Bone Marrow Transplant

Bone marrow transplantation is an important surgery for patients with bone marrow disorders that affect the production of different blood cells. Bone marrow can be defined as a group of soft spongy tissue within the bone known as stem cells, where its function is focused on the production of different blood cells such as: white blood cells, red blood cells and platelets.

Bone marrow transplantation is summarized by replacing the damaged or patient's bone marrow with a healthy bone marrow either from the patient's own cells (autologous) or from another donor (often relative of the patient from the first level), the patient first undergoes radiotherapy, chemotherapy, or both to dispose of the infected cells in the bone marrow and allow new stem cells to grow inside the bone marrow.

The hematologist and oncologist can perform bone marrow transplantation after the availability of stem cell samples and then begin a series of strict patient care procedures for best results.

Treatment period takes approximately "48 days."

A hematologist and oncologist may resort to bone marrow transplantation due to one of the following conditions:

• Blood cancers such as leukemia or lymphoma.
• Aplastic anemia.
• Sickle cell disease.
• Thalassemia.
• Neuroblastoma.
• Hodgkin's or non-Hodgkin’s lymphoma.
• Multiple myeloma.
• Primary amyloidosis.
• Some immune disorders.

Before starting the preparation procedures for the patient's bone marrow transplantation, the appropriate donor should be found and conduct all tests for both; to ensure patient-donor matching, also to ensure the donor's safety of infectious diseases and cancers, the test include:

-Patient Tests:

• Comprehensive blood tests to detect any viral or other infections in the body, such as hepatitis or AIDS and other infectious diseases.
• Echocardiogram (Echo.); to check for heart function.
• Electrocardiogram (ECG).
• X-ray examination to check the heart and lungs.
• Bone marrow biopsy.
• CT scan.
• PET scan to check for organs functions within the body.

- Donor tests:

• Blood tests to detect any viral or other infections in the body, such as hepatitis or AIDS and other infectious diseases.

- Matching tests include detection of blood type matching between patient and donor, and tissue typing (HLA test).

Bone marrow transplantation may involve some risks and complications, including:

• Pain in chest.
• A sharp drop in blood pressure.
• Apnea.
• Headache.
• Nausea.
• Fever or chills.
• Cataract.
• Menopause at an early age.
• Stomach problems such as vomiting, diarrhea and others.
• Infection.
• Failure of the liver, kidneys, lungs and heart.
• Thrombosis of small veins in the liver.
• Anemia.
• Rash.
• Bleeding in the lungs, intestines, brain and other areas of the body.

The above complications depend on several factors, including the disease that the patient suffers from, his age, the proportion of match with the donor and other factors that affect the patient's health after the transplant.

Bone marrow transplant includes the following:

After all the patient and donor tests are carried out, the health of the donor is checked for any viral or infectious diseases and the required matching is achieved through tissue matching tests, preparation of bone marrow transplantation is carried out through the following stages:

The first stage involves obtaining bone marrow by one of the following:

- Autologous; any of the patient's own cells, where the stem cells are obtained by a process called phlebotomy, after the patient is given a set of stimulant injections to stimulate the production of these cells and exit the bloodstream, then the doctor takes a sample of the patient's blood and place it in a device that separates blood components including stem cells (centrifugation), and then it is kept frozen for use in transplantation.

- From another donor (Allogeneic); a sample of the stem cells of the donor is taken and separated and preserved by freezing also until used for transplantation in the patient's body.

The second stage: The patient undergoes chemotherapy or radiation therapy to eliminate existing cancer cells or damaged or abnormal cells, inhibit immunity in the body and prepare the bone marrow to receive new stem cells, after which the patient may experience some side effects such as nausea, vomiting, fatigue and other risks. The patient is now ready to receive new stem cell samples.

The third stage: Stem cell injection (called zero day), the patient remains awake during transplantation and receives local anesthesia only as the injection does not cause pain that requires general or regional anesthesia.

Then the stem cells start its cycle within blood until reaching the marrow, to start new blood cells production stage, this will take about 18 to 30 days.

* The patient is given a calculated number of stem cells based on certain proportions related to weight and size.

The patient remains after the bone marrow transplant in the hospital in a completely isolated and sterile room, so that the air molecules are under control within a certain system through which they are not allowed to mix with any external air, as well as all the contents of the room in which the patient will stay; due to the patient's inability to resist any germs or pathogens that may sweep his body during the first period of transplantation, thus he is completely isolating for approximately 18 to 30 days.

The recovery period following bone marrow transplant is a very sensitive period in which the patient must consider a lot of factors to avoid any possible relapses and get the best results. The hematologist and oncologist give the patient a set of tips and instructions that must be observed during the first three months, the most important of which are:

• Preventing the visit for the patient, even at home during the first period, until the surgeon satisfied with his immune levels, the patient can contact with family who live with them in the same house, with the avoidance of people who suffer from flu or other viral illnesses, and it is preferred to wear a protective mask (muzzle) when dealing with anyone.
• Cleaning and disinfecting the house thoroughly, it is possible to use antimicrobial coating in the room where the patient will stay in during the first period.
• The patient should only eat well cooked food and avoid eating any varieties of fresh food, only after boiling; to get rid of germs that may be stuck on them.
• Not to leave the house for a maximum of two months, the patient can be able to get out earlier depending on his condition as determined by the specialist of oncology and hematology.
• Avoid having children in the first 6 months; due to chemotherapy given to the patient and its ability to affect the fetus.

* If the new marrow sample is from a donor, the patient is given a series of vaccines after approximately 6 months.

* The patient can return to work after the expiration of the period of three months and practice his life normally.