Bone Marrow Transplant FAQs : Top Frequently Asked Questions

1. What are stem cells and bone marrow?

Stem cells are cells that can differentiate into a huge variety of different body cell types. They function as the body’s repairing system. Adult stem cells and embryonic stem cells are the two primary kinds of stem cells. They can divide and regenerate for a long time. They can develop into specialized cells like muscle, blood, and brain cells, but they are not specialized enough to perform any particular role in the body.
Hematopoietic stem cells are found in the body’s soft, spongy bone marrow and turn into blood cells. The majority of bones contain it in the core. The blood that circulates throughout your body contains hematopoietic stem cells.

2. What are the types of bone marrow transplants?

The primary BMT varieties consist of:

• Autologous Transplant: After collection, these stem cells are frozen and kept. The frozen stem cells are thawed and reinfused into the patient’s circulation following the high-dose therapy. Autologous transplants are frequently employed in the treatment of multiple myeloma, lymphoma, and certain forms of leukemia.
• Allogeneic Transplant: An allogeneic transplant involves taking stem cells from a donor, who may be an unrelated person whose human leukocyte antigen (HLA) type closely matches that of the recipient, or it may involve a matched related donor, typically a sibling.
• Aplastic anemia, a few immune deficiency illnesses, and several hematologic malignancies, including lymphoma, leukemia, and myelodysplastic syndromes, are among the non-malignant ailments that can be treated with allogeneic transplants.
• Syngeneic Transplant: In this type of transplant, the recipient’s identical twin serves as the donor. Though rare, genetic transplants are taken into consideration when a donor who is an identical twin is available.
• Reduced-intensity conditioning (RIC) or non-myeloablative transplants use lesser dosages of chemotherapy and/or radiation to prepare the patient for transplant compared to conventional myeloablative regimens.
• Haploidentical Transplant: In a haploidentical transplant, stem cells are taken from a donor who shares only a small percentage of the recipient’s genetic makeup, typically a parent, sibling, or kid.

3. What are your blood counts? What do they mean?

One type of blood test is a complete blood count (CBC). It’s used to check for a variety of diseases, such as leukemia, anemia, and infections, as well as general health issues.

• White Blood Cell (WBC) Count: WBC count abnormalities can be a sign of several illnesses, including infections, inflammation, leukemia, and bone marrow diseases.
• Red blood cell (RBC) count: Anemia, dehydration, kidney illness, and bone marrow problems are among the conditions that might be indicated by abnormalities in the RBC count.
• Hemoglobin (Hb) Level: The blood’s ability to provide oxygen to the tissues is indicated by the hemoglobin level. Low hemoglobin levels may be a sign of anemia or other health issues.
• Hematocrit (Hct) Level: The proportion of blood volume filled by red blood cells is measured by hematocrit. It is frequently used to detect and track anemia and other blood diseases in conjunction with the hemoglobin level.
• Platelet Count: Blood contains tiny cell fragments called platelets that aid in blood clotting. The quantity of platelets in a blood sample is determined by the platelet count. Unusual platelet counts may be a sign of bone marrow problems, bleeding disorders, or other illnesses.

4. What is HLA typing?

A test called human leukocyte antigen (HLA) typing can be used to determine the precise genetic variants present in an individual’s HLA genes. The proteins that these genes encode, referred to as HLA molecules or antigens, are essential for the immune system to distinguish between self and non-self cells.

Nearly every cell in the body has HLA molecules on its surface, which aid the immune system in differentiating between the body’s cells, or self, and other cells or substances, or non-self.

HLA molecules are divided into two major classes:

• Nearly all of the body’s nucleated cells have Class I HLA molecules on their surface. They deliver peptides—fragments of proteins—to T lymphocytes capable of causing cytotoxicity.
• Class II HLA molecules are mostly present on the surface of B cells, dendritic cells, and macrophages, which are examples of antigen-presenting cells (APCs).
• HLA for Bone Marrow Transplant: To transplant bone marrow or hematopoietic stem cells, the donor and recipient’s HLAs must match. By matching HLA types, the risk of both transplant rejection and graft-versus-host disease (GVHD), a potentially fatal complication where the recipient’s tissues are attacked by the donor’s immune cells, is reduced.

