Reasons for Failure of a Bone Marrow Transplant

What if my bone marrow transplant fails? This is a troubling question in the mind of every patient who underwent a bone marrow transplant or is deciding to go for one.
Your hematologists may try their best and you may have received the treatment at the best hospital but the possibility of a failed transplant does exist. Being fully aware of this scenario will make you well-prepared for the unexpected results of your bone marrow transplant.

Some of the Reasons why a Bone Marrow Transplant may fail are:

1. Graft failure: If you have received an allogeneic transplant, your body might not be able to accept the donor stem cells. The newly transfused stem cells do not make red blood cells, platelets, and white blood cells. This is called non-engraftment or failure to engraft. Though uncommon, it is serious. Usually, this can be treated with a second transplant.
There is also a possibility of graft vs host disease. The condition occurs when the donor’s stem cells produce blood cells that recognize the patient’s body as foreign and begin attacking it.

2. Relapse: When the disease returns after your treatment, it is called a relapse. The possibility of a relapse is usually higher in the first year after the transplant but reduces with time. Your healthcare team will monitor your condition to check for signs of relapse. Usually, the tests conducted include a CT scan, PET scan, or bone marrow test. You should be observant of any unusual symptoms. If you notice worrying signs then contact your healthcare team immediately as these need to be looked at.

 What to do next?

Once your healthcare team has confirmed that the bone marrow transplant has failed,  you need to start exploring other possibilities. This will depend on several factors like your age, health, the type of transplant you underwent, and how well you responded to the first transplant.  Your doctor will discuss the following options with you:

1. Donor lymphocyte infusion: This type of treatment can be suggested if your cancer has returned. In this, the donor’s white blood cells are infused in the patient again to fight off the cancer cells. However, giving a large number of cells could increase the possibility of graft vs host disease.

2. Chemotherapy could be used to destroy cells that may have caused your blood disorder or cancer to come back. It can be given in combination with donor lymphocyte infusion. You need to weigh the pros and cons of chemotherapy before going for this treatment.

3. Clinical trials: Some patients also choose to participate in clinical trials which are studies for testing the efficacy and safety of new drugs. However, these will happen only across a few hospitals in the country. It can also vary on your physical state and the response to previous treatment.

4. Supportive care: It may not be possible for every patient to get further treatment. This may be because of the high risk or personal wish. In such a situation,  it is important that you have carefully thought about all possible options for you.

Your doctor may advise you to go for palliative care. This is aimed at making your life more comfortable by easing your symptoms. It is an integral component of end-of-life care that provides emotional, spiritual, practical, and physical support to patients so that they can manage the effects of their condition. However, this can be availed at any point in time not necessarily at the final stages of your life. It can even last for years. You will also be given antibiotics and transfusions to deal with symptoms.

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Conclusion

Since getting a bone marrow transplant involves both emotional and financial investment, a failed bone marrow transplant can be difficult to overcome. But you should know that there could be many uncontrollable reasons behind a failed bone marrow transplant. Whatever may have been the case,  it is vital you rely on the support of your friends and family to navigate this difficult phase. You should not lose hope and discuss with your doctors the other treatment options which might work out for you.

Reference Links:

• https://www.bmtinfonet.org/transplant-article/relapse
• https://bethematch.org/patients-and-families/life-after-transplant/what-if-transplant-doesn-t-work-/