Bone Marrow Transplantation

What is a bone marrow transplant and how is it performed?

Allogeneic hematopoietic stem cell transplantation is one part of the treatment of selected hematological diseases - most commonly acute myeloid leukemia, myelodysplastic syndrome, acute lymphoblastic leukemia and aplastic anemia.

The principle is the transfer of hematopoietic cells from a healthy donor into the patient's body; once trapped in the bone marrow, these germ cells begin to form platelets, red and white blood cells. It is the latter, which are an essential part of the immune system, that should carry out immune surveillance in the recipient's body, i.e. not allowing the remaining tumour cells to grow. A prerequisite for the donor hematopoietic cells to be retained in the recipient's body is a significant suppression of the function of the recipient's immune system, which is achieved before transplantation by administering chemotherapy (usually weekly), in selected diseases (acute lymphoblastic leukaemia) at the same time as whole-body irradiation. This therapy should, optimally, also help to eradicate the remaining tumour cells.

The transplant - nowadays, in most cases hematopoietic cells, very rarely bone marrow - is injected into the recipient's body via an intravenous route and the act itself is not very different from a transfusion of red blood cells or platelets.

It then takes approximately 2-3 weeks for the donor blood cells to start functioning ('engraftment') - a period when there is an increased risk of infection or bleeding due to the lack of all blood cell types, and the chemotherapy also results in damage to the digestive tract with possible nausea, vomiting and diarrhoea.

Approximately 7 to 10 days should be allowed from the time of adherence to discharge from the transplant, which is used for general rehabilitation and to ensure safe use of the tablet medication. In order to ensure the success of the transplantation, it is essential to administer immunosuppressive drugs, i.e. drugs that generally reduce the function of the immune system, for a certain period of time; the reason for their administration is both to prevent non-acceptance of the transplant and to reduce the risk of inadvertently high activity of the transplant against the cells of the recipient's body.

What side effects should be taken into account during the transplantation process?

Pre-transplant chemotherapy can be accompanied by nausea, but this is more common - along with diarrhoea - in the period between transplantation and donor hematopoietic attachment. In this period, the harmful effects of chemotherapy or radiation on organs (liver, kidneys, central nervous system) may rarely occur. The donor hematopoietic attachment phase may be accompanied by fever, bone, joint and muscle pain or rash.

After discharge and during the early recovery period (about 6 months), the most prominent symptoms are fatigue and the very common and potentially dangerous signs of increased immune activity of the donor's white blood cells against the recipient's body, i.e. the so-called graft-versus-host reaction. The typical manifestations and the need to report them immediately to the outpatient attending physician are always consistently pointed out to the patient on discharge, as are the regimen measures for the early post-transplant period, including dietary measures.

Indication of the patient for transplantation and selection of a suitable donor

The indication for allogeneic transplantation is determined by the attending haematologist, who sends the request for transplantation (including the necessary other documentation) electronically to the designated address at the IHBT. Approval of the indication is subject to the approval of the members of the expert committee set up for this purpose and is a condition for starting the search for an optimal donor, i.e. a donor with the highest possible HLA match on tissue cells.

If the patient does not have a healthy and age-matched HLA-matched sibling (25% chance), then an HLA-matched donor from international registries is considered in the selection process, if not available, then a less matched family donor. The process of finding a donor and preparing for transplantation (i.e. performing the necessary laboratory and imaging tests) takes approximately 3-5 months, during which time pre-transplant treatment of the underlying disease continues.

At the same time, a consultation with the doctor and the transplant team nurse takes place, where the patient is informed about the course and regimen during the hospitalization and is also provided with a list of recommended items for the stay (downloadable here).

IHBT is a centre that performs approximately 80 allogeneic transplants per year, the highest number in the country. The first allogeneic transplant was performed here in 1986.

The hematopoietic transplant process is not easy, but our team of doctors, nurses and other specialists are ready to help you get through it.