5. How are the stem cells collected for your bone marrow transplant?

• Bone Marrow Harvest: During the process, the donor usually lies face down. A syringe extracts the liquid marrow from the pelvic bones, typically the iliac crest, after a needle is introduced. The donor’s weight and the recipient’s requirements are among the variables that affect how much bone marrow is extracted.
• Collection of Peripheral Blood Stem Cells (PBSC): This technique involves injecting granulocyte-colony stimulating factor (G-CSF) into the donor several days before the collection. More stem cells are produced in the bone marrow by G-CSF, and these cells eventually move from the bone marrow into the circulation. Following a sufficient number of stem cells being activated in the blood, the cells are extracted using an apheresis procedure. A vein in the donor’s arm is used to extract blood for apheresis, which involves running the blood through a machine to extract the stem cells.

6. Is bone marrow transplant painful?

Individual differences exist in how much pain a bone marrow transplant patient experiences. These include the patient’s pain threshold, the kind of transplant (autologous or allogeneic), the underlying ailment being treated, and the transplant techniques employed.

The following are some of the reasons why the patient could feel pain or discomfort during the transplant procedure:

• Preparatory Treatment
• Bone Marrow Harvesting
• Infusion of Stem Cells
• Side Effects

7. What are the tests done before and after bone marrow transplants?

Before and after a BMT, the following tests and assessments are frequently performed:

• Medical History and Physical Examination
• Diagnostic tests: these may include blood tests, imaging investigations (such as X-rays, CT scans, or MRI scans), and other diagnostic procedures.
• HLA Typing: To determine the compatibility of the donor and recipient in allogeneic transplants, HLA typing is performed on both the patient and possible donors.
• Bone Marrow Biopsy and Aspiration: A sample of the patient’s iliac crest, or hip bone, is taken to evaluate the bone marrow’s condition and, if necessary, look for cancerous cells.
• Cardiac evaluation: This may involve testing using an electrocardiogram (ECG or EKG), echocardiography (echo), or stress test.
• Tests for Lung Function: These evaluate lung function and assist in identifying any prior respiratory disorders that can compromise the patient’s capacity to withstand the transplant process.

After the transplant of bone marrow:

• Blood Tests: Routine blood tests are carried out to evaluate kidney and liver function, track blood counts (red blood cells, white blood cells, and platelets), and look for any indications of infection or other problems.
• Bone Marrow Biopsy: Following transplantation, periodic bone marrow biopsies may be carried out to monitor the state of the disease being treated and evaluate engraftment, or the successful establishment of donor cells in the recipient’s bone marrow.
• Supportive Care: Patients experiencing transplant-related side symptoms and consequences, including exhaustion, nutritional deficits, nausea, vomiting, and mucositis (inflammation of the mucous membranes), are given supportive care.

8. Does a bone marrow transplant change your DNA?

A bone marrow transplant (BMT) does not modify a recipient’s genetic code in any way. After the transplant, the recipient’s body’s cells retain their original DNA. Hematopoietic, or blood-forming, stem cells are introduced into the recipient’s body by a bone marrow transplant, however. Red blood cells, white blood cells, and platelets can all be produced from these donor stem cells.

The HLA (human leukocyte antigen) type, which is essential for the immune system to distinguish between self and non-self cells, will be produced by the donor stem cells in blood cells. This implies that a recipient’s blood cells may have different genetic markers (such as HLA types) from their original cells following a bone marrow transplant.

The recipient’s non-blood cells (such as skin, liver, and brain cells), which maintain their original DNA, are usually not replaced by the donor’s stem cells, even if they can make new blood cells with their genetic traits.

9. How does a bone marrow transplant treat sickle cell disease?

The procedure can be used to treat sickle cell disease in the following ways:

• Pre-Transplant Evaluation: Tests to assess the severity of sickle cell disease, evaluate organ function, and spot potential consequences are all part of this evaluation.
• Donor Selection: A suitable donor must be found to get a bone marrow transplant to cure sickle cell disease. The donor should ideally be a sibling who fully matches the recipient’s HLA (human leukocyte antigen), as this reduces the possibility of graft rejection and graft-versus-host disease (GVHD).
• Conditioning Regimen: Any residual diseased bone marrow cells are also assisted in being destroyed by the conditioning regimen.
• Transplant Procedure: The transplanted stem cells make their way to the bone marrow, where they start to manufacture platelets, white blood cells, and red blood cells.
• Engraftment: Usually, this procedure takes a few weeks to many months.
• Follow-Up Care: Immunosuppressive medications might be administered to help assure transplant success and avoid GVHD.

