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Bone marrow transplantation
Bone marrow is soft tissue found inside many bones. In the bone marrow, stem cells (progenitor cells) mature, which later differentiate into platelets, red blood cells and white blood cells and are released into the bloodstream.
When there is bone marrow disease, where there is no stem cell production or the bone marrow produces unhealthy cells, a bone marrow transplantation is considered the best treatment option.
Bone marrow transplantation is often the only chance to cure blood cancers.
Types of bone marrow transplantation
- Autologous stem cell transplantation
In an autologous stem cell transplant, the doctor extracts stem cells from the patient’s own bone marrow or blood. The patient then receives high doses of chemotherapy with one or more drugs, sometimes in combination with radiation therapy. The duration of chemotherapy ranges from 2 to 7 days. This is called preparatory therapy.
High doses of chemotherapy destroy both cancer cells and bone marrow stem cells.
After the end of preparatory therapy, the taken stem cells are returned, after which the bone marrow independently produces new blood cells.
Autologous stem cell transplantation is mainly used in the treatment of lymphomas (Hodgkin lymphoma and non-Hodgkin lymphoma), multiple myeloma. Less commonly used in the treatment of acute and chronic leukemia.
- Allogeneic stem cell transplantation
During allogeneic stem cell transplantation, the patient receives the necessary biomaterial from the donor. The donor can be a person whose certain tissue characteristics most closely match those of the recipient.
The donor can be a close relative (usually a brother or sister). If a suitable related donor cannot be found, it is necessary to search for an unrelated donor in national and international bone marrow donor registries.
Treatment for an allogeneic stem cell transplantation, in addition to high-dose chemotherapy, is supplemented by medications that suppress and modulate the immune system. This phase is called conditioning. It helps ensure that donor stem cells are not attacked by the recipient’s body as foreign cells.
Autologous stem cell transplantation is mainly used to treat myeloid leukemia, aplastic anemia, thalassemia, Fanconi anemia.
What diseases are prescribed
How is the procedure carried out
Modern treatment of cancers of the blood and lymph glands includes high-dose chemotherapy in combination with or without radiation therapy. Chemotherapy and radiation therapy not only destroy cancer cells, but also damage healthy blood stem cells in the bone marrow.
After radiation or chemotherapy, patients need new progenitor cells to activate hematopoiesis. A bone marrow transplantation is used for this. Healthy cells are transferred into the patient’s body through bone marrow transplantation, peripheral blood stem cell transplantation, or umbilical cord blood transplantation. The donor’s stem cells migrate to the recipient’s bone marrow, where they independently begin to produce new healthy blood cells after 2-3 weeks.
Bone marrow stem cell transplant
Rarely used when collecting cells from peripheral blood is not possible.
The doctor collects the stem cells by removing bone marrow from the donor’s femur. The operation is performed under general anesthesia.
Stem cell transplantation from peripheral blood
This type of transplantation is considered more acceptable due to less stress on the donor’s body.
The bone marrow releases small amounts of stem cells into the blood. To obtain enough stem cells for transplantation, the donor takes growth factors, medications that stimulate more stem cells to migrate from the bone marrow into the bloodstream.
After 4-14 days, the stem cells are collected using apheresis. To do this, a needle is inserted into the donor’s vein, which will pass blood through a special device. The stem cells are collected separately and the rest of the blood is returned to the donor.
Stem cell transplantation from umbilical cord blood
Cord blood stem cell collection is performed from the umbilical cord and placenta immediately after the baby is born. The blood in the umbilical cord and placenta contains a large number of stem cells.
Donated cord blood is carefully screened, then frozen and stored in a cord blood bank.
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Clinics performing the procedure
Doctors performing bone marrow transplantation
Zafer Gulbash
Zafer Gulbash is a Doctor of Medical Sciences, Professor of …
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Polina Stepensky
Polina Stepensky is the Head of the Bone Marrow Transplant …
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Peter Reichardt
Prof. Dr. med. Peter Reichardt is the Head of the …
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Risks and side effects
Side effects from bone marrow transplantation may occur soon after transplantation. They are associated with the destruction of bone marrow by high doses of chemotherapy or radiation therapy.
