Finding out that you need to have a bone marrow transplant can make you feel worried and anxious. But understanding a little about bone marrow transplants can help you feel more confident about what’s going to happen.
What is a bone marrow transplant (BMT)?
Bone marrow transplants (BMT) are also sometimes called stem cell transplants. In a BMT, healthy bone marrow cells are transplanted into a person’s body to replace the cancerous bone marrow cells.
What are bone marrow stem cells?
Bone marrow is the spongy part on the inside of your bones. This is where your blood cells are made. Bone marrow contains stem cells, which are like baby blood cells. The stem cells in your bone marrow divide and mature into the specialized blood cells – red blood cells, white blood cells and platelets. These blood cells have important jobs in our bodies, including fighting infections as part of the immune system. Stem cells are also found in the blood that circulates around your body and in the blood inside a baby’s umbilical cord. You need bone marrow stem cells to survive.
What happens during the bone marrow transplant?
BMTs require your consent. Your health-care team will explain BMTs and why they think you should have one, as well as the risks. Then, you and your family will be able to ask lots of questions and think it over. A BMT is generally not the first step in your treatment, but it might be recommended if other options didn’t work well or if your team thinks it’s likely that you will relapse (get cancer again).
Before the BMT, you will need to have different tests to make sure you are healthy enough to have the transplant. These tests often include an echocardiogram, pulmonary function test, and glomular filtration rate (GFR). You will also have an appointment with the dentist. You may already have received a central line such as a port for chemotherapy, but often a different kind of central line is required for the bone marrow transplant. If you need a central line or need to switch to a different central line you will have surgery.
What happens next?
The next steps are to find healthy bone marrow cells and condition (prepare) your body for the transplant.
Finding healthy bone marrow cells
The first step in a BMT is to find healthy bone marrow cells for your transplant. There are two types of bone marrow transplants.
In allogeneic (say: al-oh-juh-NAY-ik) transplants, healthy bone marrow stem cells come from another person (a donor). This person’s bone marrow cells are similar to or 'match' yours.
The donor is often a family member such as a sibling. Sometimes the donor can be an unrelated person who has had blood drawn and registered with a bone marrow donor bank. When the donor is not a family member, this is called a matched unrelated donor or MUD.
It is really important to find a donor who matches. If the cells don’t match, your body will attack the new bone marrow cells and the transplant won’t work.
Allogeneic BMT is usually done in people with leukemia or some types of lymphoma.
In autologous (say: aw-TAWL-ah-gus) transplants, the healthy bone marrow stem cells come from you. They’re taken from either your blood or your bone marrow and frozen so they can be put back in when it’s time for the transplant. This kind of BMT is more common in people with solid tumours.
Conditioning
The next step is called conditioning treatment, which prepares your body for the transplant. Conditioning includes super high doses of chemotherapy and, sometimes, total body irradiation (TBI). The purpose of conditioning is to wipe out all the cancer cells in your body. Such strong treatment also wipes out all your bone marrow cells so your body can accept the new ones.
Risk of infection
After conditioning, and until your new marrow is working properly, you are at extremely high risk of infection. It’s mandatory that all visitors wash their hands really well. You may need to wear a mask when you are with groups of people you don’t know, such as in a hospital waiting room. If someone is even a little bit sick, tell them to send a card instead!
The transplant
Within a few days of finishing conditioning, you will have the actual transplant.
For allogeneic transplants (cells collected from a donor), the bone marrow stem cells will look like a bag of blood and will be infused (passed into your blood stream) through your central line over about four hours.
For autologous transplants (cells collected from your body) the cells will come in bags as a frozen liquid. The nurse will defrost them and give them to you through your central line. This usually takes about an hour.
The new bone marrow stem cells will then travel through your blood and make their way to your bone marrow where they will start making new blood cells. This is called engraftment and it can take up to a month, or even longer.
Recovery
You’ll need to stay in hospital for about four to six weeks after the transplant to give your new bone marrow time to make enough blood cells to keep you healthy. You’ll need to be in a private room to prevent infection. This can get a bit lonely but you will probably also feel very tired so having a quieter space to recover in may be a good thing. Your parents/caregivers are allowed to visit you and one parent/caregiver is able to stay overnight.
Monitoring by your health-care team
The nurses and the rest of your health-care team will monitor you very closely. The nurses will check your temperature and blood pressure very often. You’ll also have frequent blood tests to make sure that your new cells are starting to work. Everything that goes into or comes out of your body will need to be measured. This means anything you eat and drink will be recorded and you’ll use a special commode chair to go to the bathroom instead of a regular toilet. This can seem a little weird or embarrassing until you get used to it.
What you will need to do to help your recovery
- You’ll need to take medications such as pain medications, antibiotics for infections and anti-nausea medications for when you feel like throwing up. You’ll probably take them through your central line.
- To help your new bone marrow and blood cells grow, you’ll need to eat a lot of calories and protein. You will also be placed on a low-bacteria diet to minimize any risk of infection. This can be tough when you’re not feeling well. A dietitian will help you come up with a meal plan to keep your body strong. You’ll also learn techniques to help you with eating in the section on Eating well for health. At times, it may get so difficult to eat that you’ll need to get liquid nutrition either through a feeding tube or your central line.
- You will need to try to move around the room as much as you can (even though it’s a very small room without anywhere to really go). Try to get up to use the commode or toilet often, or spend some time sitting up in the chair, out of bed. This is to prevent complications like muscle weakness, sores and pneumonia.
Side effects
The side effects of a bone marrow transplant are the same as for chemotherapy or radiation except worse because the treatment you had during conditioning was so strong. Check out the section on Managing your symptoms for tips on managing common side effects.
Possible complications of a BMT
- Infection: Without an immune system you are at high risk of infection. You will need to take antibiotics if you have a fever higher than:
- 38.3°C or more when temperature is taken by mouth one time
- 38°C or more when temperature is taken by mouth for one hour or more
- 37.8°C or more when temperature is taken under the arm one time
- 37.5°C or more when temperature is taken under the arm for one hour or more
- Bleeding: Without bone marrow your body doesn’t have enough blood cells, called platelets, to make a blood clot (like a scab). This can lead to bleeding from any part of the body, such as nosebleeds. If your platelets are really low, you may need a blood transfusion.
- Graft-versus-host disease (GvHD): After a BMT, there is the possibility that the new bone marrow stem cells (the graft) will react against your body (the host). You will take medications to prevent GvHD, but sometimes you will experience symptoms anyway such as a red rash, itching, stomach cramps, diarrhea or a yellow colour to your eyes and skin (jaundice). GvHD can occur up to six months after your BMT, but it can be treated and does not mean there’s a problem with your transplant.
- Fatigue: There are many reasons why you will feel tired before and after the transplant. One reason is that your bone marrow is low on red blood cells. Red blood cells carry oxygen to the rest of your body and give you energy. If your hemoglobin is very low, you will receive red blood cell transfusions.
- Deconditioning (weakness): Deconditioning (or becoming less fit) happens when your body is less able to move around. Because you will spend a lot of time in bed after your BMT, your muscles will become weaker and your body will sometimes lose flexibility.
BMTs are really complicated and are different for each person. This section is just a quick overview of what they are and how they work. Your health-care team will explain your BMT to you and your parent/caregiver. If you have any questions, ask your doctors and nurses.
For more information, check out the
Blood and marrow transplant learning hub from AboutKidsHealth.