Blood cancer treatment bone marrow transplants 

 

Although “blood cancer” term in medical terminology adhere to many different types of blood problems, but to make it simple, we will describe the most common blood cancer, lymphoma and leukemia, that may need bone marrow transplants.

 For more about blood system and its problems you can read blood section.

 

 

Blood cancer treatment bone marrow transplants 

 

What you will read next:

 

Types of leukemia

Blood cancer general treatment

What is a bone marrow transplant?

Bone marrow transplant recovery time

How is a bone marrow transplant performed?

Autogenic and allogeneic transplantation

Side effects of bone marrow transplantation

Care after a bone marrow transplant

Recovery after bone marrow transplantation

When to see a doctor?

What points should be considered to recover as soon as possible after a bone marrow transplant?

Rejection of bone marrow transplant

What are the symptoms of graft rejection or GVHD?

 

 

Types of leukemia

When the white blood cells become malignant, depending on where in the maturity process of white blood cells (WBC) the problem begins and where the cancer presents, whether in the bloodstream or lymph nodes, they called leukemia or lymphoma respectively.

When the very beginning steps of WBC maturity getting malignant, then we have myeloma.

As mentioned above, there are different types of WBC malignancy, in other words, the origins of different types of WBC malignancy are different.

 Name them briefly, the types of blood cancers will be as follows:

 

1. Leukemias

2. Lymphomas

3. Myeloma

 

They have more subtypes that the most common subtypes are as follow:

 

1. Leukemias:

In all of them there is significant malignant cells in the blood stream and can be found on blood tests.

 

2. Lymphomas:

The basic rule to classify these two types is the presence of a specific type of cell called a reed-Sternberg cell.

When the cell presents in the lymph node examination then the lymphoma is called Hodgkin's lymphoma. If this cell is not seen, the lymphoma is non-Hodgkin lymphoma.

 

3. Myeloma:

when the very immature blood cells becomes malignant they will form some type of blood cancer named myeloma.

Different type of myeloma are as bellow:

Multiple myeloma

• Solitary myeloma

• Myelomatosis

• Plasma cell leukemia

Extra skeletal myeloma

This type of blood malignancy is a more specialized type of myeloma that is classified as a hematopoietic stem cell malignancy.

 

 Blood cancer general treatment

As you have noticed, there are different types of blood cancers, so it is obvious that each one has different treatment options and medications.

In general, the set of treatments that are used to treat blood cancers are:

  • Chemotherapy
  • Immunotherapy (help the person's immune system to heal)
  • Radiotherapy
  • Stem cell (the first immature cell in blood cells production) transplantation, which includes bone marrow transplantation

In this article, for your acknowledgment, we provide explanations about bone marrow transplantation.

 

What is a bone marrow transplant?

Briefly, bone marrow transplantation is the process by which diseased and damaged bone marrow cells is replaced by the healthy one.

These new cells can be driven from ones own body but in most cases it will be taken from another healthy doner.

Stem cells have the special ability to make any type of blood cells.

Physicians use this feature in the treatment of many leukemias, lymphomas, myelomas and immune disorders.

 

Bone marrow transplantation called "blood stem cell transplantation" and more specifically "hematopoietic stem cell transplant.

 

There is two way to enter the new stem cell into the patients blood production sites ( mostly bone of the pelvic and spine):

 

Peripheral blood stem cell transplant:

In this method the stem cells are taken from the donor's bloodstream and after purifying process enter the recipient's bloodstream.

 

Bone marrow transplant:

Here we take the stem cells from the bone marrow of a healthy donor and after purifying process inject them directly into the blood producing sites of patient which is pelvic in most cases.

It is common rule that if a person with leukemia who has undergone a bone marrow transplant does not have a recurrence of the disease within the first five years, he or she is more likely to survive without any problem for the next 15 years.