Among the complications and side effects of bone marrow transplantation, doctors identify:
- Weakness;
- Nausea and vomiting, diarrhea;
- Cataract;
- Infertility;
- Cancer recurrence;
- Secondary cancer;
- Organ damage;
- Graft failure;
- Hormonal changes;
- Graft versus host disease;
- Increased risk of developing infectious diseases.
Frequently Asked Questions
What is a bone marrow transplantation?
A bone marrow transplantation is a procedure in which damaged or destroyed bone marrow is replaced with healthy bone marrow stem cells from your body or a donor.
A bone marrow transplantation is also called a stem cell transplant.
Where is bone marrow transplantation performed?
The leading countries for bone marrow transplantation are Israel and Turkey. The cost of bone marrow transplantation procedures in Turkey is 30-50% lower compared to similar procedures in other countries. However, despite the price difference, the quality of medical services remains on par with the best clinics in Europe and the USA.
Anadolu Medical Center. Highly qualified oncohematologists perform all types of bone marrow transplantations for patients over 16 years of age. The clinic carries out procedures according to modern American protocols.
Medipol University Hospital. Medipol doctors perform bone marrow transplantation for patients of any age. According to the hospital, the success rate of bone marrow transplantation in Medipol is 98%.
Sourasky Medical Center (Ichilov Clinic). One of Israel’s leading clinics for bone marrow transplantation. The pediatric oncohematology department is certified by EBMT (European Society for Blood and Marrow Transplantation).
Sheba Medical Center. The clinic specializes in the treatment of oncohematological diseases in children and adults, as well as in operations and procedures of any complexity. The hospital employs a practicing oncohematologist who is among the TOP best transplantologists in the world.
For what diseases is bone marrow transplantation performed?
- Leukemia (acute and chronic);
- Aplastic anemia;
- Hodgkin’s lymphoma;
- Non-Hodgkin’s lymphoma;
- Multiple myeloma;
- Myelodysplastic syndrome;
- Neuroblastoma;
- Germ cell tumors.
What is graft-versus-host disease?
Graft-versus-host disease (GVHD) is a complication of allogeneic stem cell transplantation. Occurs in 20-50% of patients undergoing allogeneic bone marrow transplant, usually after 2-18 months.
GVHD is when the donor’s immune cells recognize the recipient’s (host’s) own cells as foreign and attack them.
There are acute and chronic GVHD. Acute develops in the first 100 days after transplantation. Chronic occurs more than 100 days after transplantation.
Who can be a bone marrow donor?
Transplantation from a matched related donor.
The donor is a relative (one of the parents, a brother or sister). The probability that the cells will match is 1 out of 4. Donation is possible even with a donor that is not completely compatible (if the cells match 50%). This is called a haploidentical transplant.
Transplantation from a matched unrelated donor.
If there is no compatible donor in the family, a compatible unrelated person found in a special registry (national or international) can become a donor.
What is the difference between autologous and allogeneic bone marrow transplantation?
Autologous and allogeneic transplantation are the two main types of bone marrow transplantation.
Autologous – material is taken from your own bone marrow or blood. The main advantage of autologous stem cell transplantation is the absence of rejection (graft-versus-host disease).
Allogeneic – bone marrow transplant from a donor (relative or stranger).
What is an umbilical cord blood transplantation?
There are three ways to obtain cells for transplantation:
- From bone marrow;
- From peripheral blood;
- From umbilical cord blood.
Blood is taken not from the baby, but from the umbilical cord and placenta immediately after birth. Donor cord blood is screened. Eligible cord blood is frozen and stored in a cord blood bank.
What type of transplantation to choose?
The choice of the method of extracting blood cells and the type of bone marrow transplant depends on the disease and its stage, as well as the clinical picture and well-being of the patient.
The decision is made by transplantologists, hematologists and oncohematologists.
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