Autologous Bone Marrow Transplant: Overview

An autologous bone marrow transplant is a process where a patient uses his or her own stem cells to replenish bone marrow cells previously destroyed by the process of chemotherapy.

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How does it work?:

Stem cells are removed from you before you receive high-dose chemotherapy or radiation treatment. The stem cells are then stored in a freezer (cryopreservation). After, you are administered high-dose chemotherapy or radiation treatments to eliminate the cancer your body, but along with these cancer cells, bone marrow is destroyed as well.Your stems cells are then put back in your body to replace the old marrow and make (regenerate) more. This is also called a rescue transplant.
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When would you need an autologous bone marrow transplant?:

An autologous bone marrow transplant may be necessary if you have lymphoma, multiple myeloma, amyloidosis, Hodgkin's disease, germ cell cancer, or certain types of leukemia. These cancers are ones that can be treated with the use of heavy chemotherapy, which as a side effect kills bone marrow cells. The purpose of an autologous bone marow transplant is to be able to regenerate the depleted cell quantity after the chemotherapy is completed.
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What is bone marrow anyways?:

Bone marrow is the soft, spongy center of your bone where blood is produced. Marrow is filled with blood-producing cells, called stem cells, which in this case develop into mature white blood cells, red blood cells or platelets.
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Stem Cells: A Summary

Stem cells are a class of undifferentiated cells that are able to differentiate into specialized cell types.
- undifferentiated in this case means that the cells have not yet begun development into a certain type of cell
Stem cells are important in the medical field because their unique ability to be induced into a desired type of cell allows for new, revolutionary treatments to be implemented in hospitals everywhere.
Autologous bone marrow transplants make use of adult cells, which are able to develop and form specific types of cells based on their tissue of origin, and can even regenerate their organ of origin entirely.


Treatment: From a patients point of view

  • First: The Preparation Process

- A Pre-Evaluation Process takes place, where your medical record and history are evaluated, a physical exam is administered, and a treatment plan is recommended
- Preadmission tests, such as blood tests, urine collection, bone marrow aspiration biopsy, and chest X-ray are givrn to ensure that the heart, lungs, kidney and liver are functioning normally, and that you do not have an undiagnosed infection.
- Stem Cell Collection:
Stem cells in the bone marrow are stimulated using a hormone called G-CSF causing them to enter the blood stream, where they can be extracted through a procedure called a peripheral blood stem cell transplant
  • Second: The Procedure:

-After stem cell collection, high dose chemotherapy takes place. Precautions may be taken to weaken the side effects of these drugs, such as showering twice a day to remove drug excretion from the skin, thus preventing or weakening chemotherapy burns
-Total Body Irradiation (TBI)
TBI is a form of radiation therapy that may be given to patients in addition to chemotherapy, intended to destroy remaining cancer cells and further suppress the immune system. The treatment itself is painless, but there may be uncomfortable side effects after treatment, such as nausea

- The transplant procedure occrs one to three days after your last chemotherapy dose, and is conducted similar to a simple blood transfusion. It will be done in your hospital room, and will take about 45 minutes, depending on the volume of stem cells. If you are receiving bone marrow, the infusion may take several hours. The blood stem cells will be infused through your central venous catheter.
-Waiting for Engraftment: The new bone marrow does not recover immediately after it has been translpanted. The stem cells of the transplanted marrow will travel to the bones, refill the empty marrow space in the bone, and go through a growth process before the mature cells are released from the bone marrow into the blood stream. It will take eight to 14 days from the day of transplantation for your marrow to start producing white blood cells, red blood cells and platelets.
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  • Third: Recovery

- When your neutrophil (neutrophil = most abundant type of white blood cell) count rises above 1,000, talk of leaving the hospital will begin. Assistance with your daily needs, along with availability for clinic visit transportation, will be necessary.
- In order to be allowed to leave the hospital, you will need to be:

  • Walking
  • Eating at least 1,000 calories daily
  • Drinking at least one quart of fluid daily
  • Free of active medical problems
  • Without a fever
  • Off intravenous medications and taking your pills without problems
- After leaving the hospital, your doctor and nurse practitioner will follow you closely after your transplantation.
- Keeping healthy and making sure infection is prevented is critical, as your risk of infection is much higher than normal for at least 3 months. Especially in the first month you have to be very careful, as this is the time when risk of infection is highest. During this period you should spend most of your time at home and away from people, and doctors refer to this as house arrest.

