What is a Bone Marrow Transplant?
A bone marrow transplant, also known as a stem-cell transplant, treats certain cancers and other diseases affecting blood cells. Normally, new blood cells are made continuously in the bone marrow from precursor cells called stem cells. In a bone marrow transplant, damaged or diseased stem cells are destroyed and replaced with healthy blood-forming cells.
What does a Bone Marrow Transplant Treat?
A bone marrow transplant may treat cancers and other disorders that disrupt the production of blood cells. Some examples include:
- Hodgkin lymphoma
- Non-Hodgkin lymphoma
- Multiple myeloma
- Myelodysplastic syndromes (MDS)
- Myeloproliferative neoplasms
- AL amyloidosis
- Severe aplastic anemia
- Sickle cell anemia
At NewYork-Presbyterian, our experts will customize your therapy to the type, stage, and biology of your disease, your age, and overall health.
Types of Bone Marrow Transplants
The types of bone marrow transplants, also called stem cell transplants, are named according to the source of the cells transplanted.
Stem cells for transplant may be collected from your own blood or bone marrow (autologous), a donor (allogeneic), a family member, or an unrelated volunteer donor. Another possible source for healthy cells is a blood bank that stores donated umbilical cord blood from newborns, which is rich in blood stem cells.
- Autologous stem cell transplant uses cells that come from your blood or bone marrow. The cells are collected and stored such as through bone marrow harvest. Then, after you have prepared for the procedure, the cells can be infused back into your blood system.
- Adult donor allogeneic transplantation uses stem cells from a donor's blood or healthy bone marrow. The donor can be a relative or an unrelated person located through a donor registry whose immune system matches your own. NewYork-Presbyterian participates in the National Marrow Donor Program, providing us access to all available donors worldwide and enhancing your chances of finding an appropriate donor. We also have experience performing bone marrow transplantation with mismatched or partially matched donors, making this procedure possible for people who may have difficulty finding a matched donor.
- Umbilical cord blood transplants use stem cells from a blood bank that stores donated umbilical cord blood from newborns. Umbilical cord blood is a rich source of stem cells. Stem cells from cord blood are sometimes combined with donor stem cells.
At NewYork-Presbyterian, our Bone Marrow and Hematopoietic Stem Cell Transplantation Program is a Center of Excellence in stem cell transplantation, as designated by the National Cancer Institute and accredited by FACT (Foundation for the Accreditation of Cellular Therapy).
How is a Bone Marrow Transplant Performed?
If you need a bone marrow transplant, your doctor, our transplantation experts, blood cancer experts, and transplantation immunologists will create the most effective treatment plan for you. Treatment aims to cure (or put into remission) cancers and other blood diseases, and this is done by replacing diseased blood-forming cells with healthy ones. Bone marrow transplant follows these basic steps:
- Healthy blood-forming stem cells are obtained from the treated person, a donor, or a cord blood bank
- Chemotherapy, and sometimes radiation therapy, are given to eliminate the patient’s cancer cells and the diseased blood-forming cells in the bone marrow
- Healthy stem cells are infused into the patient’s bloodstream. Stem cells can find their way into the bone marrow, so they can be infused similarly to a standard blood transfusion.
- The healthy stem cells take over and begin making healthy blood cells in the bone marrow
Risks to Consider
Risks of bone marrow transplant range from minimal discomfort to life-threatening complications, varying from person to person. Our dedicated infectious disease consultants, gastroenterologists, pulmonary specialists, nephrologists, and critical care specialists are on call in case complications arise.
Short-term risks and side effects from bone marrow transplant include:
- Mouth sores and sore throat
- Nausea and vomiting, diarrhea
- Lung inflammation
- Liver damage
- Graft failure (transplanted stem cells do not make new blood cells)
Before undergoing a bone marrow transplant, you and your doctors will discuss your risk of complications based on your disease, age, and other factors, as well as the possibility of additional long-term risks.
Donor stem cell risks
For people who have bone marrow transplants using stem cells from a donor (allogeneic), graft-versus-host disease (GVHD) is a common complication. This happens when the donor cells attack healthy organs in your body. The reaction can range from mild to life-threatening. GVHD can develop shortly after transplant (acute) or several months, or even years, later (chronic).
Common symptoms of GVHD include:
- Skin redness, rash
- Loss of appetite
- Weight loss
Preparing for Bone Marrow Transplant
As you prepare for a bone marrow transplant, you and your care partner will discuss all aspects of the transplant process with your doctor and other care team members. Your doctor will record your complete medical history and do a physical exam. A biopsy (small sample) of bone marrow will likely be taken from your pelvis. Your doctor will order imaging tests, such as CT, MRI, and blood tests, and assess your heart and lung function.
You may also consult with a dietitian, social worker, and other care team members. You’ll have a temporary catheter (similar to a large intravenous line) placed in your upper chest to facilitate the infusion of stem cells and to minimize needlesticks for blood draws.
Most stem cells are found in the bone marrow, but some circulate in your blood. Transplanting your own cells (autologous bone marrow transplant), involves collecting stem cells from your blood. The blood is taken from a vein and passed through a machine that isolates the stem cells. The remaining blood is returned to your body through a catheter placed in your chest. This process is called apheresis.
To prepare for a donor (allogeneic) stem cell transplant, your doctor will help you find a donor whose immune system matches yours, so your body will not reject the transplant. A donor may be a sibling or other family member, or someone listed in a registry of potential donors. If a registry match is made, the donor will be contacted and go through a process of removing stem cells from their blood (apheresis). The cells will be preserved for your transplant and can remain frozen for many years if needed.
Before receiving a bone marrow (stem cell) transplant, you will undergo a conditioning process. You will receive high-dose chemotherapy and possibly radiation therapy to completely destroy your body's cancer cells and diseased stem cells. The details of your conditioning treatment depend on your cancer type, what kind of transplant you will receive, and whether you have had chemotherapy or radiation therapy.
Side effects of conditioning include:
- Mouth sores
- Hair loss
These and other side effects will be discussed in detail before the transplant. Depending on your age and health history, your doctor may recommend a less intense approach to conditioning. This treatment uses lower doses of chemotherapy, with or without lower doses of radiation. Like high-intensity conditioning, this treatment aims to prepare your bone marrow for the donor cells to take over. Side effects are less severe. These reduced-intensity regimens make transplants an option for older individuals and people with heart or lung disease.
At NewYork-Presbyterian, we tailor bone marrow transplant preparation to the unique needs of each patient. Our multidisciplinary team provides compassionate, respectful, and state-of-the-art care.
After the Transplant
Most bone marrow transplant recipients stay in the hospital for 3 to 4 weeks after the procedure. Our advanced, dedicated bone marrow transplant units offer personal monitoring, private rooms, and special airflow systems for patients with weakened immune systems. You will be cared for during your bone marrow transplant recovery by our highly trained nurses, pharmacists, social workers, and dietitians. You’ll have access to experienced and compassionate care from all hospital services for treatment of side effects. You will be ready to go home when new blood cells grow in your bone marrow and reach a healthy level in your blood. Your doctor will talk with you and your care partner about your needs for continued recovery after discharge.
Receive a Bone Marrow Transplant at NewYork-Presbyterian
At NewYork-Presbyterian, our nationally and internationally known bone marrow and stem cell transplant experts offer a comprehensive, multidisciplinary approach to care. Schedule an appointment for our top-ranked cancer care services.