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Bone Marrow Transplant

Bone marrow is the spongy center of the bone. This place is filled with blood-producing cells, called stem cells, which develop into mature white blood cells, red blood cells or platelets. The marrow is the place where blood is produced. While white blood cells of various kinds make form a part of the immune system which fights infections, red blood cells are responsible for carrying oxygen throughout the body and platelets help in clotting the blood to prevent bleeding. Stem cells are constantly produced by the marrow, and develop into the types of cells the body needs.

A bone marrow transplant replaces bone marrow that either is malfunctioning or has been damaged due to various reasons. The doctor may recommend a bone marrow transplant if the patient -

  • has been confirmed to have cancers such as leukemia, multiple myeloma and/or lymphoma.
  • is suffering from disease that affects the production of bone marrow cells, such as congenital neutropenia, aplastic anemia, sickle cell anemia and, thalassemia.
  • had chemotherapy that destroyed the bone marrow

There are different types of procedures that exist for bone marrow transplant today.

Allogeneic Transplants

Allogeneic transplant involves receiving a donor's bone marrow or peripheral blood stem cells. For this the donor is genetically matched. The potential candidates for an allogeneic bone marrow transplant are those who have one or a combination of these among other types of cancers -

  • Leukemia
  • Aplastic anemia
  • Myelodysplasia
  • Myelofibrosis
  • High-grade lymphoma

An allogeneic transplant involves receiving high doses of chemotherapy and/or radiation therapy, followed by the infusion of the donor's bone marrow or peripheral blood stem cells into the patient. The high-dose cancer fighting treatments are given to eliminate the cancer in the patient's body.

A reduced-intensity allogeneic transplant involves receiving lower doses of chemotherapy and radiation therapy followed by the infusion of the donor's bone marrow or peripheral blood stem cells. The objective of the transplant is to suppress the patient's bone marrow by injecting just enough chemotherapy and radiation therapy to allow the donor cells to engraft and grow within the patient.

Umbilical cord blood transplant

This is a type of allogeneic transplant. Stem cells are removed from a newborn baby's umbilical cord right after birth. The stem cells are frozen and stored until they are needed for a transplant. Umbilical cord blood cells are very immature so there is less of a need for matching. But blood counts take longer to recover.

Autologous Transplants

An autologous transplant is a procedure in which the damaged bone marrow or peripheral blood stem cells are replaced from the patient's own health stem cells from another part of the body.

The term auto means self. Stem cells are removed from the patient before infusing high-dose chemotherapy or radiation treatment. The stem cells are stored in a freezer (cryopreservation). After high-dose chemotherapy or radiation treatments, your stems cells are put back in your body to make (regenerate) normal blood cells. This is called a rescue transplant.

The potential candidates for an autologous bone marrow transplant are those with -

  • Lymphoma
  • Multiple myeloma
  • Amyloidosis
  • Hodgkin's disease
  • Germ cell cancer

Syngeneic Transplants

A syngeneic transplant is possible when the patient has an identical twin as the procedure involves using the twin's bone marrow or peripheral blood stem cells.

Before the transplant, chemotherapy, radiation, or both may be given. This may be done in two ways:

  • Ablative (myeloablative) treatment: High-dose chemotherapy, radiation, or both are given to kill any cancer cells. This also kills all healthy bone marrow that remains, and allows new stem cells to grow in the bone marrow.
  • Reduced intensity treatment, also called a mini transplant: Patients receive lower doses of chemotherapy and radiation before a transplant. This allows older patients, and those with other health problems to have a transplant.

Surgical Oncology

Surgical Oncology constitutes skillful removal of complex tumours. This requires the exceptional expertise of highly experienced and motivated surgical oncologists.

Whether a patient is a candidate for surgery or not depends on factors such as the type, size, location, and stage of the tumor. Also considered are general health factors such as age, physical fitness and other coexisting medical conditions the patient may have.

For many patients, surgery could be combined with other cancer treatments, such as chemotherapy, radiation therapy or hormone therapy. These nonsurgical treatments may be administered before surgery or after surgery to help prevent cancer growth, spread or recurrence.

Stem Cells Collection

Donor stem cells can be collected in two ways:

  • Bone marrow harvest - This minor surgery is done under general anesthesia. This means the donor will be asleep and pain-free during the procedure. The bone marrow is removed from the back of both hip bones. The amount of marrow removed depends on the weight of the person who is receiving it.
  • Leukapheresis - First, the donor is given 5 days of shots to help stem cells move from the bone marrow into the blood. During leukapheresis, blood is removed from the donor through an IV line in a vein. The part of white blood cells that contains stem cells is then separated in a machine and removed to be later given to the recipient. The red blood cells are returned to the donor.

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