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Bone marrow is located at the center of many bones and is made up of soft tissue, blood vessels and capillaries.
The primary function of bone marrow is to produce the blood cells which help to maintain a healthy vascular and lymphatic system, producing over 200 billion cells every day. Bone marrow produces both red and white blood cells.
The constant production and regeneration of these cells is essential in helping the body to fight disease and infection, and also keeps the respiratory system working.
There are a number of medical conditions which can prevent bone marrow producing cells efficiently such as leukemias and cancers, tuberculosis and sickle cell anemia. If left untreated, diseases affecting bone marrow can be fatal. Once identified, the first step in treating a bone marrow disease is the surgical extraction of the affected bone marrow. This is analysed to provide a diagnosis and to assess which treatment option is most suitable. If cancerous cells are discovered, the most likely course of action will involve chemotherapy or radiotherapy, with the aim of destroying the cancer cells and preventing them from spreading further. In the process a number of red and white blood cells will also be damaged. The most effective way of treating a bone marrow condition is a bone marrow transplant, involving the replacement of the damaged marrow and cells with new, healthy ones. A bone marrow transplant usually involves stem cells, which are early development cells which can produce both red and white blood cells.
The stem cells are injected from donor blood marrow, which can come either from an external donor or from elsewhere in the patient's body. Stem cells from an external donor must be a very close match to the patient's, and are usually taken from the pelvis area. The donor stem cells are translated into the patient's bone through a vein using a drip infusion, a procedure which does not require anesthesia and is minimally-invasive. The donor material travels to the bone marrow over the course of several hours. It will take around 2 to 4 weeks before the implanted stem cells begin to produce new red and white blood cells, and with a high risk of infection during this time the patient will need to remain in isolation.
Where can I find bone marrow transplants around the world?
A bone marrow transplant is a complex procedure requiring the expertise of experienced specialists, and can therefore be expensive. Many people choose to look abroad for their treatment, either to save money or to find specialist care. Bone Marrow Transplant in Germany Bone Marrow Transplant in India Bone Marrow Transplant in Turkey For more information, read our Bone Marrow Transplant Cost Guide .,
A bone marrow transplant is performed to replace damaged or destroyed bone marrow. Bone marrow may stop functioning as a result of diseases such as aplastic anemia or sickle cell anemia, or from being destroyed by chemotherapy or radiation therapy used to treat cancer or other diseases. Bone marrow is the spongey tissue located inside the bones in the body. It is made up of stem cells. These stem cells produce other blood cells, such as white cells to fight against infection and red cells and platelets, which help the blood to clot and to circulate oxygen throughout the body. There are 3 different types of bone marrow transplants which are autologous, allogenic, and syngeneic. Autologous bone marrow transplant harvests the patients own bone marrow before receiving chemotherapy or radiation therapy, and stores it in a freezer until the treatment is complete.
The healthy bone marrow is then transplanted back to the patient after they are finished with treatment and are in remission. Allogenic transplants involve taking the bone marrow from a donor, which is commonly a family member, and transplanting this to the patient. Syngeneic transplants involve taking bone marrow from the patient's identical twin or from an umbilical cord and transplanting it to the patient.
Recommended for Leukemia Aplastic anemia Lymphoma Patients who have had chemotherapy which has destroyed the bone marrow Sickle cell anemia Autoimmune diseases such as MS Time requirements Average length of stay abroad 4 - 8 weeks. The length of hospital stay required varies with each type of transplant performed and with each patient. Number of trips abroad needed 1. Bone marrow is generally harvested from the sternum or the hip using a needle to extract it. Time requirements Average length of stay abroad 4 - 8 weeks. The length of hospital stay required varies with each type of transplant performed and with each patient. Number of trips abroad needed 1. Time requirements Average length of stay abroad 4 - 8 weeks. The length of hospital stay required varies with each type of transplant performed and with each patient. Number of trips abroad needed 1. Bone marrow is generally harvested from the sternum or the hip using a needle to extract it.,
Before receiving a bone marrow transplant, patients will undergo an extensive evaluation to ensure that it is the best option for them. A series of tests will be performed to ensure the patient is healthy enough to receive the transplant and they will usually need to arrive at the clinic or hospital around 10 days before the transplant, to have a central line fitted in their chest, in preparation for the transplant. For the donor, they must also undergo a series of tests and evaluations to ensure that they are the correct match for the recipient.
