Bone marrow or a stem cell transplant is a curative procedure for many diseases that do not respond to treatment. Nowadays, the process or the concept of stem cell transplant is being misused for many other diseases, such as arthritis, epilepsy, and others diseases.
The actual stem cell transplant, which is being carried out or approved, is for blood cancers and some blood disorders, such as leukemia, lymphoma, multiple myeloma, some types of brain tumors, such as primary central nervous lymphoma, and some other diseases, such as aplastic anemia, thalassemia, and some blood or blood product disorders.
What is the main purpose of a stem cell transplant?
The main purpose of a stem cell transplant is to replace the defective bone marrow, to eradicate the disease by high doses of chemotherapy or radiation therapy, and after that, to recover the marrow, which usually happens in an autologous bone marrow transplant.
How does the stem cell dose affect the recovery period?
Stem cell dose plays an important role in the recovery or engraftment period. The cell dose is calculated according to the patient’s body weight. The cell dose for an autologous transplant is a minimum of 3 million/kg body weight. For an allogenic stem cell transplant, the recommended dose is a minimum of 5 million/kg body weight.
If in case, the cell dose is low, there will be late recovery or delayed engraftment; if the dose is more than 8 million, there are more chances of graft versus host disease. So, the cell dose will not be less or more than the required dose.
What is an autologous transplant? Diseases need a bone marrow transplant
In this type of transplant, the patient’s stem cells are harvested first, then high-dose chemotherapy is given to destroy the patient’s disease; these heavy doses of chemotherapy destroy the patient’s marrow, besides killing the cancer cells.
After the completion of the chemotherapy regimen, the patient’s stem cells are reinfused into the patient’s body; the main purpose of these cells is to rescue the patient.
What will happen if the patient does not receive his own stem cells after high-dose chemotherapy?
As the heavy doses of chemotherapy drugs destroy the bone marrow of the patient, if the prior collected stem cells are not returned to the patient, the patient will become aplastic, meaning the bone marrow will not be able to make new blood cells. This marrow works as a fuel in the vehicle.
What if the collected stem cells are destroyed for any reason?
It is very crucial to preserve the stem cells in a proper setup and at a proper temperature. If, in case, the cells are destroyed due to some reason, there is no other option to get the patient’s own cells. The preservation requires special, trained staff to handle the stem cells; furthermore, they need proper banking protocols to ensure they are safe at a suitable temperature.
What are the diseases that need a stem cell transplant?
The following are the diseases that need a stem cell transplant
Primary Brain tumor (primary CNS lymphoma)
Aplastic anemia /Fanconi anemia
Thalassemia major platelet and red blood cell disorders, such as Bernard-Soulier syndrome, Glanzmann syndrome, red cell aplasia
Some disorders related to defective immunity, such as SCIDs (severe combined immunodeficiency syndrome)
Why are chemotherapy and radiation therapy given in a bone marrow transplant?
The chemotherapy and radiation therapy given in the bone marrow transplant are called conditioning regimens. Moreover, the purpose of this conditioning chemotherapy is for different purposes as follows:
To eradicate the disease
Create the space for new marrow /stem cells
Prevent the reaction between donor cells/graft and prevent graft versus Host disease
What kind of chemotherapy is given during a stem cell transplant?
In stem cell transplant, different chemotherapy regimens are used, depending upon the type of disease, the patient’s physical well-being, and the type of transplant.
The regimens used during bone marrow transplant are as follows:
Myeloablative chemotherapy regimens: diseases need a bone marrow transplant
In this type of regimen, the whole bone marrow of the patient is damaged by very high doses of chemotherapy /radiation therapy; such regimens have benefits as well as harmful side effects.
The benefit of this kind of regimen is the full eradication of diseases and a lower chance of relapse of the disease, and it enhances the survival of the patient. But there are some flaws too, as giving high doses of chemotherapy, complete eradication of bone marrow, which makes a patient more risky for bleeding due to a very low number of platelets, a very low number of white blood cells, and hemoglobin. Moreover, prolonged neutropenia leads to a patient getting more infections.
Non-myeloablative regimens: do diseases need bone marrow transplant?
These regimens are less toxic than myeloablative chemotherapy. The benefit of this regimen is that it’s less toxic and has lower side effects than myeloablative chemo. The risk of giving this chemotherapy is that there is a chance of disease relapse after transplant.
Reduced intensity chemotherapy regimens:
This type of chemotherapy is less intensive or uses reduced doses of chemotherapy than full standard doses. The regimen, the chemotherapy, and radiation used in this regimen again have lower side effects than full doses.
How to prevent infections during BMT:
A patient undergoing a bone marrow /stem cell transplant is highly susceptible to life-threatening infections such as:
Central line-associated infections
Chest infection, such as hospital-acquired pneumonia
Urinary infections
Fungal infections
Abdominal infections such as C-diff colitis
Mouth ulcers due to damaged mucosa
What are the acute complications of a stem cell transplant?
During a bone marrow /stem cell transplant, patients experience different complications and side effects as a result of high doses of chemotherapy and radiation therapy. These complications or side effects are as follows.
Infections (urinary, bloodstream infections, chest infections
Bleeding (gum bleeding, bleeding from the urinary tract (hemorrhagic cystitis due to side effect of a chemotherapy drug cyclophosphamide), vaginal, sometimes intracranial bleeding due to low platelets and uncontrolled blood pressure, and rectal bleeding due to preexisting rectal issues such as hemorrhoids.
Pain (bone pain, headache, abdominal pain, throat pain, or mucositis pain due to mouth ulcers
Graft rejections
Nutritional deficiencies due to oral ulcerations, fever, loss of appetite, nausea, and vomiting.
Diarrhea or sometimes constipation
High blood pressure is a result of antirejection medications such as cyclosporine.
Reactions related to blood and blood products
Organs’ toxicities, such as deranged liver tests /acute liver failure
Kidney toxicities as a result of the side effects of medication.
Intra-abdominal infections
Fits or seizures as a result of cytotoxic chemotherapy medication such as busulfan. To prevent this complication, antiepileptic medications must be administered before the therapy.
VOD: This happens mostly in thalassemia patients.
Hence, the transplant is a complex procedure, during which the patient may experience many side effects as a result of medications. A well-trained team is needed to take care of transplant patients. However, Nurses, paramedics, and junior doctors should be well-trained to prevent complications and ensure safe handling and care of a transplant patient.
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