10. How does a bone marrow transplant treat Leukemia/ Lymphoma?

Leukemia and lymphoma may respond well to hematopoietic stem cell transplantation (HSCT), commonly referred to as a bone marrow transplant (BMT). The impact of BMT in leukemia/lymphoma is explained as follows:

• Destroying Cancer Cells: Patients typically receive conditioning therapy, which includes high-dose chemotherapy and occasionally radiation therapy, before the transplant.
• Replacing Diseased Bone Marrow: Following conditioning therapy, the patient is given healthy stem cells, either from an autologous (their own body) or allogeneic (the body of a donor) bone marrow. These stem cells may differentiate from peripheral blood, umbilical cord blood, or bone marrow.
• Rebuilding the Immune System: After being transplanted, stem cells infiltrate the bone marrow where they produce platelets, white blood cells, and red blood cells (engraftment).
• Graft-Versus-Leukemia (GVL) effect: Remaining leukemia or lymphoma cells may be attacked by the donor’s immune cells because they identify them as foreign. This might reduce the chance of a cancer relapse following transplantation.
• Managing Complications: A bone marrow transplant involves risks and complications that need to be taken into consideration. These include infections, organ damage, graft-versus-host disease (GVHD), which occurs when the recipient’s tissues are attacked by donor immune cells, and graft failure, which occurs when the transplanted cells do not engraft.

11. What are the possible side effects of bone marrow transplants?

Following a bone marrow transplant, the following side effects could occur:

• Graft-versus-host disease: an allogeneic transplant-specific complication
• Failure of stem cells (transplant)
• Organ injury
• Infections
• The cataracts
• Unable to conceive
• New malignancies
• Death

12. What is the success rate for bone marrow transplants?

It is challenging to determine the total success rate. Nevertheless, according to the most recent data, the majority of recipients of autologous stem cell transplantation had multiple myeloma or both Hodgkin and non-Hodgkin lymphomas. The following details pertain to three-year survival rates:

• Data on multiple myeloma indicate that 79% of patients survived three years following transplant.
• For Hodgkin lymphoma, three years following treatment, 92% of recipients of stem cell transplantation were still alive (most recipients of transplants do so because their Hodgkin lymphoma returned following chemotherapy).
• Non-Hodgkin lymphoma: Due to the recurrence of the disease, most patients with non-Hodgkin lymphoma have stem cell transplants. Three years following the diagnosis, 72% of those people were still alive.

13. Am I a donor for BMT?

Donating bone marrow stem cells will begin if you are a match for a recipient of a transplant. Whether you are giving to a family member or someone who is registered with organizations that deal with the requirements for bone marrow transplants, the procedure is the same.

You will undergo a couple of days of consultation before your donation, which will include:

• Comprehensive assessment of health
• Medical background
• Blood examinations
• Completing permission forms
• Discussing the donation process with medical professionals

14. Can recurrence happen over time?

After a transplant, a patient’s illness can occasionally return. It is referred to as relapse. Relapses are expected for certain people. For example, patients who received stem cell transplants for multiple myeloma are aware that the illness may eventually recur. Prolonging their life and slowing the disease’s course are the goals of the transplant.

Various factors influence your likelihood of relapsing:

• The nature and extent of your illness before receiving a transplant
• How long has it been after your transplant and what kind of transplant you had
• There is no magic number that tells you when you are cured, but generally speaking, the longer it has Been after your transplant, the more likely it is that you are cured.

15. How can I take care of myself after the transplant?

Your life can be changed by a successful bone marrow transplant, which can either cure your illness or delay its progression. But the change doesn’t happen instantly. You might not fully heal for up to a year. The following obstacles and solutions are listed:

• Defend against infections: Avoid touching sick individuals, wash your hands frequently, and find out from your doctor what vaccines are recommended for you.
• Consume wholesome food: Prioritize healthy grains, low-fat dairy, lean protein, and a range of fruits and vegetables.
• Relax: You might experience both good and bad days. There may be days when you feel worn out. A challenging day does not indicate poor performance. You must give yourself a rest, according to this.
• Take care of your skin: After a transplant, your skin may become more sensitive. When taking a bath or shower, use gentle soap and shampoo, and don’t forget to moisturize and shield your skin from the sun.
• Maintain your dental health: Maintain proper dental hygiene and schedule checkups every six months.

16. What are the further approaches that can be followed after a bone marrow transplant?

Bone marrow transplant patients need a holistic approach that takes into account their physical, emotional, and psychosocial requirements during their treatment to promote the best possible outcome. Personalized treatment plans that are based on the unique needs of each patient, access to full rehabilitation services to enhance physical function and quality of life, creation of an encouraging and secure atmosphere through support groups and counseling, and equipping patients with information and resources to control side effects of treatment and advance general health are important tactics. Furthermore, facilitating smooth coordination and communication between healthcare providers and including patients in joint decision-making might improve the efficacy of rehabilitation initiatives.