The donor is usually given medication prior to donating the bone marrow as a means of increasing bone marrow production. The bone marrow is then harvested from the donor, usually from the hip or sternum using a needle. Alternatively, the bone marrow can be collected from peripheral blood stem cells, which involves extracting blood and filtering it through a machine that withdraws the stem cells, and returns the remaining blood back to the donor.
Often times, the the bone marrow is taken from the patient before treatment and then returned back to them, rather than using a donor. Patients with complex conditions may benefit from seeking a second opinion before beginning a treatment plan. A second opinion means that another doctor, usually an expert with a lot of experience, will review the patient's medical history, symptoms, scans, test results, and other important information, in order to provide a diagnosis and treatment plan.
Chemotherapy or radiation therapy is often used as part of the process to treat the cancer or disease in the bone marrow and to make room for bone marrow transplant by destroying the damaged bone marrow. Once this phase is complete, the bone marrow is then transplanted to the patient into the blood, through the central line in their chest.
The new stem cells will travel via the blood to the bone marrow and begin to produce new and healthy cells. Anesthesia General anesthetic Bone marrow is harvested from the patient or donor and used to replace unhealthy bone marrow.,
Patients will need to spend a few weeks in the hospital after the procedure, in order to recover. Regular blood counts will be taken in the proceeding days after the transplant and blood transfusions may be needed.
In the case where an allogeneic transplant has been performed, the patient is usually given medication to take as a precaution to preventing graft-versus-host-disease, whereby the new cells may begin to attack the patient's tissue. Recovery from the transplant can take months after the patient leaves the hospital and they will need to attend regular check-ups.,
A bone marrow transplant may be needed if:
In order to undergo a transplant, we must obtain stem cells from a donor. The process of collecting these cells is called harvesting. There are two basic ways to harvest or collect stem cells:
• Bone marrow harvest: The stem cells are collected directly from the hip bone of a donor.
• Blood stem cell harvest: The stem cells are collected directly from the blood (veins) of a donor.
The transplant team includes the following professionals:
• Pre-Transplant Nurse Coordinators
• Inpatient Nurses
• BMT Clinic Nurses
• Nurse Practitioners and Physician Assistants
• Clinical Pharmacists
• Blood Bank Technologists
• Physical/Occupational Therapists
Following are the steps:
• Initial Consultation
• Disease Status Evaluation
• Organ Function Evaluation
• Caregiver Plan
• Stem cell Mobilization and Collection Procedure
• Admit for transplant
Following are the steps:
• Initial Consultation
• Search for Donor
• Disease Status Evaluation
• Organ Function Evaluation
• Caregiver Plan
• IV Catheter Placed
• Final Tests
• Admit for Transplant
Patient must take care of:
Discharge is available for patients if they fulfil:
• Stable vital signs and no fevers for 24 hours
• Infections and graft versus host disease (GVHD) should be absent, stable, or under control
• Not requiring daily transfusions (especially platelet transfusions)
• Able to tolerate oral medications, food, and fluids
• Active enough to function outside the hospital
• Nausea, vomiting, diarrhea under control
• Infections: During and after your transplant, you will be at risk for developing many different types of infections. Immediately after your transplant you are at risk for bacterial and fungal infections, as well as for reactivation of certain viruses that reside in your body (for example, the chicken pox or herpes simplex virus). During the first several months after your transplant you will continue to be susceptible to infections, especially viral infections.
• Veno-Occlusive Disease (VOD): This is a complication that typically affects the liver. It is caused by the high doses of chemotherapy that may be used during the transplant. When VOD occurs, it becomes very difficult for the liver and subsequently lungs and kidneys to function normally. The signs and symptoms of VOD may include jaundice (yellow skin and eyes), a swollen and tender belly (especially where your liver is located), and weight gain. Treatment for VOD may include various medications, blood transfusions, careful monitoring of your liver and kidney function, and blood tests.
