Bone marrow transplant (transplantation) is the transfer of stem cells that make up healthy blood cells from one person to the same person or someone else. This transplant is also called a stem cell transplant. Stem cells are specialized cells produced by the bone marrow. They can turn into red blood cells (erythrocytes) that carry oxygen to all parts of the body, white blood cells (leukocytes) that fight infection, and blood platelets (thrombocytes) that help stop bleeding. There are two types of bone marrow transplant, autologous bone marrow transplant, and allogeneic bone marrow transplant. has. In autologous bone marrow transplantation, the donor (bone marrow donor) is the patient himself. Stem cells taken from the patient are transferred to the patient directly or after certain procedures. In allogeneic bone marrow transplantation, the bone marrow is taken from another donor, not from the patient himself. The stem cells taken are transferred to the patient.
Why Bone Marrow Transplantation Is Performed?
A bone marrow transplant is a procedure done if the patient’s bone marrow is damaged or is no longer able to form healthy blood cells. A bone marrow transplant is usually done if other treatment options have failed. This decision is made considering the complications that the patient may encounter after bone marrow transplantation. The benefit from treatment is compared with the extent of complications that may occur. The cases in which bone marrow transplantation is performed are divided into cancer-related causes and non-cancer-related causes. The most common causes of cancer-related cases are leukemia and lymphoma.
Some of the other reasons are:
Acute myeloid leukemia (AML),
Chronic myeloid leukemia (CML),
Acute lymphoblastic leukemia,
Hodgkin lymphoma,
Non-Hodgkin Lymphoma,
Neuroblastoma,
Ewing Sarcoma,
Multiple myeloma,
Myelodysplastic syndromes,
Some diseases other than cancer may also require a bone marrow transplant:
Thalassemia (Mediterranean anemia),
Sickle cell anemia,
Aplastic anemia,
Fanconi anemia,
Some autoimmune diseases,
Immunodeficiency syndromes.
However, there are some conditions that need to be taken into account, both due to the underlying disease itself and the immunosuppressive drugs used during and after the bone marrow transplant.
1- Transfer Denial
Intensive chemotherapy and radiotherapy can be applied to the recipients during the preparation period for bone marrow transplantation. If immunity is insufficiently suppressed during the preparation period, the patient’s immune cells may reject the transplanted bone marrow.
2- Infection
Immunosuppressive drugs weaken the immune system’s response, preventing the transplanted bone marrow from being rejected by the body. However, immunosuppressive drugs make the patient more susceptible to infections. Recovery of immunity after transplant usually takes 3-12 months. In this process, the immune system response is followed regularly with blood tests. Until the immune system response improves, the person faces an increased risk of infection. Some measures that can be taken in this situation are as follows:
Washing hands frequently with an antibacterial soap
Avoiding people who are sick and at risk of transmitting disease,
Wearing masks in public,
Applying to the hospital in cases of infection symptoms such as fever, runny nose, shortness of breath, diarrhea, cough,
Taking care of oral and dental health,
Paying attention to personal hygiene.
3- Side Effects Related to Chemotherapy and Radiotherapy
Due to the intense chemotherapy and radiotherapy applied during the preparation process for bone marrow transplantation, the person may encounter some side effects:
nausea and vomiting,
Diarrhea,
Hair loss,
mouth sores and ulcers,
Infection,
Bleeding,
Infertility (Infertility),
Tiredness,
Cataract.
4- Regular Medication Use
Especially in allogeneic bone marrow transplants, immunosuppressive drugs are used to protect the person from transplant rejection and to prevent Graft versus host disease. These drugs should be used regularly. Since the risk of infection increases after the transplant, antibiotic treatment can be given to protect the person from infection during this period. These antibiotics should also be used regularly.
5- Smoking and Secondary Cancer Risk
The risk of secondary cancer has increased due to both the insufficient immune system response and the intense chemotherapy and radiotherapy received during this period. Another reason that increases the risk of secondary cancer is smoking. If a person smokes, they should quit immediately. The skin should be protected by applying sunscreen when going out. Cancer screening programs recommended by the doctor should be followed regularly and these programs should be followed.
6- Diet
After the transplant, it is important to eat healthily and prevent excessive weight gain. The diet can be adjusted by considering nausea and vomiting, one of the common side effects of chemotherapy and radiotherapy. Food safety guidelines can be followed to prevent foodborne infections. A person’s diet should contain all nutrients in a balanced way. Salt intake should be restricted. Foods and beverages that interact with medications, such as grapefruit and grapefruit juice, should be avoided. If necessary, support from dietitians can be obtained.
7- Exercise
Regular exercise in the post-bone marrow transplant period has many benefits. Exercise during this period provides weight control; helps to strengthen bones, increases muscle strength and endurance, and protects heart health. As the person recovers, physical activity, duration and intensity of exercise can be increased.
8- Bleeding
After bone marrow transplantation, blood cells may not be synthesized sufficiently until the bone marrow begins to show its main function. One of the blood cells is platelets, which help stop bleeding and clot blood. When the platelet level is not sufficient, the risk of bleeding increases. These bleedings can manifest as bleeding gums, nosebleeds and bleeding on the skin. In addition, bruises that occur as a result of hitting something may also occur depending on this situation. Unless the physician recommends, drugs with blood thinning effects should not be used.
9- Weakness
After transplantation, cell production and cell growth accelerate. For this reason, the energy requirement of the body increases in the early stages. During this period, the person may feel sluggish and tire easily. However, the person should be aware that his fatigue and weakness will pass with the recovery period and that this situation is temporary. The duration and intensity of physical activities should be increased gradually along with the recovery period, in accordance with the general condition of the person.
10- Graft Versus Host Disease (GVHD)
There is a risk of developing GVHD after allogeneic transplantation. After the transplant, the donor’s bone marrow now begins to produce the recipient’s new immune system cells. The resulting immune system cells may perceive the recipient’s tissues and organs as foreign and attack the tissues and organs. Graft versus host disease can develop at any time after transplantation. Although the risk of developing GVHD increases as the biological proximity between the recipient and the donor decreases, the disease may develop at some point regardless of the degree of closeness.
There are two types of graft versus host disease, acute and chronic. Acute graft versus host disease develops earlier. It is more likely to happen in the first months after transplantation. It typically involves the skin, digestive tract, and liver.
Chronic graft versus host disease can affect any organ and cause some symptoms. Some of these symptoms may be:
Muscle and joint pains,
Shortness of breath,
chronic cough,
Blurred vision with dry eye
Debris,
Jaundice,
Dry mouth,
Mouth sores,
Diarrhea,
Nausea and vomiting.
The person should be aware of graft versus host disease, which is a serious complication that can occur after bone marrow transplantation. He should follow the changes in his body and apply to the hospital when necessary.
If you or a relative has been recommended a bone marrow transplant, you can apply to the nearest health institution for detailed information. We wish you healthy days.