Bone Marrow (Stem Cell) Transplants
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If you have blood cancer, the specialists at the Blood and Bone Marrow Cancer Program can help. Your hematology oncologist may recommend you have a bone marrow, or stem cell, transplant. The bone marrow transplant procedure is highly individualized and disease-specific. It depends on a number of factors:
- How advanced your blood cancer is
- The type of blood cancer you have
- Your own personal medical condition and response to therapy
Beth Israel Deaconess Medical Center (BIDMC) is a certified site of the National Marrow Donor Program (NMDP). This organization provides access to donors from around the world through a registry of more than 5 million possible donors. This partnership provides you with better access to the care you need.
How Bone Marrow Transplants Work
Think of a bone marrow or stem cell transplant as a transfusion of blood and immune cells rather than a surgical procedure.
Stem cells — also known as pluripotent stem cells — are immature blood cells that can develop into red blood cells, white blood cells and platelets. These blood cells are essential to life:
- Red blood cells carry oxygen from your lungs to the rest of your body, including all your organs, and return carbon dioxide to the lungs to be exhaled.
- White blood cells prevent and fight infections
- Platelets help the blood clot and prevent excessive bleeding
Bone Marrow
Bone marrow is essential for producing these three main types of blood cells. Bone marrow is the soft, spongy tissue inside bones.
Stem cells are mainly concentrated in your bone marrow space in bones like the hips, sternum and skull. Most stem cells are found in the bone marrow, although some, called peripheral blood stem cells, circulate in blood vessels throughout the body. Stem cells also are found in umbilical cords.
Bone Marrow versus Stem Cell
The main difference between a bone marrow and a stem cell transplant is in the method of collecting the stem cells. Bone marrow donation is a surgical procedure, under either general or epidural anesthesia. Donating stem cells is similar to donating blood, through a sterile needle in your arm. The blood passes through a special machine that separates and collects the stem cells, and then returns the blood through the other arm.
Candidates for Bone Marrow Transplant (BMT)
Typically, treatment for blood cancers involves chemotherapy or a combination of different types of chemotherapy. Treatment can be given with or without a bone marrow transplant, and radiation therapy in some cases.
Your cancer care team may recommend a bone marrow transplant for you in these situations:
- For early-stage Hodgkin disease — a highly curable cancer — treatment is a combination of chemotherapy and radiation therapy
- Myeloma may require a bone marrow transplant
- Lymphoma may require a transplant if the cancer returns
- For leukemia, if and when to have a bone marrow transplant depends on a range of factors
Some patients undergoing a bone marrow transplant may need chemotherapy and/or whole-body radiation to destroy diseased bone marrow and create space for new, donated marrow.
Your transplant doctor will discuss with you the treatment options best suited for your diagnosis. If you aren’t clear about the transplant type your physician has chosen for you, please contact your nurse transplant coordinator. The coordinator can discuss the type of transplant you need, or they can schedule an appointment for you with your transplant doctor to review your treatment.
More About Bone Marrow (Stem Cell) Transplants
There are three types of bone marrow or stem cell transplants at the BIDMC Transplant Institute:
Autologous Stem Cell Transplants
These are stem cells that come from your own bone marrow or blood. Doctors extract stem cells from your blood or bone marrow, place them in frozen storage and re-infuse them back into your body following high-dose chemotherapy to eliminate blood cancers.
Allogeneic Stem Cell & Bone Marrow Transplants
These are stem cells that come from matched related donors (siblings, for example), or from matched unrelated donors or donated umbilical cords.
Cord Transplant
Sometimes we are unable to find an adult donor. In those circumstances, we can almost always use donated cords. The umbilical cord from a newborn baby is rich with stem cells. After a delivery, if someone chooses to donate, these cords are typed, and then put in a cord blood bank, waiting for a patient match.
Stem cells used in the transplant can come from three sources in the body:
- Blood. To collect peripheral cells for transplant, the care team can give medications to push more of these stem cells from your marrow into the blood. Your doctor then collects the blood through a process known as apheresis. We’ll separate out, remove or harvest the stem cells for the transplant.
- Bone marrow. In some cases, your doctor removes the stem directly from the bone marrow through a surgical procedure.
- Umbilical Cord. The umbilical cord from a newborn baby is rich with stem cells. Doctors sometimes use these cords as a source of stem cells.
You’ll spend time in the hospital after your bone marrow transplant. Learn more about the recovery and transplant unit to prepare yourself and your family for your time in the hospital.
You will stay in the hospital for about three weeks if you are having an autologous stem cell transplant, and about four weeks if you are having an allogeneic stem cell transplant. You will have a private room, which our team has specially cleaned and prepared for you.
In order to keep your environment protected and clean, the door of your room will remain closed. When the door is opened, the air pressure will ensure that air from the hallway will not enter. We’ve furnished each room with these amenities:
- Private bathroom
- Cupboard and closet
- Small refrigerator
- Telephone
- Television and VCR/DVD player
Blood Count Monitoring
During your transplant, the number of blood cells (white blood cells, red blood cells and platelets) in your body will drop. To monitor this effect, we’ll watch your blood counts very closely. Your care team will make important decisions about your care according to the results.
For several weeks, we will draw a complete blood count (CBC) each day. The CBC gives details on the level of various cells in your blood.
Inpatient Physical Therapy
While you’re spending time in the hospital following your bone marrow transplant, you’ll likely work with a physical therapist. Physical therapists can perform a comprehensive evaluation and set up a care plan to minimize the effects of your extended hospital stay. Physical therapists prescribe exercise and conditioning programs to keep you strong, modifying these programs according to your performance and medical condition. Physical Therapy Cooperative Program students can help with your exercise needs.
Visitors
We encourage you to have visitors throughout your hospital stay. Visitors often provide a needed break in your daily routine. Although the Bone Marrow Transplant Unit does not have strict visiting policies, suggested visiting hours are between 11:00 am and 9:00 pm. This allows you to get proper rest. There is flexibility to these suggested times, but no one is allowed to stay overnight in your room.
Leaving the Hospital
Your cancer care team will decide when the time is right for you to return home after your stem cell transplant. You’ll continue to be closely monitored when you return home.
Learn more about preparing for your bone marrow transplant.
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