A Bone Marrow Transplant is the most effective and, in some cases, the only curative treatment for many blood disorders such as Aplastic Anaemia, Sickle Cell Disorder, Leukaemia and Thalassemia, and multiple sclerosis.
What do we mean by a Bone Marrow?
Bone Marrow is something you must have heard a lot in recent years. Let us try to understand what it is in layman terms.
It is a soft and spongy tissue which is located in the cavities inside the bone. The main function of this tissue is to produce blood-forming cells in the body. Bone marrow may be Bone marrow can be affected either by diseases or drugs.
The following are the types of marrow found in the human body:
- RED MARROW, which produces the blood cells in the body.
- YELLOW MARROW, which is basically the fatty tissue.
Both red and yellow marrow consists of ample amount of blood vessels and capillaries.
Anatomy of the Bone: Compact bone, spongy bone, and bone marrow make up the basic structure of the bone. The outer layer is the compact bone. Ends of the bone are made up of spongy bone and consist of red marrow. Bone marrow has an ample amount of blood supply.
In human beings, bone marrow is responsible for new blood cell production (or hematopoiesis). Ribs, vertebrae, sternum, and bones of the pelvis consist of blood-forming bone marrow tissue. Studies show that bone marrow makes up for 4% of the total body mass of humans.
Around 500 billion cells are pushed daily into the circulation by the bone marrow. Bone marrow is the site of formation, growth, and differentiation of both myeloid and lymphoid lineages of blood cells. But the lymphoid cells complete their maturation process in the lymphoid organs such as the thymus or the spleen.
Bone Marrow Stem Cells:
Mesenchymal and hematopoietic stem cells make up the bone marrow in human beings.
Redbone marrow specializes in the formation of red blood cells, white blood cells, and the platelets. As a result of which it is highly fibrous with a number of blood vessels.
Yellow marrow is responsible for the production of fat, cartilage and mainly the new bone. It is made up of the mesenchymal stem cells.
Stem cells are the type of cells in the human body that have the ability to turn into a number of different types of cell.
Cells such as monocytes, macrophages, neutrophils, basophils, eosinophils, erythrocytes, dendritic cells, and megakaryocytes or platelets, as well as T cells, B cells, and natural killer cells are formed by the bone marrow. These cells belong to two main lineages i.e. myeloid and lymphoid lineages. They are different in terms of their regenerative capacity and potency.
The blood cells are formed by a process of growth and maturation of these stem cells and the process is called “Haematopoiesis”.
A bone marrow transplant involves the transfer of these particular cells.
Stem cells undergo rapid processes of multiplication to make millions of blood cells each day.
Blood cells live for a limited number of days. For red blood cells it is around 100-120 days and then they get replaced. This marks the importance of the production of new stem cells in the body.
Mature blood cells contain proteins that attach to and pass through the blood vessel. Some stem cells cross the marrow barrier and these are the ones that are obtained from peripheral or circulating blood.
The stem cells in red bone marrow can multiply and mature into three types of blood cells:
Red blood cells (erythrocytes): These help to transport oxygen throughout the body.
White blood cells (leukocytes): These play a key role in fighting infection and disease. These consists of lymphocytes – which is the backbone of the immune system – while the myeloid cells include granulocytes: neutrophils, monocytes, eosinophils, and basophils
Platelets (thrombocytes): They help in the formation of clot or plug after an injury. Platelets are formed from small parts of the cytoplasm from the precursor of platelet cells.
These blood cells are then transferred from the marrow into the circulating blood to perform the basic functions in the body.
What do we mean by a Bone Marrow Transplant?
Now that we know what actually bone marrow is, we can now focus on the main topic of the article. A bone marrow transplant is used in the following cases:
In conditions such as leukemia, aplastic anemia, and sickle cell anemia, it replaces the “diseased marrow” with a healthy functioning one.
It regenerates the immune system after the chemotherapeutic treatment to kill the remaining cancer cells.
The bone marrow transplant is also done after the chemo to replace the damaged bone marrow.
The bone marrow transplant is the most preferred treatment option for diseases which affect the working of the marrow such as blood cancers.
A transplant will facilitate to replenish the body’s capability to supply blood cells and get the numbers back to their original level. A number of cancerous and non-cancerous lesions can be successfully treated with a bone marrow transplant.
Cancerous diseases may or may not be of the blood tissue, but the treatment can destroy the body’s ability to produce new blood cells. A person with cancer can ordinarily bear therapy before transplantation.
