Diagnosis & Treatment

Bone Marrow (Stem Cell) Transplant

What is a bone marrow transplant?

A bone marrow transplant (BMT), 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 your blood cells. Bone marrow health and blood cell production 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, chemotherapy is used, with or without radiation, to treat blood cancer. Your stem cells are affected by this process and are replaced by stem cells from a donor (allogeneic stem cell transplant) or from your own stem cells that are collected ahead of time (autologous stem cell transplant). In diseases that directly affect stem cells and blood formation, like sickle cell disease, blood forming stem cells are eliminated using chemotherapy, with or without radiation, and replaced with new, healthy stem cells that help your body rebuild its blood-forming and immune systems.

Types of stem cell transplants

Bone marrow (stem cell) transplants benefit individuals with life-threatening cancers. It’s an advanced form of treatment most often used when the disease is high-risk, not responding to treatment, or recurrent. Candidacy for treatment is determined with a comprehensive evaluation of the cancer type and stage, patient age, overall health, and the availability of a suitable donor.

Types of cancers treated with bone marrow transplants include:

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

What to expect during a bone marrow transplant

A bone marrow transplant is a complex treatment process that needs careful preparation and a recovery period over several months. You’ll be surrounded by a multidisciplinary team of specialists and compassionate caregivers to support you through your journey—from the initial evaluation through conditioning, infusions, early recovery, and ongoing follow-up care.

The steps for stem cell treatment can include:

Evaluation (2 to 4 weeks). Patient evaluation typically includes blood tests, a physical exam, a bone marrow biopsy, imaging scans, and heart and lung functioning tests. Some patients may receive an outpatient procedure to insert a central venous catheter (CVC) into the chest. A donor search and matching process will be conducted for allogeneic transplants.
Conditioning (1 to 2 weeks). A high dose of chemotherapy with or without radiation is given to destroy the underlying blood cancer or the diseased marrow cells and suppress the immune system, creating space for new cells in the process.
Transplant day – Day 0 (30 minutes to 4 hours). Healthy stem cells are infused intravenously, like a blood transfusion. The patient is closely monitored for immediate reactions. This process is painless and no surgery is involved.
Early recovery (Days 1–30 after transplant). Most patients stay in the hospital for 2-3 weeks to monitor and treat the side effects of the conditioning chemotherapy as well as to monitor for and treat any infections that may occur. During this early period your blood counts may be low which makes you susceptible to infections and you may need blood and platelets transfusions. Other infection prevention strategies (like wearing a mask) are also needed.
Early recovery/engraftment (Days 14-30). Blood counts begin to rise, and new cells start growing. Side effects start to go away.
Early recovery (Days 30–100). Patients are typically discharged but require frequent outpatient visits (2-3 times/week) to monitor for Graft-versus-Host Disease (GVHD), infections, and other side effects.
Long-term recovery (100 Days to 1 Year or more). The patient’s immune system continues to recover, and vaccinations are often restarted after 6 to 12 months. Most patients regain their energy and can resume normal activities, though full recovery can take up a years.

Side effects of bone marrow transplant

While a 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 will work 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 the conditioning phase include:

Mouth sores
Nausea
Vomiting
Diarrhea
Hair loss
Fatigue
Infertility

Short-term risks and side effects of bone marrow transplants can include:

Mouth sores and sore throat
Nausea, vomiting, diarrhea
Infections
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 it 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 acute GVHD symptoms include:

Skin redness, rash
Nausea, vomiting and diarrhea
Loss of appetite
Weight loss
Jaundice (yellowing of the eyes/skin)

Chronic GVHD can affect most organs of the body. Common symptoms include:

Skin rash or other skin changes
Mouth sores
Eye dryness, irritation, light sensitivity and vision changes
Nausea, vomiting, difficulty swallowing and weight loss
Abnormal liver functioning
Shortness of breath, cough, oxygen requirement
Muscle pain and inflammation, joint stiffness and tightening, and body pain

The good news about GVHD is that the risk does not last forever. Eventually you can safely stop the medications used to prevent GVHD. Your doctor and care team will carefully evaluate you and let you know when it is safe to lower the dosage or stop GVHD preventing medications.

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

Why choose us

At NewYork-Presbyterian, we understand your needs during the lengthy journey that patients and their caregivers follow during bone marrow transplant. We work with patients and their families to provide effective care and connect them with a network of resources and support to enhance their recovery.

In addition to world-class doctors, we offer:

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.
High-experienced recovery care. 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.
Excellence in stem cell transplant. Our Bone Marrow and Hematopoietic Stem Cell Transplant Programs are Centers of Excellence, as designated by the National Cancer Institute and accredited by FACT (Foundation for the Accreditation of Cellular Therapy).