Diagnosis & Treatment

Bone Marrow Transplant

What is a bone marrow transplant?

A bone marrow transplant, also known as a stem cell transplant, is used to treat certain cancers and other diseases affecting blood cells. Stem cells in your bone marrow are the precursor cells that produce all of your blood cells. They can be affected by certain types of cancers — like leukemias, lymphomas, or multiple myeloma — and by other blood diseases, such as sickle cell disease or aplastic anemia. During a bone marrow transplant, your bone marrow stem cells are eliminated using chemotherapy, with or without radiation, and replaced with healthy stem cells that help your body rebuild its blood-forming and immune systems.

What diseases do we treat with bone marrow transplant?

Leukemia, including acute lymphoblastic leukemia and acute myeloid leukemia
Hodgkin lymphoma
Non-Hodgkin lymphoma
Multiple myeloma and POEMS syndrome
Myelodysplastic syndromes (MDS)
Myeloproliferative neoplasms
Myelofibrosis
AL amyloidosis
Severe aplastic anemia and other bone marrow failure syndromes
Sickle cell anemia
Thalassemia

Our experts will customize your therapy to the type, stage, and biology of your disease, your age, and your overall health.

Types of stem cell transplants

Allogeneic stem cell transplant. You receive healthy stem cells donated by a fully or partially matched donor — either a relative or an unrelated volunteer located through a donor registry. NewYork-Presbyterian participates in the National Marrow Donor Program, providing access to all available donors worldwide and enhancing your chances of finding an appropriate donor.
Umbilical cord transplant. Your stem cells may come from a blood bank that stores donated umbilical cord blood from newborns. Umbilical cord blood is a rich source of stem cells. Double cord blood transplants, which infuse two cord blood units to deliver a higher dose of stem cells, make transplantation possible for some patients without suitable adult donors. NewYork-Presbyterian/Weill Cornell Medical Center is internationally recognized for its expertise in umbilical cord blood transplantation.
Autologous stem cell transplant. This transplant uses your own stem cells, which are collected from you before you start intensive cancer treatment. You'll receive medications for a few days to help move the stem cells into your blood. When ready, you'll be connected to an apheresis machine to collect stem cells from your blood, which are frozen until we are ready to give them back to you.

What type of stem cell transplant is best for me?

Your care team will carefully review each option to help determine the best stem cell transplantation approach for you. If you receive stem cells from a donor, they are matched to you based on immune cell proteins called human leukocyte antigens (HLA). The more the donor matches you, the better. If a fully matched option is not possible, however, our experts have decades of experience using stem cells from partially matched donors, such as haploidentical donors, mismatched unrelated donors, and umbilical cord blood units.

How is a bone marrow transplant performed?

If you need a bone marrow transplant, your doctor, our transplant experts, blood cancer experts, and transplant immunologists will create the most effective treatment plan for you. Treatment aims to cure (or put into remission) cancers and other blood diseases by replacing diseased blood-forming cells with healthy ones. Bone marrow transplantation 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 your cancer cells and the diseased blood-forming cells in your bone marrow.
Healthy stem cells are infused into your bloodstream. The stem cells find their way into your 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 your bone marrow.

Preparing for a bone marrow transplant

Your transplant doctor and care team will help you prepare for the bone marrow transplant. When you meet with your care team, they will explain the procedure to you and provide you with a detailed calendar so you know when each step of the process is happening.

Assessment. Your doctor will review 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 any needed imaging tests, such as CT, MRI, echocardiogram, pulmonary function tests, and blood tests, to carefully assess your condition and your overall health before the transplant. A dietitian, social worker, and other care team members may also review your needs and help you create a caregiver plan.
Catheter insertion. 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.

Identifying the source of stem cells

Autologous transplant. Your blood is taken through a vein and passed through the apheresis machine to isolate the stem cells. The remaining blood is returned to your body through the catheter in your chest.
Allogeneic transplant. Your doctor will help you find a donor whose immune system best matches yours. This reduces the risk of graft-versus-host disease (GVHD, a complication of transplantation in which immune cells from the donor attack your body's tissues) and rejection of the transplant. If your donor is a relative, they will be carefully evaluated by our transplant team, who will walk them through the process. If your donor is not a relative, your transplant team will coordinate processing and shipment of the donor stem cells.

Conditioning

Before you get the bone marrow transplant, you will receive high-dose chemotherapy and possibly radiation therapy. This is called a conditioning regimen. It is designed to 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, whether you have had chemotherapy or radiation therapy, and your health and underlying conditions.

Depending on your age and health history, your doctor may recommend a less intense approach to conditioning that 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.

Side effects of bone marrow transplant

While bone marrow transplant can achieve a remission, or even a cure, for your condition, there are risks and side effects to consider. Your transplant team will carefully discuss these risks with you before the transplant and connect you with expert specialists to address any side effects.

Your team works closely with dedicated experts in infectious disease, gastroenterology, pulmonary medicine and critical care, nephrology, cardiology, and dermatology in case complications arise. They can also facilitate a referral for fertility preservation, if needed, since bone marrow transplant can affect your fertility.

Side effects of conditioning

Mouth sores
Nausea
Vomiting
Diarrhea
Hair loss
Fatigue
Infertility

Short-term risks and side effects of bone marrow transplant

Mouth sores and sore throat
Nausea, vomiting, diarrhea
Infection
Lung inflammation
Liver damage
Graft failure (transplanted stem cells do not make new blood cells)
GVHD

About GVHD

Graft-versus-host disease is a possible complication of allogeneic stem cell transplants. While the best match will be used for you, your donor is not identical to you, and their immune cells can attack healthy organs in your body. GVHD can be a mild illness but is sometimes life-threatening. It can develop shortly after transplant (acute GVHD) or several months, or even years later (chronic GVHD). We use medications to help prevent GVHD during the high-risk period. Common GVHD symptoms include:

Skin redness, rash
Nausea
Vomiting
Diarrhea
Loss of appetite
Weight loss
Jaundice (yellowing of the eyes/skin)

Your transplant team will carefully monitor you for GVHD symptoms throughout the bone marrow transplant process and afterward. Our transplant physicians are experts in the prevention and treatment of GVHD. Investigators at NewYork-Presbyterian have a strong background researching GVHD prevention and have pioneered novel GVHD treatments.

After the bone marrow transplant

Most bone marrow transplant recipients stay in the hospital for 3 to 4 weeks after the procedure. Some types of transplants can be performed on an outpatient basis; your doctor will let you know if that is an option for you.

Dedicated units. Our advanced, dedicated bone marrow transplant units offer personal monitoring, private rooms, and special airflow systems that protect patients with weakened immune systems from infections.
Recovering from the transplant. In addition to your doctor, our highly trained nurses, pharmacists, social workers, and dietitians will care for you during your recovery. You’ll have access to experienced and compassionate care from specialists who are available to treat any side effects.
Going home. 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 you leave the hospital.
Monitoring your health. After you go home from the hospital, your transplant physician and team will continue to monitor your recovery and address any complications that may arise.

Advancing the field

Investigators at NewYork-Presbyterian continue to conduct clinical research to enhance the effectiveness and expand the applications of bone marrow transplantation, offering clinical trials of promising new approaches.

Why choose us

At NewYork-Presbyterian, our nationally and internationally known bone marrow and stem cell transplant experts offer a comprehensive, multidisciplinary approach to improving your health. We understand the lengthy journey that patients and their caregivers follow when bone marrow transplantation becomes part of their care. We work with patients and families to overcome social and financial barriers to effective care and connect them with resources and support to enhance their recovery.