Bone Marrow Transplant Types:
Autologous transplant: In this, the healthy stem cells from the patients are taken weeks before the start of chemo and the stem cells are then transplanted back after the treatment. The autologous transplant involves the extraction (apheresis) of stem cells from the patient and storage of the harvested cells in a freezer. The patient is then treated with high-dose therapy with or while not radiation therapy with the intention of eradicating the patient’s cancer. The patient’s own stored cells are then transfused into his/her blood, where they replace the damaged tissue and resume their normal function. This might take a few weeks though. Autologous transplants offer a low risk of infections. Also, there are minimal chances of rejection as the tissue is obtained from the same individual. This makes the autologous stem cell transplant very safe.
Syngeneic Transplant: In this case, the identical twin acts as the donor for the stem cells. An ‘identical’ twin of the patient has the same DNA as the patient.
Allogeneic Transplant: In this case, the stem cell donor can either be a sibling or relative, or an unknown donor. Allogeneic Transplant involves the (healthy) donor and the (patient) recipient. Allogeneic Transplant donors must have a tissue type that matches the recipient. Allogeneic transplant donors may be related (usually a closely HLA matched sibling), syngeneic or unrelated (a donor who is not related and found to have a very close degree of HLA matching).
Umbilical Cord Blood: A type of allogeneic transplant in which those stem cells are used which are removed from a new-born baby’s umbilical cord right after birth. The stem cells square measure frozen and keep till they’re required for a transplant. Umbilical cord blood cells are immature thus the requirement for matching is very less. The only that needs to be kept in mind, is that it takes a longer time to get the numbers back to normal.
A person’s tissue sort is outlined because of the form of human white cell substance (HLA) on the surface of most of the cells of their body. HLA could be a macromolecule or marker that the body uses to assist it to verify if the cell belongs to the body or not.
The doctors examine various types of proteins on the surface of the cells to check if the donor tissue matches with the recipient. Their square measure immeasurable totally different tissue varieties, however, some square measure a lot of common than others.
Tissue type and DNA is passed from the parent to their children. This means a relative is a lot of doubtless to possess an identical tissue sort.
However, if a bone marrow donor can’t be found from the patient’s relatives, the doctor tends to look for a match in the bone marrow registry.
Several tests square measure performed before to check for compatibility.
Few of them are:
• Tissue typing and complete blood counts
• X-ray of the chest
• CT or CAT scans
• heart function tests including an electrocardiogram and echocardiogram (ECG)
• Bone Marrow Biopsy
• Skeletal survey
Patients also need to get a dental check-up to eliminate all the possible risks of infection after the bone marrow transplant.
How to Harvest Bone Marrow:
Bone marrow examination includes both marrow aspiration and biopsy.
The bone marrow is mostly obtained from within the bones of the hips (ilium). A needle is inserted into the bone from where marrow tissue is taken out. The extracted tissue is then stored and frozen under appropriate conditions.
The donor is under either local or general anesthesia during the procedure. It is done routinely all over the world.
The upper tibia or the shin bone is used in the children for a bone marrow transplant.
According to the National Marrow Donor Program (NMDP) guidelines, the amount of bone marrow can be removed to around fifteen mL/kg of donor weight. A dose of one X 103 and a couple of X 108 marrow mononucleate cells per weight unit square measure needed to determine engraftment in autologous and allogeneic marrow transplants, respectively.
Some of the basic complications associated with a bone marrow transplant are the infection, injury to the bone and allergy due to anesthesia.
In some cases, the stem cells are obtained from the peripheral blood. In order to do that, the patients are given certain drugs that facilitate the transfer of cells from the marrow into the blood. The blood sample is then taken and the stem cells are collected. In new-born, umbilical cord acts as the source of cells.
Diseases in which BMT is Indicated:
A number of diseases cause a threat to bone marrow. As a result of which they stop marrow from turning stem cells into essential cells.
A bone marrow examination is done to confirm the diagnosis of:
1. Blood smear showing neutrophil, white blood cell, and Leukemia.
Unusual cases of Anemia
Other Hematological diseases.
2. Diseases that can be treated with Hematopoietic Stem Cell transplant.
More than 1/2 autologous transplantations are done to treat Myeloma and Non-Hodgkin malignant neoplastic disease.
A bone marrow transplant is usually the most effective likelihood for survival for patients diagnosed with blood cancer every year.
