Last week’s article urged readers to become potential bone marrow donors by signing up at bethematch.org. The process required to enter the registry is so simple and yet most people haven’t done it. Imagine what it would be like to save a life or be a terminal patient who discovers that there is still hope. Last week, the donation process was described and this week will focus on what the bone marrow recipient experiences.
Going through a bone marrow transplant is a difficult, but potentially lifesaving process. This procedure consists of infusing healthy blood stem cells into a patient who has damaged or diseased bone marrow. It is also called a stem cell transplant. Conditions that may require a bone marrow transplant are many, and include blood cancers like leukemias and lymphomas, bone marrow diseases like aplastic anemia, and immune system or genetic diseases like sickle cell anemia.
To review, patients are matched to donors by comparing specific protein markers called human leukocyte antigens, or HLA markers. There are three types of transplants.
- Autologous – cells banked from the patient’s own blood.
- Allogeneic – cells from an unrelated donor or a related donor (haploidentical).
- Umbilical – cells that come from a newborn’s banked cord blood.
When a suitable match has been found, the process can begin. This has the potential to be a challenging and emotional time, so having a reliable support system in place is critical.
Prior to receiving new bone marrow, the patient’s health will be evaluated in order to ensure that he/she is physically prepared to undergo a transplant. During this time a catheter (central line) is placed intravenously in order to provide access to the circulatory system. This is where medicines and the new stem cells will be introduced into the recipient’s bloodstream. The patient then enters what is called the conditioning process. During this period, chemotherapy (and possibly radiation) will be administered. The goal is to destroy any existing cancer cells and suppress the immune system (in hopes that it won’t attack the new stem cells after the transplant).
The day of the transplant is called “day zero.” Once the stem cells are infused, the patient will be closely monitored in the bone marrow transplant unit for several weeks. Lab tests will be scrutinized in order to determine if engraftment is taking place. This is the process by which donor stem cells travel to the bone marrow and begin to make healthy blood cells. This usually occurs within thirty days, but can take longer. White cells engraft first, followed by red cells and then platelets. Periodic infusions of all of these may be necessary until the marrow starts producing enough of them on its own.
Several complications can arise after the transplant has been done. These include stem cell graft failure, organ damage, infections, cataracts, infertility, new cancers and death, but one of the more common conditions is called graft versus host disease or GvHD. This occurs when the donor cells that comprise the new immune system regard the patient’s own tissues and organs as “foreign” and attacks them. GvHD can range from mild to severe and is typically treated with immunosuppressives and steroids, such as prednisone and ibrunitib. Symptoms of GvHD can appear within weeks or months, but usually arise within one year of the transplant. Because the immune system has been weakened, there is an increased risk of infection (particularly for allogeneic transplant patients who acquire GvHD) in the first few months after the procedure. Bacterial, fungal and viral infections are the most common, so a transplant patient may be required to take a multitude of medications during this period in order to fight them. Patients can also experience a wide range of unpleasant conditions related to the transplant, including chest pain, drop in blood pressure, fever, chills, flushing, funny taste in the mouth, headache, hives, nausea, pain and shortness of breath.
One of the more challenging hurdles is the prolonged isolation that is required after a transplant. Medical protocol will require visitors (generally limited to a small group of family and friends) to wear a mask and gloves. Sometimes these patients are kept in rooms with special air filtration systems or protective barriers. Children may be in the hospital for several weeks.
The first one hundred days after a transplant are critical. Patients must take their temperatures frequently in order to detect infection, they must adhere to a strict set of rules regarding hygiene, and upon going home, several other lifestyle adjustments will be necessary. These include refraining from certain outdoor activities and interaction with pets and other animals. These protocols can be confining and feel very restrictive. After a transplant, it is critical that the patient keeps a healthy diet and exercises regularly. Though this is a difficult journey, fraught with myriad challenges, it is doable. The good news is that more bone marrow transplant recipients are surviving than ever before. In the last five years, the number of patients who are alive one year after receiving a transplant from an unrelated donor increased from forty-two percent to sixty percent!
Please consider joining the bone marrow donor registry. Go to bethematch.org for more information.