How Does a Bone Marrow Transplant Work?

A bone marrow transplant is a treatment for certain types of cancer and blood disorders — including leukemia, lymphoma, multiple myeloma, among others — that replaces your bone marrow with healthy cells. The replacement stem cells can either come from your own body or from a donor.

The source of stem cells for transplant is determined by the cancer or blood disorder being treated and the transplant team. Bone marrow transplant, stem cell transplant and hematopoietic stem cell transplant are all terms for the same process.

Types of bone marrow transplants

A bone marrow donor can be the patient or someone else.

When the patient is the donor, it is called an autologous bone marrow transplant. When the donor is someone other than the patient, it is called and allogenic bone marrow transplant.

In an allogeneic bone marrow transplant, stem cells come from a genetically matched donor, often a brother or sister. Other donors for allogeneic bone marrow transplants may include a parent, child or an unrelated donor identified through national bone marrow registries. Allogenic bone marrow transplants may also come from an umbilical cord blood transplant.

If you are between the ages of 18-40 you can register to be a stem cell donor on the National Marrow Donor Program’s website. Registering involves a simple cheek swab. Volunteer donors are extremely important and may save lives through bone marrow transplant. The need for diversity amongst donors is especially critical as minority ethnicities have very few donors available in the national registries.

Ochsner’s Stem Cell Transplant and Cellular Therapy Program is fully accredited by the Foundation for the Accreditation of Cellular Therapy (FACT) to perform autologous and allogeneic bone marrow and stem cell transplants. FACT is the only accrediting organization that addresses all quality aspects of stem cell and cellular therapy.

What is the process of a bone marrow transplant?

In both autologous and many allogeneic transplants, a donor’s stem cells are removed by a special type of blood donation called apheresis (a-pher-esis). In this process, the donor is given medication to stimulate extra stem cell production in the bone marrow. The stem cells are then collected by blood donation through an IV line. It is rare that a surgery, called a bone marrow harvest, is used to collect stem cells from a donor for allogeneic transplant.

Once collected, the stem cells are either taken to the patient for their transplant procedure or stored until it’s needed. If frozen and stored, the stem cells are thawed before they’re given to the patient.

The transplant recipient is given the stem cells through a vein, like a blood transfusion. The stem cells travel to the bone marrow, where they engraft or “take” and start to make blood cells. Signs of the new blood cells usually can be seen in the patient’s blood tests in 1-2 weeks.

Who is a candidate for a bone marrow transplant?

People who are physically healthy, people who are in the early stages of disease and people who have not already had a lot of treatment often do better with transplants. Major health problems — such as serious heart, lung, liver or kidney disease — might disqualify someone from being eligible for a bone marrow transplant.

Talk with your health care provider about your treatment options and whether you are a candidate for a bone marrow transplant.

How long does it take to recover from a bone marrow transplant?

Recovery from a bone marrow transplant begins after the stem cell infusion. During recovery, you are waiting for the stem cells from the transplant to engraft or “take.” They will eventually start to multiply and make new blood cells. This new production of blood will be evident in your lab tests.

The time it takes to start seeing a steady return to normal blood counts varies by patient, but it’s usually about 2 to 6 weeks. You should plan to be in the hospital or visit the transplant center daily for several weeks. Transplant patients need to plan to have one or more caregivers, usually friends and family, available to stay with them and assist with their recovery after the transplant.

During and after your transplant, your doctor might prescribe antibiotics to help you fight infections, as you will have low numbers of red and white blood cells and platelets. You will also need to receive all childhood and adult vaccinations again after the transplant.

You may experience side effects including stomach, heart, lung, liver or kidney problems. You might also feel distress, anxiety, depression, joy or anger. Adjusting emotionally after the transplant can be hard because of the length of time you feel ill and isolated from others. Support and encouragement from family, friends and the transplant team are important to help get you through this time.

At Ochsner, our experience and our cutting-edge research ensures highly specialized, comprehensive, innovative care in a patient-friendly, state-of-the-art facility. Our team of physicians and staff will work together, for you and with you, for the best possible outcome.

Who can donate bone marrow?

First-degree family members between 18 to 65 are often considered first as potential donors. First-degree family members are parents, siblings, and children.  A family member will need a blood test to see if they are a good DNA match. If they are, they are tested to see if they are healthy enough to have the donation procedure.

Around 70% of patients who need a bone marrow transplant do not a have a family member that qualifies for donation. That is why donors in our national registries are needed to help save lives.

Donors who want to join the national registry must be between 18 and 40, and in good health. If a donor on the registry is determined to be a match, they will go through a series of tests to make sure they meet the criteria to donate and to make sure they are healthy enough to do so.

What happens to the donor in a bone marrow transplant?

If a match is found for a donor, the donation takes place in a sterile environment. The donation may occur by apheresis, or the surgery called a bone marrow harvest.  During a bone marrow harvest; the donor receives anesthesia in the hospital, and doctors use needles to withdraw liquid marrow from both sides of the back of their pelvic bone. The marrow is then transported to the patient’s location for their transplant procedure.

Side effects after the donation can vary from person to person. The common side effects after the procedure may include hip pain, headaches, fatigue and bruising at the collection sight. The discomfort could last up to a few weeks. Marrow donors can expect to return to most day-to-day activities within a week. Your marrow will return to normal levels within a few weeks.