Around thirty percent of patients find an identical donor in their families, but 70 percent, or around 14,000 each year, have to rely on marrow donated by someone unrelated.
3.) Autologous HSCT is used to treat:
Non-Hodgkin and Hodgkin lymphoma
Acute Myeloid Leukemia or AML
Autoimmune disorders, such as systemic lupus erythematosus and systemic sclerosis
4. Allogeneic HSCT is used to treat:
Acute Myeloid Leukaemia and acute lymphocytic Leukemia
Chronic Lymphocytic Leukemia
Myelodysplastic Syndromes Multiple Myeloma
Pure red cell aplasia
Paroxysmal nocturnal hemoglobinuria
Genetic disorders relating to metabolism, such as
Severe Congenital Neutropenia
5. HSCT helps in the treatment of:
Testicular cancer in some patients.
Some genetic immunologic or hematopoietic disorders.
Bone marrow transplants are required treatments in cases of high-dose chemotherapy and radiation therapy.
Bone Marrow Tests:
Marrow tests are to obtain information on the type of blood diseases and blood cancers. This data is then used to design a treatment plan.
Bone marrow aspiration uses a hollow needle to get rid of a little sample (about one ml) of bone marrow for examination beneath a magnifier.
Stem cell or bone marrow transplants are complicated treatments that carry a big risk of significant complications. Generally, younger folks that haven’t got the other serious conditions or people who receive transplants from a closely matched relative are less doubtless to expertise serious issues. People receiving transplants of their own stem cells (autologous transplants) are less doubtless to expertise serious facet effects. The main risks of a blood and marrow stem cell transplant are infections, graft-versus-host disease (GVHD), and graft failure.
Graft-Versus-Host Disease (GVHD):
Sometimes, the normal immune cells of the body reject the transplanted cells leading to the failure of the procedure. This is referred to as Graft Versus Host Disease(GVHD). In some cases, due to some anomaly, the immune cells of the body fail to recognize even their own cells. This may sometimes prove to be useful as they may also attack any cancer cells that are left after the treatment. It will occur inside a couple of months of the transplant or develop many months or sometimes a year or 2 later. The condition gentle, however, will sometimes be dangerous.
Symptoms of GVHD Includes:
• An itchy rash
• Feeling and being sick
• A sensitive and dry mouth
• Dry eyes
• Dry, flaky skin
• Shortness of breath
• Joint pain
• Yellowish discoloration of the skin and eyes
In order to reduce the symptoms of the Graft vs Host Disease, the doctors prescribe the immunosuppressants (drugs that slow down the immune system).
Patients will simply catch infections once the transplant attributable to the weak system. The risk of infections decreases because the system recovers.
Following steps can be taken to prevent infections:
• Regularly cleaned room of the patient
• Bathing or showering daily
• Carefully cleaning the teeth and gums
• Avoid having lightly cooked or raw eggs.
Transplant recipients sometimes are given vaccines to prevent viruses and infections, such as the flu and pneumonia. If a patient develops an infection, the treating doctor will prescribe medicines to treat.
When the new stem cells are failed to be recognized by the immune system the “graft failure” occurs. It also can occur if
• less than the required number of stem cells are used,
• damage to the new cells during storage,
• Bone marrow is damaged after the transplant.
• People who get stem cells from poorly matched donors also are more likely to have graft failure.
• When the patient is not adequately prepared for the transplant
After you get the transplantation, the future of transplantation depends on:
• The type of BMT done
• How well the donor’s cells match the patient’s cell
• What type of cancer or illness the patient is suffering
• Patients age and overall health
• The intensity and type the chemotherapeutic drugs that patient had undergone.
• Any complications the patient may have
A bone marrow transplant could utterly or partly cure the ill health. Patient can return back to his/her normal activities in case no problems occur after the transplant process. Usually, it takes up to one year to recover absolutely, depending on what complications occur. Complications or failure of the bone marrow transplant will result in death.
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1) Q: How many types of cancer are there?
A: There are more than 100 types of known cancer types.
2) Q: What are the early symptoms of blood cancer?
A: The most common symptoms of blood cancer include fever or chills, a chronic feeling of fatigue and tiredness, loss of appetite, frequent infections
and night sweats.
3) Q: Why does the diagnosis seem to delay in most of the cases?
A: Cancer cells multiply literally billions of times before the symptoms start to show. That is why some methods of screening and prevention are important.