 

Blood cancer treatment bone marrow transplants 

 

Bone marrow transplant recovery time

The length of time that patients with blood cancers need to recover after a bone marrow transplant depends on many factors. It is usually said that it takes about three months for a bone marrow to recover, the time is approximate, and recovery may take a bit more or less.

 

How is a bone marrow transplant performed?

In summary, the following three steps must be taken to perform a bone marrow transplant:

  • Preparing the patient's body to receive stem cells
  • Stem cell collection from the bone marrow of a healthy person (donor)
  • Stem cell placement in a sick person; linking stage

 

In the following, we will explain about each step:

1. The stage of preparing the patient to receive the transplant

This step is called "conditioning". Depending on the patient's physical condition, underlying diseases and the type of cancer, chemotherapy is used alone or in combination with radiotherapy at this stage.

The following results are obtained by performing chemotherapy with or without radiotherapy:

 

• Your immune system is weakened in a controlled way so that it does not reject the new bone marrow transplant.

• Kill any cancer cell in the patient's body.

• Cleanses the bone marrow of the patient to place connective tissue and make it ready for new guest cells.

 

The preparation phase usually lasts one week, the patient receives chemotherapy within a week and then a single session of radiotherapy is performed.

 In cases where we need to repeat radiotherapy sessions, the sessions will usually be completed within a few days.

 

2. The stage of collecting healthy stem cells for transplantation

Stem cells can be obtained from three locations:

 

1. Blood:

The most common place to collect healthy stem cells is blood flow. To do this, the treatment team takes the donor's blood flow from one hand. This blood enters the filter device through a tube and the stem cells are separated from the blood flow by this device.

The rest of the blood enters the opposite hand from another direction. This process takes about two to three hours and the donor is awake and alert all the time and does not feel any pain or discomfort.

 Doner usually need to go to the hospital for a few sessions to repeat this process and collect the right amount of stem cells; there is no need to be hospitalized after the sessions in most cases.

2. bone marrow:

Within one to two hours, parts of the donor's bone marrow (from the pelvis) are taken with big needle.

Sometimes the doctor uses sleeping pills for this procedure to take the donor stem cells without discomfort or pain.

3. Umbilical cord:

Sometimes the stem cells in a newborn umbilical cord, which are compatible with the patient's condition, are used with the permission.

Umbilical cord blood is very rich in stem cells.

 

Link stage:

Usually, few days after the preparation of new stem cells is over, the patient will be ready to receive the transplant.

The patient is referred to the hospital and a central intravenous route is implanted. Lying down, through a thin tube, a collection of collected and purified stem cells enters his body, he will not have pain and discomfort while receiving the stem cells.

It takes about two hours to transfer the stem cells through the central vein.

 

What happens after the transplant?

Stem cells in the patient's body move to the bone marrow and are replaced there, and after a few months the transplant response is determined.

Freezing stem cell samples contain preservatives that the recipient will usually receive injectable serum to reduce the side effects of these substances.

 

Autogenic and allogeneic transplantation:

Stem cells can be harvested and become frozen any time during the healthy life status and consumed later as a donor or a compatible patient.

We use the term allogeneic transplant in cases where the patient receives a stem cell from another person vs autogenic transplant that healthy stem cells are gathered previously in someone’s healthy status or from preserved own umbilical cords blood.

 

Certainly, autogenous transplants are better tolerated and less rejected, but because it is difficult to completely separate cancer cells from healthy stem cells, the possibility of cancer recurrence after autogenous transplantation is higher, and we do not usually use this method in the elderly patients.

Usually, before the stem cells are taken, drugs containing growth factors are given to the donor so that the stem cells can enter the bloodstream from the bone marrow.

The collected samples use techniques and methods called (purging) to clear the samples from any type of cancer cells.

