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Bone Marrow Transplant Problems

Bone marrow transplant (BMT), a treatment for patients with leukemia, lymphoma and multiple myeloma, is the overhaul of a dysfunctional immune system, replacing it with a new one. The three main types of transplant are autologus (when marrow comes from the patient himself), allogeneic (when someone else donates for the patient), and cord blood (when cells come from an umbilical cord). No matter who the donor is, BMT is a serious process.

  1. How Transplant Works

    • Bone marrow, the spongy part of the bone, produces white blood cells (which combat infection), red blood cells (which carry oxygen to tissues) and platelets (which assist with clotting). First, bone marrow or cells are collected from the donor. The recipient receives several days of chemotherapy and/or radiation to destroy his or her bone marrow, then rests for a day or two before receiving the transplant. The transplant occurs as a bag of marrow or cells drips into the recipient intravenously, much like a blood transfusion.

    Infection

    • Because of the chemotherapy and/or radiation, the transplant recipient's white cell count will drop to almost nothing, destroying the immune system. Medication is prescribed to prevent bacterial, viral and fungal infections. Fever is common. If the recipient experiences temperature spikes, antibiotics must be changed immediately to prevent blood infection and, ultimately, life-threatening shock.

    Bleeding

    • Chemotherapy and radiation also wipe out platelets by destroying the bone marrow; thus, bleeding is not unusual among transplant recipients. Bruises and nosebleeds may occur spontaneously. To prevent bleeding, platelets are transfused when their count drops below a certain level. If bleeding occurs in the brain or lungs, the consequences can be grave, and swift action must be taken.

    Graft vs. Host Disease

    • In allogeneic and cord transplants, the bone marrow or cells come from someone other than the recipient. The recipient's body is aware of the foreign matter and may attack it, a process called graft vs. host disease (GVHD). GVHD can manifest with nausea, diarrhea, intestinal cramps, skin rashes or liver disfunction. Steroids are the first line of therapy against GVHD. If they are ineffective, other therapies are available. GVHD is fatal if left uncontrolled.

    Cost

    • BMTs are performed in a small number of hospitals across the country. The price tag is $50,000 and up; insurance may pay for most of it, but the recipient will have out-of-pocket expenses as well. Recipients lose pay when they take time off work. They travel, sometimes out of state, and must pay for airfare and lodging. There are prescriptions, parking and food expenses and possibly child-care costs. Recovery can take a year, so the transplant recipient may not be able to work for a while.

    A Final Word

    • BMT is not easy, cheap, nor risk-free. For some people, however, it is a last chance at life, and they will gladly take that chance.

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