Find out what bone marrow is and how bone marrow transplants are used as treatment for some types of cancer.
Stem cell transplants
You're now more likely to have a stem cell transplant (also called peripheral blood stem cell transplant) than a bone marrow transplant.
This is because:
- it's easier to collect stem cells from the blood than the bone marrow
- your treatment team can usually collect more cells
- your blood cell levels tend to recover faster
Your doctor considers many different factors when deciding which type of transplant is right for you. Ask them to talk you through it if you are unsure.
What bone marrow transplants are
Bone marrow transplant is a way of giving very high dose chemotherapy, sometimes with whole body radiotherapy. This treatment aims to try to cure some types of blood cancer such as leukaemia, lymphoma and myeloma.
Bone marrow is a spongy material that fills the bones.
It contains early blood cells, called stem cells. These develop into the 3 different types of blood cell.
You have a bone marrow transplant after very high doses of chemotherapy and sometimes whole body radiotherapy. The chemotherapy and radiotherapy have a good chance of killing the cancer cells, but also kill the stem cells in your bone marrow.
Before your chemotherapy, your team collects your bone marrow or a donor's bone marrow. After the treatment you have the bone marrow cells into a vein through a drip. The bone marrow cells find their way back to your bone marrow. Then you can make the blood cells you need again. This is called a bone marrow rescue.
Having bone marrow from a donor
You might have a bone marrow transplant using bone marrow from a donor. This is called an allogeneic transplant. The cells need to be as similar as possible to yours.
So these can be from:
- a brother or sister (a sibling match)
- someone not related to you but whose stem cells are similar to yours (matched unrelated donor)
Matching donor cells
First, laboratory staff check the surface of your blood cells and the donor blood cells for certain proteins. The proteins are called HLA markers or histocompatibility antigens. So the test is called HLA typing or tissue typing.
Everyone has their own set of proteins. Staff compare the proteins on the cells in the blood samples to see if the HLA markers are the same or very similar. Usually 10 HLA markers are checked.
The results of your blood test and the donor's test tell your doctor how good the HLA match is between you. Members of your close family are most likely to have similar proteins to yours.
You can have a transplant without a perfect match. This is called a mismatched transplant.
If you have a mismatched transplant, you are more likely to have a reaction afterwards. The reaction is called graft versus host disease (GVHD). This means the immune cells from the donated stem cells attack some of your body cells.
GVHD typically causes skin rashes, diarrhoea and liver damage. You will have anti rejection drugs to help stop it developing. GVHD can be severe and even life threatening for some people. But mild GVHD can also be helpful for some people. It is an immune system reaction and can help to kill off any cancer cells left after your treatment.
Your doctor may consider a half matched transplant (haplo identical transplant). This means the donor is at least a 50% match with you. This could be one of your parents, a sibling or your child.
In the past these transplants have been difficult to do due to the increased risk of severe GVHD and infection. But doctors are finding new ways of improving this type of transplant and reducing the risk of GVHD.
Having your own bone marrow back
You might have your own bone marrow given back to you after high dose treatment. This is called an autograft or autologous transplant.
Having your bone marrow taken out
You have your bone marrow taken (bone marrow harvest) under a general anaesthetic. This means you are asleep and can't feel anything during the procedure.
You lie on your side on a couch. Your doctor puts a needle through your skin into the hip bone (pelvis). The doctor gently draws out the bone marrow through the needle into a syringe. To get enough bone marrow the doctor needs to put the needle into several parts of the pelvis. You have about 2 pints (1 litre) of bone marrow taken out and then it's frozen until it's needed.
The procedure takes about an hour.
You have the puncture sites covered with plasters.
When you wake up you might feel:
- a bit sleepy from the anaesthetic
- sore and bruised from the procedure
- more tired than normal for 1 or 2 weeks
You might have to stay in hospital for 1 or 2 nights after a bone marrow harvest. Your nurse will give you painkillers to take home if you feel sore.
Help for you
The Anthony Nolan charity has helpful information. They have a register to match people willing to donate their bone marrow or blood stem cells to people who need transplants. They also provide information, support and an online forum for patients and families going through a transplant.