 

Side effects of bone marrow transplantation:

In general, the side effects that the patient experiences while receiving the transplant are very minor and are mostly due to the presence of preservatives. These side effects are:

Chest pain

Nausea

Headache

Feel the taste of garlic or … in the mouth

•Ague

Urticaria

 

Cares after a bone marrow transplant:

After receiving the transplant, the patient is hospitalized in an isolated room to avoid exposure to infectious agents. Even visits are limited, and people who come to visit must fully stick to protective tips such as wearing appropriate gowns, masks and gloves.

 

During this period, the transplant team, which includes specialist doctors and nurses, will monitor you regularly in case of any side effects such as:

  • Diarrhea
  • Coagulation disorders such as nosebleeds
  • nausea and vomiting
  • Oral ulcers
  • Weakness and fatigue

They will help you and improve the situation if any happens.

 It is necessary to know that most of these complications are due to chemotherapy and radiotherapy and are controlled by the actions taken by the transplant team.

The positive and hopeful psychological status of the patient and the support of family and friends along with the transplantation team are essential to have a successful transplantation.

 

Recovery after bone marrow transplantation:

It takes a few weeks to a few months for you to be discharged. After discharge, you should take extra care of yourself and use the support of social workers and groups of friends and family to go through the post-transplant period.

In the first few months after the transplant, you may feel tired and weak, or the taste and smell of previous foods may have changed. This is normal; it generally takes about a year to return to the previous condition.

 

Necessary post transplantation cares:

• Personal care to prevent infections

Wash hands regularly

• Stay away from people with infections

• Use standard masks and gloves in public

 

When to see a doctor?

In the following cases, you should contact your doctor as soon as possible:

  • Fever above 38 degrees Celsius
  • Tremors
  • Sneezing and coughing
  • Diarrhea
  • Blurred vision
  • Unusual pain and swelling in the body
  • Exposure to a person with chickenpox and other infectious diseases
  • Mucosal ulcers

 

What points should be considered to recover as soon as possible after a bone marrow transplant?

Life changes after bone marrow transplantation

To improve as soon as possible, it is necessary to observe the following points:

  • Use a proper and balanced diet
  • Drink enough healthy water
  • Avoiding alcoholic beverages
  • Regular and tolerable exercise
  • Eat fresh vegetables and fruits regularly (consult your doctor before eating grapefruit)

Limit the consumption of fatty foods and sweets and canned and prepared foods

 

Rejection of bone marrow transplant

This complication is more common in allogeneic transplants, where stem cells are taken from another person.

This problem occurs when a type of donor white blood cell that enters the host's body with stem cells reacts with and damages the patient's healthy cells.

This complication named GVHD (graft versus host disease) .

This complication can be mild, moderate, or very severe. Usually, when the host body begins to make its own white blood cells, mild to moderate cases of this complication go away. This syndrome can occur acutely or chronically.

 

Symptoms of transplant rejection or GVHD

  • Skin: Sun-like rashes, blisters.
  • Gastrointestinal tract: Persistent nausea, loss of appetite, vomiting, feeling of premature satiety, diarrhea, persistent abdominal pain, feeling of fullness, blood in the stool.
  • Liver: Yellowing of the skin and white parts of the eyes, tea-colored urine, pain in the right and upper abdomen, swelling of the legs, Ascites (collection of fluids in the abdomen).
  • Musculoskeletal system: joint pain and stifness, muscle cramps, muscle weakness
  • Eyes: Dry eyes, loss of tears, blurred vision, eye irritation
  • Mouth: mouth sores, pain, lip cracks
  • Lungs: Persistent cough, short and hard breaths
  • Genital system: dryness, skin rashes, painful sexual intercourses

 

If you have any of the above symptoms, it is necessary to contact the transplant team immediately.

 It is better to always have a brief description of your treatment status and medications, as well as your doctor's contact number in writing on hand.

Not all of the symptoms mentioned above will be experienced by the affected person nor will be last permanently.

Some symptoms can remain permanently in the person for a long time but most of the symptoms disappear with proper treatment.

 

 

 

 

 

 

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