BMT Process

Unlike organ transplants, blood and marrow transplants are not a surgical process. They're more like blood transfusions. The more difficult part of the BMT process is managing the complications following the transplant, when the patient is extremely susceptible to infection. Following is a brief overview of the process--from preparations to donor harvest to transplant.

Harvesting stem cells
Stem cells may be harvested from a number of sources: bone marrow, peripheral blood and umbilical cord blood.

• Donor Marrow Harvest
  Stem cells are harvested from the bone marrow. Using a special needle and syringe, bone marrow is surgically removed from the pelvic bones. The donor is given general anesthesia and can be discharged from the hospital that day or the following with some soreness that may linger for several days following the procedure.

• Peripheral Blood Stem Cell (PBSC) Harvest
  Peripheral or circulating blood is collected using a large intravenous (IV) needle or a special IV catheter. The donor is given growth factors before the procedure to mobilize stem cells from marrow to the peripheral blood. Similar to collecting blood, the procedure is done on an outpatient basis.

• Umbilical cord blood
  Umbilical cord blood is taken from the umbilical cord and placenta of a newborn baby. Cord blood, normally discarded following the birth of a baby, is rich in stem cells and a good source for a BMT. The cord blood is collected with parental consent and stored in cord blood banks. Fairview-University Medical Center is the only local area hospital that collects cord blood. It is stored in a public cord blood bank created by the hospital, the University of Minnesota and the American Red Cross.

Preparing for a BMT
Laboratory and diagnostic tests are performed to confirm the medical appropriateness for transplant and to establish baseline data. High doses of chemotherapy and/or radiation are given to destroy the cancer or disease and to stop the production of bone marrow cells so that the transplanted cells can grow and not be rejected by the body. This preparative regimen is usually conducted in the hospital and takes approximately seven to 10 days. With select diseases, part or all of the procedure is done on an outpatient basis.

The Transplant
The transplant takes place after chemotherapy with/or without radiation therapy. During the transplant, the stem cells that have been previously collected from the donor or patient will be given to the patient. The transplant, itself, is similar to a blood transfusion and takes about an hour or less.

Patients may be given medications before the transplant to prevent or manage side effects such as chills or nausea. Healthy marrow or stem cells are given to the patient through an IV connected to a central venous catheter. The cells travel through the patient's bloodstream until they reach the bone marrow, where they begin to grow and divide, making new red and white blood cells and platelets, called "engraftment." Cell counts typically return to normal levels two to four weeks after the transplant. Use of "growth factors" can accelerate engraftment. Following engraftment, new marrow begins to manufacture healthy blood cells. New white blood cells help to fight off infections.

Supportive Care
During the weeks before the newly transplanted stem cells produce new blood cells, a patient's body is unable to produce white blood cells, increasing his or her risk of infection. Patients are closely monitored and receive medications to prevent infection. They are also kept in protective isolation on the BMT unit.

While the new stem cells are growing, patients need transfusions of red blood cells and platelets to replace those they are not yet producing. There's always a chance of a reaction to blood transfusions. Medications can be given to help prevent reactions.

Potential Complications and Recovery
Depending on a patient's circumstances, he or she is treated in the hospital several days to several months following transplant. Patients may experience some complications as a result of chemotherapy and/or radiation treatment, including mouth sores, nausea, vomiting and diarrhea.  A number of medications can help to increase comfort as well as the use of healing touch, imagery and self-hypnosis therapies. Until a patient's bone marrow begins making blood cells on its own, he or she may experience bleeding from mouth sores or nose bleeds. Platelet or red blood cell transfusions are given when there are signs of bleeding.

The first few weeks following transplant present the greatest risk for infection. To reduce the risk of infection, patients' hospital rooms have special air filtration; patients are tested each week for infections and special precautions are taken including requiring visitors to wash their hands before entering a patient's room and restricting them from visiting if they have a fever. Graft-versus-host disease (GVHD), a potential complication of allogeneic transplants, can occur when the donor cells recognize the body's own cells as foreign and tell the immune system to attack those cells. Medications are given before and after transplant to prevent GVHD.

Following discharge from the hospital, patients return to clinic several times a week as needed to monitor symptoms and recovery. Patients are allowed to return home as soon as their medical condition permits. Full recovery may take up to one year.