Bone marrow transplant

Read about bone marrow transplant for chronic myeloid leukaemia (CML).

The aim of a bone marrow transplant is to try to cure your CML, or control it for longer. You might have a transplant if your CML is no longer responding to targeted cancer drugs, such as imatinib, nilotinib and dasatinib.

Bone marrow is a spongy material that fills the bones.

Diagram of bone marrow

It contains early blood cells, called stem cells. These develop into the 3 different types of blood cell.

Diagram of three 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 has a good chance of killing the cancer cells but also kills the stem cells in your bone marrow.

For CML, you usually have a bone marrow transplant using bone marrow from a donor. This is called an allogeneic transplant. The bone marrow is collected from your donor before your chemotherapy.

After your treatment you have the bone marrow cells through a drip into a vein. 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

The bone marrow of your donor needs to be as similar as possible to yours.

The most suitable donor is usually a brother or sister. There is a 1 in 4 chance of a brother or sister being a good match.

It might be possible to get a match from a donor who is not a relative. Your doctor will contact one of the registers in the UK to see if there is a suitable donor. This is called a matched unrelated donor (MUD).

Matching donor cells

Everyone has their own set of proteins on the surface of their blood cells. The staff in the laboratory compare the surface of your blood cells and the donor blood cells. Your brother or sister are most likely to have similar proteins to you. 

The staff check to see how similar the donor cells are to your own. This test is called HLA typing or tissue typing.

The laboratory staff look for proteins called HLA markers and histocompatibility antigens. They check for 10 HLA markers. The result of this test shows how good the HLA match is between you and the donor.

Collecting bone marrow from your donor

Your donor has their bone marrow taken (bone marrow harvest) under a general anaesthetic. This means they are asleep and can't feel anything.

During the procedure the doctor puts a needle through your donor's 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. Occassionally, they might need to take bone marrow from the donor's chest bone (sternum). 

Your donor has 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. 

Your donor stays in hospital for 1 or 2 nights after a bone marrow harvest. They might feel sore and bruised and may be tired for 1 or 2 weeks. They have painkillers to take home if they feel sore.

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

But there is a higher risk of a side effect called graft versus host disease (GVHD) with a stem cell transplant.

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.

Last reviewed: 
23 May 2019
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    Professor J F. Apperley
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    Annals of Oncology, 28, (Supplement 4) pages 41-51, 2017

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    British Society of Blood and Marrow Transplantation, 2012

  • Hematopoietic SCT in Europe: data and trends in 2011
    JR Passweg and others
    Bone Marrow Transplant, 2013. Volume 48, Issue 9

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