Bone Marrow Transplant

                                      

Function of Blood

Blood carries nourishment, electrolytes, hormones, vitamins, antibodies, heat and oxygen to the body tissue. It also carries wastes away from body tissues.

• Red Blood Cells: carry oxygen from lungs to rest of body
• White Blood Cells: help fight infections and aid the immune process
• Platelets help in clotting

Where are blood cells made?

All elements of the blood are formed in the bone marrow and are believed to originate from a primitive cell called a stem cell.

What is bone marrow?

Bone marrow is the spongy tissue found inside of bones that is responsible for make 95% of the body's blood cells and immune system. Certain cells in the bone marrow, known as stem cells, are the parent cells of all blood cells.  Stem cells, when transplanted, find their way to the recipient's marrow and mature into the different blood cells.

 What is an allogeneic transplant?  

Allogeneic transplantation is typically used to treat people with bone marrow disorders such as leukemia or aplastic anemia. in this procedure, the diseased bone marrow is destroyed by high-dose chemotherapy and/or radiation and replaced with a donor's blood stem cells collected from the bone marrow.

Does Claire have a donor?

Yes. All five of Claire's siblings were tested, and her 14 year old sister Faith is a match.

What does Faith have to do?

The procedure used to collect bone marrow from a donor is called a bone marrow harvest. it is a surgical procedure that takes place in a hospital operating room. While the donor is under anesthesia, a needle is inserted into the rear hip bone where a large quantity of bone marrow is located. the bone marrow, a thick red liquid, is extracted with a needle and syringe. Several skin punctures on each hip and multiple bone punctures will be required to extract sufficient bone marrow for transplantation. The amount of bone marrow harvested depends on the size of the patient and the concentration of stem cells in the marrow. Usually, one to two quarts of marrow and blood are harvested. while this may sound like a lot, the body can usually replace it in four weeks. Donors can typically resume normal activities in a few days.



Preparing for the Transplant

• Pre-transplant workup to evaluate all baseline body functions (EKG, Pulmonary Function Test, CT scan, MRI, dental eval, audiology testing)
• Conference with transplant team to review information obtained during the workup.
• Admission to the Immunocompromised Unit of Primary Children's Hospital. Admission begins the countdown (seen as - days) until the transplant (day 0).
• Preparative Regimen - high dose chemotherapy and radiation administered to patients during the week preceding their transplant. The preparative regimen has two objectives: to destroy the patient's disease, and to suppress the patient's immune system so that the donor's blood cells can engraft and begin producing healthy blood cells. Drugs used in the preparative regimen are sometimes the same as those used in standard chemotherapy to treat the disease. The dosages, however are much higher.

Transplant

Known as Day 0, the stem cells are given through the central venous catheter into the bloodstream, similar to receiving a blood transfusion. Light sedation may be given and the patient is checked frequently for signs of fever, chills, hives and chest pains.

Engraftment

Known as + days, the two to three week period after the transplant is a critical time. The preparative regimen will have destroyed the patient's stem cells, temporarily crippling the immune system.  Until the transplanted stem cells migrate to the cavities of the bones and begin producing normal blood cells, the patient is very susceptible to infection and excessive bleeding. Multiple antibiotics and blood and platelet transfusions will be given to help fight infections and prevent bleeding. Daily blood samples are taken to determine whether the stem cells have begun producing healthy blood cells. During this time, the new cell growth helps the body heal from the effects of the chemotherapy. It can take 2-3 weeks for the cells to be fully engrafted and to get off the IVs and necessary medications.  The patient generally leaves the hospital 4-5 weeks after admission, provided there are no complications.

How patients feel during treatment

A transplant is a physically and emotionally taxing procedure for both the patient and family. After the preparative regimen, patients often feel extremely tired, sick and weak, with nausea, fevers, pain from mouth sores, and mental confusion related to medications. In addition to the physical discomfort, there's also emotional and psychological discomfort. Transplant patients must not only deal with the fact that they have a life-threatening disease, but the transplant itself.  They can feel isolated, helpless, and angry. The time spent waiting for blood counts to return to safe levels increases the emotional load.  Recovery can be like a roller coaster ride: one day you may feel much better only to awake the next day feeling as sick as ever.  Family and friends may not understand the gravity of the situation and the emotional trauma involved in a transplant.