• Lung and Heart Complications: Pneumonias are common following transplant. Approximately 30-40% of patients undergoing an allogeneic transplant and approximately 25% of patients undergoing an autologous transplant will develop pneumonia at some point during their transplant course. The pneumonia may be severe, even life threatening in some cases. Not all pneumonias are caused by infections.
• Bleeding: Bleeding after transplant is common, especially when your platelet levels are very low. Platelet transfusions are given to try to prevent severe bleeding. Your platelet count and signs of bleeding will be monitored often by your medical team during your transplant. Blood in the urine (called hematuria) is also common after certain types of transplant, and is often due to a specific virus that infects your bladder
• Graft Versus Host Disease: Graft versus host disease (GVHD) is a complication that occurs when the new stem cells (the graft) react against your body (the host). It can range from a very mild complication or may progress to a life-threatening one.
Many of these precautions and restrictions are necessary to prevent infections and bleeding. Your bone marrow needs time to mature before it is considered fully recovered. Until that time, there are things you should watch for and help prevent. These restrictions will lessen over time, as your bone marrow and immune system become fully functioning.
• Masks: A mask is not necessary when you are at home or out for a walk but is required if visiting in polluted conditions.
• People: Avoid close contact with anyone who is ill. Avoid crowded areas, especially during cold and flu season. Stay away from anyone exposed to communicable and/or childhood disease.
• Pets and Animals: Household pets can remain in the home, except for birds and reptiles. Avoid all contact with birds or reptiles and their droppings; they carry many infections. Avoid contacting animal waste.
• Plants and Flowers: These can remain in the home. Avoid gardening, mowing the lawn and other activities that stir up soil or the ground. Avoid handling fresh-cut flowers in vases; the water can carry large amounts of bacteria.
• Travel: Notify your doctor before you travel. In general, you should avoid swimming in lakes, public pools and sitting in hot tubs due to the possibility of exposure to excessive bacteria.
• Physical Activity: It is essential to maintain the activity program outlined in the hospital by your physical therapist. There is a potential for developing infections in your lungs after the transplant, and remaining active helps keep your lungs stronger.
• Driving: You will not be able to drive for at least three months following your transplant. This period may be shorter for patients receiving their own stem cells. Physical stamina is generally reduced and could lead to a decrease in the reflex time necessary for safe driving.
• Returning to Work or School: Your return to work or school will depend on the type of transplant you receive and how your recovery proceeds. For the first 100 days after your transplant you will not return to work or school.
• Reimmunizations: Since your immune system is so intensely affected by the transplant, it may no longer remember its previous exposures to childhood vaccinations. Therefore, you will be reimmunized with several of your “baby shots” one to two years after transplant.
• Diet: Loss of taste and appetite happens frequently following transplant. If you are having problems eating a diet adequate in calories and protein, talk with our dietitian.
It is okay to eat raw fruits and vegetables after you are discharged from the hospital. These foods should be cleaned thoroughly under running water and bruises or bad spots should be removed. Fruits and vegetables that cannot be cleaned well should not be eaten raw.
Pepper and other dried herbs may be added to foods that are going to be baked or heated to a steaming temperature in the microwave. You should not add pepper to foods that have already been heated or will be eaten raw.
It is okay to eat food that is hot, freshly prepared and fully cooked. Uncooked or stir-fried fruits, vegetables, and salads should be avoided. Avoid salad bars, smorgasbords, and potlucks. Ask that food be prepared fresh, and order food without toppings or condiments (lettuce, tomato, mayonnaise). Meats and fish must be cooked thoroughly. Do not eat raw seafood including oysters, sushi, sashimi, lightly steamed seafood like mussels, clams, and snails.
You may have lost some muscle mass during your hospitalization. Eating enough protein is important to restore lean body mass and avoid fluid retention. Try eating more of these foods: beef, poultry, fish, cheese, eggs, dairy products, peanut butter, and beans. If you do not have an appetite for these foods following transplant, ask your Registered Dietitian for some high protein drink recipes
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|The University Hospital of Tokyo|
|Asan Medical Center|
|BLK-MAX Super Specialty Hospital|
|Incheon St. Mary's Hospital|
|CARE Hospitals, Hi-Tech City|
|Seoul National University Bundang Hospital|
|Dongguk University Ilsan Medical Center|
|Chiangmai Ram Hospital|