Spinal cord transplant (BMT): procedures and functions

Definition

What is a bone marrow transplant (BMT)?

Bone marrow transplant or bone marrow transplant (BMT) is a medical procedure performed to replace damaged bone marrow with new bone marrow. This procedure also has another term, namely stem cell or stem cell transplant (stem cells).

Bone marrow is a soft, spongy tissue located in the center of the bone. In the bone marrow, there are stem cells that function to produce all cells in the body, including blood cells which include red blood cells, white blood cells, and platelets.

Each blood cell has an important role for the body. Red blood cells work to carry oxygen throughout the body. White blood cells are responsible for protecting the body from infection, such as viruses or bacteria. Platelets or platelets prevent excess bleeding in the body by blood clotting.

When the bone marrow has problems due to certain health conditions or diseases, it causes a disturbance in the production of red blood cells in the body.

Bone marrow transplant procedure or bone marrow transplant (BMT) aims to:

replace damaged bone marrow, so that the body can re-produce healthy blood cells
restores a balanced and healthy blood cell level
restores the immune system, especially in patients with problematic white blood cell production
prevent health complications due to bone marrow damage

What diseases can this procedure treat?

Reporting from the BMT InfoNet website, here are some diseases that can be treated with a bone marrow transplant procedure or BMT:

leukemia
multiple myeloma
lymphoma
thalassemia
aplastic anemia
sickle cell anemia
neuroblastoma tumor
multiple sclerosis

What are the types of BMT?

BMT or spinal cord transplant can be divided into 2 types, namely:

1. Autologous transplant

Autologous BMT is done by using blood stem cells taken from the patient's own bone marrow. In autologous transplants, blood stem cells are usually collected before the patient undergoes chemotherapy or radiotherapy procedures for cancer treatment.

Sometimes, cancer treatment requires high doses of chemotherapy or radiotherapy. Too high a dose can damage the immune system and blood stem cells in the bone marrow.

That is why, the doctor will first remove the blood or bone marrow stem cells before the cancer treatment process begins.

After the cancer treatment is complete, the doctor and medical team will restore your bone marrow, so that the body can re-produce blood cells and fight cancer cells.

2. Allogeneic transplant

In contrast to autologous, allogeneic BMT is performed using blood stem cells from other people or donors. Donors can come from blood relations.

However, it is possible that donors can be obtained from other people without blood ties.

Process

What needs to be prepared before undergoing this procedure?

The doctor and medical team will recommend the type of transplant or BMT according to your health condition. The type of bone marrow transplant depends on the disease, bone marrow health, age, and the patient's overall health.

Before undergoing a transplant, you also need to undergo some additional tests to confirm your health condition.

Here are some medical tests that need to be done before undergoing a BMT procedure:

blood test
imaging tests, such as x-rays or CT scans
heart function tests
dental examination
spinal cord biopsy

How does a bone marrow transplant or BMT work?

Depending on the type of BMT being performed, you may go through different stages of the procedure. Here's the explanation.

Autologous transplant process

If you have to undergo an autologous type of bone marrow transplant, here are the steps you will undergo:

The doctor will take blood stem cells through a vein in your chest or arm.
You will undergo medication or treatment before the transplant. This step usually takes 5-10 days. You will receive high doses of chemotherapy or radiotherapy.
Next, the medical team will re-insert the blood stem cells that have been taken from your body before. This procedure uses a catheter needle and takes 30 minutes for each blood stem cell dose.

Allogeneic transplant process

If you are using bone marrow obtained from a donor, you will need to undergo tests to determine the compatibility of your blood stem cells and the donor's. This test is called the HLA examination (human leukocyte antigen).

HLA is a protein contained in white blood cells. Finding a blood stem cell donor with a suitable HLA is very important to avoid risks graft-versus-host disease (GVHD), in which the transplanted bone marrow attacks the patient's blood stem cells.

Because the HLA protein is heritable, the best blood stem cell donors are usually family members. However, it is possible that the patient did not find stem cells that matched his own family members.

In such cases, the doctor will consider another donor with a suitable HLA even though he or she is not related by blood to the patient.

If the situation is very urgent and no suitable donor is found, the doctor can choose other bone marrow alternatives, from:

blood stem cells (stem cells) of the umbilical cord of the newborn
blood stem cells from family members who have a match of at least 50%

Here are the next steps in BMT or allogeneic type transplants:

After carrying out the HLA compatibility test, the medical team will take blood stem cells from the donor. The collection can be done through the bloodstream or directly from the bone marrow.
Before the transplant process, you will undergo chemotherapy or radiotherapy treatment for 5-7 days.
Then, a donor stem cell transplant will be performed by inserting a catheter needle into your bloodstream. This procedure usually takes 1 hour.

How is the recovery process after a bone marrow transplant?

After the BMT procedure or bone marrow transplant is complete, you will need to stay in the hospital for a few weeks or months. The doctor will ensure that:

Your bone marrow makes enough healthy blood cells
You don't have any serious complications
You feel good and any sores in your mouth and / or diarrhea have improved or healed
Appetite has increased
You don't have a fever or vomit

During the first few weeks and months after leaving the hospital, you will often go to an outpatient clinic. This allows your doctor to monitor the progress of your condition.

The recovery process may take anywhere from 6-12 months. During that time, it is important that you learn how to prevent infection, get plenty of rest, and follow your doctor's instructions on medications and examinations.

In some cases, the patient will also need to receive additional medication during the recovery process. For example, if BMT is performed as part of the treatment of thalassemia, the patient may have to perform a phlebotomy or iron chelation procedure to remove excess iron residue from the body.

Risks and side effects

What are the risks and side effects of a bone marrow transplant or BMT procedure?

Just like any transplant procedure, bone marrow transplantation or BMT also carries certain risks and side effects. The likelihood of a side effect occurring will depend on the suitability of the patient's and donor's blood stem cells, the patient's health condition and age.

1. Infection

You can easily catch infections after a transplant because your immune system is weak. The risk of infection can be reduced when your immune system recovers.

Transplant recipients are sometimes given vaccines to prevent viruses and infections, such as the flu and pneumonia. If you have an infection, your doctor will prescribe medication to treat it.

2. Disease graft-versus-host (GVHD)

GVHD is the most common complication for people who get donor stem cells from other people. In this case, the new blood stem cells attack the blood stem cells in your body.

GVHD is divided into acute and chronic. In acute cases, symptoms will appear within 3 months after the BMT procedure.

GVHD is classified as chronic if it lasts more than 3 months after transplant. Doctors will usually treat this condition with corticosteroids.

3. Other risks

In addition to the two risks above, it is possible that patients undergoing BMT procedures or transplants will also experience other side effects, such as: