Patient Education
TRAINING and EDUCATION
UNDERSTANDING BONE AND BLOOD MARROW TRANSPLANTS
Bone marrow is the soft tissue inside the bones that makes blood-forming cells known as blood stem cells . These grow into red blood cells ( carry oxygen throughout the body ), white blood cells ( help fight infections ), or platelets ( help control bleeding ).
Healthy marrow and blood cells are needed to live . When a disease such as cancer affects the bone marrow , the bone marrow may not function , requiring a marrow or cord blood transplant in some patients . Thousands of people with blood cancers and diseases – such as leukemia , lymphoma , and sickle cell anemia – depend on a bone marrow or cord blood transplant for treatment .
Read below for more information about transplants . This “ Patient Education ” tear sheet was produced in collaboration with the National Marrow Donor Program ( bethematch . org ).
What Is a Blood or Marrow Transplant ?
A bone marrow transplant ( also known as a BMT ) takes a donor ’ s healthy blood-forming cells and puts them into the patient ’ s bloodstream , where they relocate to a patient ’ s bones and begin to grow and make healthy red blood cells , white blood cells , and platelets . Cells can be acquired from the patient ( autologous transplant ) or donated from someone else ( allogeneic transplant ), either a family member ( related donor ), unrelated donor , or umbilical cord blood unit . Based on a patient ’ s disease and health status , the doctor will recommend either autologous or allogeneic transplant . Donor cells can come from three sources :
• Bone marrow : soft , spongy tissue inside of bones
• Peripheral blood stem cells ( PBSC ): blood-forming cells from the circulating blood
• Cord blood : the blood collected from the umbilical cord and placenta after a baby is born
Each patient needs a donor who is a close human leukocyte antigen ( HLA ) match . This is different than blood type , since HLA is part of DNA . HLA is a protein – or marker – found on most cells in the body . The best transplant outcome happens when the patient ’ s and donor ’ s HLA closely match because it :
• increases the likelihood of a successful transplant
• improves engraftment ( when the donated cells start to grow and make new blood cells or platelets )
• reduces the risk of complications after transplant , especially graft-versus-host disease ( GVHD ), which is a potentially serious complication that occurs when the immune cells , which are part of the donated marrow or cord blood , attack the body similar to getting blood or medicine through an intravenous catheter or tube . Around 30 to 100 days posttransplant , the new blood-forming cells will engraft and the patients will start to recover . The engraftment and early recovery period is longer for cord blood transplants .
Follow-Up Care
Post-transplant , follow-up care is important to detect any changes in health , including :
• the disease returning ( relapse )
• new cancer
• problems due to treatment
• changes in quality of life ( QOL )
When issues are caught early , there may be more treatment options . Follow-up care includes :
• Long-term screening : Complications from transplantation can develop long after a patient leaves a transplant center .
• Vaccinations : Transplant recipients may remain immunocompromised beyond two years after transplant , especially individuals with chronic GVHD . Therefore , patients should be routinely revaccinated after transplant until they regain immune competence . Transplant recipients also need to have their childhood vaccines repeated after recovering .
• Watching for relapse : Sometimes the disease comes back after transplant . If the disease does come back , options for care and therapy are based on the disease and the patient ’ s overall health .
Resources from the National Marrow Donor Program
Over the past 25 years , Be The Match ®, operated by the National Marrow Donor Program ( NMDP ), has managed the largest and most diverse marrow registry in the world , working to save lives through transplant . NMDP has facilitated more than 74,000 marrow and cord blood transplants and nearly 6,400 transplants a year to give patients hope for a future . Be The Match continues to develop services and interactive technologies used by transplant experts around the world to reach more patients , while also developing new cellular therapies , advancing services to speed the transplant process , and improving treatments for posttransplant complications .
For more information about NMDP , visit bethematch . org .
For more patient information , visit bethematch . org / transplant-basics .
To get involved , visit bethematch . org / support-the-cause .
Cut out and give to a patient
Seventy percent of patients ( 7 out of 10 ) do not have a fully matched related donor .
How Does a Transplant Work ?
During transplant , the donor ’ s healthy blood-forming cells are put into the patient ’ s bloodstream , where they move through the patient ’ s bloodstream and settle in the bones to produce new blood-forming cells .
Prior to transplant , patients will receive a preparative treatment ( conditioning regimen ) consisting of chemotherapy , with or without radiation , that is given in the days just prior to the infusion of blood-forming cells .
On transplant day , known as “ day zero ,” the replacement cells are put into the blood stream in a process
• Screening for GVHD ( for those who received an allogeneic transplant ): Uncontrolled chronic GVHD is associated with increased non-relapse mortality , significant morbidity , and lower health-related QOL . Ongoing surveillance , management , and multidisciplinary care can resolve most cases of chronic GVHD within five years . Acute GVHD , often characterized by a red rash , diarrhea , and elevated liver tests , usually starts prior to 100 days post-treatment . When people develop GVHD symptoms in their mouth , eyes , skin , or other organs , it is called chronic GVHD . Chronic GVHD – an immune response of the donorderived T cells against recipient tissues – occurs in 30 to 70 percent of patients receiving an allogeneic transplant .
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