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Bone marrow transplants

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This page tells you about bone marrow transplants, which are used as a treatment for some types of cancer. You can find the following information

 

A quick guide to what's on this page

About bone marrow transplants

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 cancer, such as leukaemia, lymphoma and myeloma.

The bone marrow is the spongy substance inside your bones which makes all your blood cells. High doses of chemotherapy drugs kill off your bone marrow. So doctors can take bone marrow from a donor or from you and store it before you have the chemotherapy. If you have bone marrow from a donor it needs to closely match your own. You and the donor will have tests to make sure that the bone marrow is as similar to yours as possible.

Collecting the bone marrow

You have a general anaesthetic. To remove the bone marrow, the doctor puts a needle through the skin into the hip bone (pelvis). The bone marrow is sucked out through the needle into a syringe. To get enough marrow, the doctor usually has to put the needle into several different parts of the pelvis. Occasionally, the doctor uses the chest bone (sternum) as well. You will have about 2 pints (1 litre) of bone marrow removed. The marrow is then frozen until it is needed.

When you wake up, you will have up to 6 puncture sites covered with plasters (band-aids). You usually have to stay in hospital for 1 to 2 nights. This makes sure you have recovered from the anaesthetic. You may also need a blood transfusion. You will feel a bit sore and bruised for up to a week and will need to take painkillers.

Having the bone marrow

After you have had the high dose chemotherapy and perhaps whole body radiotherapy, you have the donor's or your own bone marrow back into your bloodstream through a drip. The bone marrow cells then find their way back to your bone marrow and start to make blood cells again.
 

CR PDF Icon View a summary of the bone marrow and stem cell transplant section

 

 

What a bone marrow transplant is

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 cancer, such as leukaemia, lymphoma and myeloma. Because you can have higher doses of chemotherapy with this treatment, there may be a better chance of curing the cancer than with standard treatment.

The bone marrow is the spongy substance inside your bones which makes all your blood cells. High doses of chemotherapy drugs kill off your bone marrow. This means you can't make any blood cells. So doctors can take bone marrow from a donor or from you before you have the chemotherapy. This is called a bone marrow harvest. They can freeze the bone marrow until you need it.

After you have had the high dose chemotherapy and perhaps whole body radiotherapy, you have the donor's or your own bone marrow back into your bloodstream 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. This is because bone marrow is given back to you to rescue you from the effects of your high dose treatment.

A transplant using donated bone marrow is called an allograft. A transplant using your own marrow is called an autologous transplant. Autologous bone marrow transplants are not often used now. 

Doctors use stem cell transplants more commonly than bone marrow transplant these days. We have information about stem cell transplants in this section.

 

Bone marrow from a donor

If you have bone marrow from a donor, it needs to closely match your own. A brother or sister is most likely to be a close match. Sometimes, if you don't have a brother or sister (a sibling donor) who is a match, you can have marrow from a donor who is not related to you but whose bone marrow cells are similar to yours. This is called a matched unrelated donor (MUD) transplant.

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 how many of the HLA markers are the same. Members of your close family are most likely to have similar proteins to yours. Usually 10 HLA markers are checked before a bone marrow transplant. 

The results of your blood test and the donor's test tell your doctor how good the HLA match is between you. You can have a transplant without a perfect match. This is known as a mismatch. If you have a mismatched transplant, you will be more likely to have a reaction after the transplant called graft versus host disease (GVHD). This means the immune cells from the donated bone marrow 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 in some people. GVHD is not always a completely bad thing. As it is an immune system reaction, mild GVHD can help to kill off any cancer cells that are left after your treatment.

In some cases, your doctor may consider a half matched transplant (haploidentical transplant). With this, the donor is at least a 50% match with you. These transplants are generally between siblings or a parent and their 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 a bone marrow harvest

Before your bone marrow is taken you will have a general anaesthetic. To remove the marrow, the doctor puts a needle through your skin into the hip bone (pelvis). The bone marrow is sucked out through the needle into a syringe. To get enough marrow, the doctor usually has to put the needle into several different parts of the pelvis. Occasionally, the doctor uses the chest bone (sternum) as well. You will have about 2 pints (1 litre) of bone marrow removed. The marrow is then frozen until it is needed.

When you wake up, you will have up to 6 puncture sites covered with plasters (band-aids). You will feel a bit sore and bruised. This can last for up to a week. Your doctor or nurse will give you some painkillers to take.

You usually have to stay in hospital for 1 to 2 nights for a bone marrow harvest. This makes sure you have recovered from the anaesthetic. You may also need a blood transfusion.

 

More about bone marrow transplants

We have information about having a transplant in this section. 

If you would like more information about anything to do with bone marrow transplants, you can phone the Cancer Research UK nurses on freephone 0808 800 4040. The lines are open from 9am to 5pm, Monday to Friday. You can also send the nurses a question. They will be happy to help.

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. You can find out about them on their website at www.anthonynolan.org.

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Updated: 16 March 2015