family member to step in. Potential donors can register with the National Marrow Donor Program (NMDP) and either receive a mail-in kit or visit a donor center to provide a cheek swab or blood sample for analysis. Once the sample is analyzed, the volunteer donor’s HLA type is recorded in the NMDP database. Then, if an HLA match with a prospective BMT patient is identified, the NMDP contacts the prospective donor to confirm the match and provide information about the donation procedure.

If you’re a donor who’s matched to a patient that needs a transplant, you’ll meet with a representative of Be The Match® to complete a health questionnaire and go over the details of the donation procedure. If you agree to move forward with your donation, you’ll also undergo a physical exam and give blood samples.

A blood marrow donation requires surgery in a hospital operating room, during which you’ll be given anesthesia and doctors will use needles to withdraw liquid marrow from your pelvic bone. You may go home late the same day or be kept in the hospital overnight for observation. You may experience side effects; hip or back pain and fatigue are the most common. Most donors return to work or school within seven days. Donors do not incur medical costs.

Moffitt Cancer Center’s approach to a blood & bone marrow transplant

At Moffitt Cancer Center, we understand that a blood and bone marrow transplant is a complicated procedure that requires a great deal of commitment on the part of a patient and his or her caregiver. As a result, we’re here to provide comprehensive support to all of our transplant recipients, every step of the way.

To determine whether or not a patient is a good candidate for a bone marrow transplant, Moffitt’s transplant team will evaluate his or her age, individual care needs and medical history. During this process, we will also consider the various transplant techniques to determine which will be most beneficial to the patient.

If the patient requires an allogeneic transplant but does not have a sibling who is able to be the donor, Moffitt can search for a suitable volunteer donor through the NMDP. Currently, more than half of our allogeneic transplants are arranged with a volunteer donor, although an HLA match must still be obtained. Moffitt will also screen potential donors to ensure they are able to tolerate a stem cell harvest and that they do not have any active infections or other complications that might negatively impact their ability to donate.

When a patient is approved for a blood or bone marrow transplant procedure, Moffitt’s experienced physicians, nurses, lab technicians, transplant coordinators, dietitians and other medical professionals will work together to provide individualized guidance at every phase of the transplant process. This approach helps us achieve the most positive outcomes possible, while helping to enhance each patient’s quality of life.

If you have questions about our approach to blood and bone marrow transplant procedures, call 1-888-663-3488 or complete our new patient registration form online. We take pride in providing all new patients with rapid access to a cancer expert within a day, which is faster than any other cancer hospital in the nation.