Bone Marrow Transplantation (BMT)

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Definition | Body Parts Involved | Reasons for Procedure | Complications | What to Expect | Outcome | Call Doctor If

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Definition

A procedure in which healthy stem cells from a donor's bone marrow are injected into a recipient's vein. The new cells travel through the bloodstream to the recipient's bone cavities (stem cells are cells that can produce red blood cells, white blood cells, and platelets).

Bone marrow transplantation may be performed using bone marrow from a donor, called allogeneic transplant, or using stored bone marrow from the recipient, called autologous transplant.

Parts of the Body Involved

Donor: Hip bone

Recipient: Blood stream, bone marrow

Reasons for Procedure

To replace a malfunctioning or deficient bone marrow, which may be necessary in these situations:

• Infection
• Cancer (leukemia, lymphoma)
• Cancer treatment (chemotherapy and/or radiation)
• Immunodeficiency disorders
• Severe anemia (such as aplastic anemia)
• Blood disorders (such as sickle cell disease, thalassemia)

Risk Factors for Complications during the Procedure

The risk for complications increases as the recipient's age increases, and in cases where the recipient is severely debilitated.

Bone marrow transplant is usually avoided in people with diseases of the heart, lungs, liver, or kidneys, or in people with diabetes.

What to Expect

Prior to Procedure - The donor will be carefully tested to check for communicable disease. Both the donor and the recipient will be tested to insure that their tissues are compatible. In order for bone marrow transplant to be successful, certain markers (called HLA types) on the donor's and recipient's blood cells and bone marrow cells must match.

The recipient will be given medications to suppress the immune system, and therefore prevent the body from rejecting the donor bone marrow. In the weeks prior to the bone marrow transplant, the recipient may undergo intense chemotherapy and/or radiation therapy to rid the body of diseased cells and to clear the bone marrow cavities for the new bone marrow. This process is called "conditioning."

During Procedure – Removal of bone marrow from the donor, called "harvesting," takes place in an operating room. The donor receives sedation, anesthesia, and perhaps intravenous fluids. The recipient receives the bone marrow in an isolation room, and may require fluids and anti-nausea medications during administration.

Anesthesia:

Donor: General

Recipient: None

Description of the Procedure

Donor: The area of the hip from which the bone marrow will be harvested is cleaned with an antiseptic solution. A hollow needle and syringe is used to remove bone marrow from the donor's hip bone. Several punctures are made in order to harvest an adequate amount of bone marrow for transplantation (1-2 quarts). The puncture wounds are then covered with bandages.

Recipient: The donated marrow is filtered and then administered through a small, flexible tube called a catheter into a large vein in the recipient's chest. Depending on the reason for the bone marrow transplantation, the recipient may first require high doses of chemotherapy and/or radiation therapy, in order to completely destroy the diseased bone marrow.

After Procedure - The donor will recover quickly. The recipient will need to be placed in isolation to avoid infection until their new marrow begins to produce infection-fighting cells.

How Long Will It Take?

Donor: About 30 minutes

Recipient: Several hours

Will It Hurt?

Donor: Anesthesia prevents pain during the procedure. You may have some pain or discomfort in the area where the bone marrow was removed, but pain medication may be given to relieve pain and soreness during recovery.

Recipient: You won't feel any pain while the bone marrow is infused. You may have some nausea, which can be treated with medication.

Possible Complications:

Donor:

• Bleeding

• Infection

Recipient:

• Infection during the period when the original bone marrow is being destroyed via chemotherapy and/or radiation, and before the donor bone marrow begins to function

• Rejection of donor bone marrow

• Acute graft versus host disease, which occurs when the immune cells in the donor's bone marrow attack the recipient's tissues

Average Hospital Stay:

Donor: Overnight

Recipient: 1-2 months

Postoperative Care:

Donor: Pain medication and antibiotics to prevent infection

Recipient:

• Immunosuppressant medications to decrease the chance of transplant rejection

• Antibiotics to prevent infection

• Platelets and blood transfusions to prevent bleeding

• Frequent blood tests to monitor whether bone marrow is taking hold or being rejected

Outcome

It may take about a month for the donor bone marrow to begin functioning fully within the recipient. If the transplant is successful, diseased cells will have been removed during pre-treatment with chemotherapy and/or radiation, and new bone marrow cells will produce healthy red blood cells, white blood cells, and platelets.

Call Your Doctor If Any of the Following Occurs

• Nausea and/or vomiting
• Severe pain
• New onset of pain more than 24 hours after the procedure has been completed
• Redness, swelling, increasing pain, excessive bleeding, or discharge from the needle insertion site
• Signs of infection, including fever and chills
• Rash
• Diarrhea

SOURCES:

Merck Manual OnLine. Merck & Co., Inc., 2000.

National Cancer Institute, National Institutes of Health

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Last reviewed February 2001 by Medical Review Board