Bone Marrow Transplant Procedure
A bone marrow transplant is one of the treatment options available to a patient suffering from bone marrow cancer, and the suitability for this type of treatment will be decided by the patient’s healthcare provider. During a bone marrow transplant the diseased bone marrow of the patient is destroyed and healthy bone marrow is inserted into the blood stream of the patient. When a bone marrow transplant is successful the newly-inserted bone marrow travels to the cavities of the larger bones, grafts, and subsequently begins the production of normal blood cells.
In the event that a donor’s bone marrow is not identical to the recipient’s the transplant is referred to as an allogeneic BMT, whereas if the donor is an identical twin of the patient the transplant is referred to as a syngenic BMT. In an allogeneic type of transplant the new bone marrow given to the patient must provide as close a match to the genetic makeup of the patient’s own bone marrow as possible.
In the first stage of compatibility testing blood tests are undertaken to ascertain whether or not the genetic types of the bone marrow match. This is crucial, as if the given bone marrow is not a good generic march it will be rejected as “foreign material” by the patient’s body and will be attacked and destroyed in what can become a life-threatening condition (known as Graft Versus Host Disease – GVHD). Also, the patient’s immune system may attack and destroy the bone marrow in what is known as “graft rejection”.
In order to be successful in most cases a transplant relies primarily upon the fact that the patient is sufficiently healthy to undergo what is a very rigorous procedure. Such factors as the patient’s age, general physical health, their actual diagnosis and the stage of the cancer will all be taken into account when determining the suitability of the transplant procedure.
At this point once a transplant has been decided upon a range of tests will be conducted to be certain that the patient will withstand the procedure, and these will include testing the lungs, kidneys, heart and other vital organ functions to establish a baseline in which to test post-transplant results against. In this way doctors can measure whether or not organ functions have been impaired as a result of the transplant.
The transplant will be undertaken by an expert team of doctors, nurses and support staff that are all experienced in bone marrow transplant procedures and will be able to react quickly to any problems that may occurs. They will also ensure that the patient and their family are given sufficient support before, during and after the procedure.
Irrespective of who provides the bone marrow that is used in the transplant the harvest procedure is the same – conducted in an operating room under a general anesthetic a needle is inserted into the cavity of the iliac crest (rear hip bone), as a large amount of bone marrow can be found here. This is then extracted with the needle for infusion into the patient.
Upon admission for the procedure the recipient will initially undergo a few days of chemotherapy or radiation treatments that will destroy both bone marrow and cancerous cells in order to provide room for the new bone marrow. This is known as the “preparative regime”, and after the chemotherapy or radiation treatment the transplant will take place in which the marrow is infused intravenously into the patient. The transplant does not take place in an operating room as it is not a surgical procedure.
During bone marrow infusion the patient will be continually checked for chills, hives and chest pains. In the two-to-four week period after the transplant the patient and healthcare team will wait for the new bone marrow to migrate to the cavity of the large bones to begin grafting and the subsequent production of normal blood cells. At this time the patient must be carefully monitored, as the initial conditioning prior to the graft and its chemotherapy treatments will have crippled their immune system as well as make them susceptible to excessive bleeding and infection.
Blood samples and tests will be taken in order to monitor functions and general health regularly as well. The patient will spend anywhere up to eight weeks in hospital post-transplant and will also receive antibiotics and blood transfusions in order to prevent and fight any infections. They will also receive platelet transfusions in order to prevent bleeding. The patient will also be protected from bacteria and viruses during this stage, including the preclusion of plants, flowers and fruits from the patient’s room as these often carry bacteria and fungi. Afterwards, should the transplant be successful, the patient will most likely be discharged from the hospital’s care and allowed to return home slowly and have their new immune system re-introduced to the world.
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