Risks/ Side effects of an autologous bone marrow transplant

Although autologous bone marrow transplants are procedure that are greatly beneficial to the well being of many, no procedure come without its risk, concerns, and/or side efects.
- Complications resultant from an autologous bone marrow transplant can include:
  • Anemia
  • Bleeding in the lungs, intestines, brain, and other areas of the body
  • Cataracts
  • Clotting in the small veins of the liver
  • Damage to the kidneys, liver, lungs, and heart
  • Delayed growth in children who receive a bone marrow transplant
  • Early menopause
  • Graft failure, which means that the new cells do not settle correctly into the body, and do not start producing stem cells
  • Infections, which can be very serious
  • Mucositis (Inflammation and soreness in the mouth, throat, esophagus, and stomach)
  • Pain
  • Stomach problems, including diarrhea, nausea, and vomiting
- Some common symptoms one may experience after receiving an autologous bone marrow transplant are:
  • Chest pain
  • Chills
  • Drop in blood pressure
  • Fever
  • Flushing
  • Funny taste in the mouth
  • Headache
  • Hives
  • Nausea
  • Pain
  • Shortness of breath


Sources:



Zoƫ T- I know that there are some forms of cancer, or diseases in general that directly affect bone marrow and cell production. Say if your bone marrow is compromised, can another person's bone marrow/stem cells supplement for the loss or do they have to be from your body? Can your body reject them? Also, why are stem cells destroyed in the process of chemotherapy? Are they weaker than most other cells?
Blake M- If your own bone marrow is compromised, another persons bone marrow/ stem cells can in fact be utilized to treat the disease affecting you. This process of using the bone marrow/stem cells of a donor is called an allogeneic bone marrow transplant, and is very similar to an autologous bone marrow transplant in most areas, such as procedure and side effects. The body is not able to reject ones own bone marrow during an autologous bone marrow transfer, because this bone marrow originates from that individuals body, and the immune system is able to recognize it. However, bone marrow originating from a b]one marrow donor that is utilized in an allogeneic bone marrow transplant is in fact able to be rejected by the body, because there is a chance the immune system will view this foreign material as a threat. This occurrence is referred to as Graft vs. Host disease. Stem cells are damaged or destroyed in the process of chemotherapy as a result of the extremely high doses of radiation given through the chemotherapy used as treatment, as these stem cells are in fact not strong enough to withstand such radiation.


David K. - Stem cells are currently being used for bone marrow transplant but seem to have the potential to be used in a variety of medical practices.

Are they currently being actively applied in other areas? If so, where? If not, what steps are being made to make progress in applying this potentially

revolutionary study of stem cells?
Blake Miranda: Currently, stem cells are only being utilized in the process of bone marrow transplants. However, scientists are very actively researching new ways to utilize these cells, as they are seen to have unlimited potential in the medical field. Embryotic stem cells are the main area of importance, as they are cells which have not at all begun differentiating into a certain type of cell, so they are able to be influenced by scientists to develop into an specific cell the scientist desires or deems necessary for a certain procedure. These cells could be used to treat countless conditions, such as blindness, deafness, spinal cord injuries, diabetes, or even wounds obtained by soldiers as they are fighting for their country. The main hindrance of this research is ethics, as there are many groups that believe the extracting of these cells from embryos is wrong. They instead believe that these embryos should be allowed to develop into human beings instead of having their cells extracted and the remaining embryo being disposed of.

Alyssa - I have read and heard that stem cells can also come from the fetus, and the umbilical cord. Many people for this reason, reject stem cell research because they see it as being immoral. So, is there a difference between the stem cells in bone marrow and in the embryonic tissue? If not, why can't stem cells from bone marrow be taken out and used for research instead of from the fetus? Also, can you use someone else's stem cells or do they have to be from your body?
Blake M.- YEs, there is a difference betwenn the stem cells in bone marrow and those in embryonic tissue. This difference is that in bone marrow stem cells, the stem cells have already partially differentiated, and can only make white blood cells, red blood cells, and platelets when they mature complete. Embryonic stem cells, on the other hand, have not began to differentiate at all, so the can be influenced by scientists to form anything from blood cells to teeth. However, recent developments have been made that show these bone marrow stem cells can actually be reverted back to their undifferentiated state, thus removing the need for the extraction of stem cells from embryos entirely.
and yes, stem cells from another persons body are able to be used for a bone marrow transplant, and this procedure would be referred to as an allogeneic bone marrow transplant. However, it is safer to utilize an autologous bone marrow transplant, as there is no risk of your body rejecting the transplanted stem cells.

Nice job Blake! This is a fantastic and educational page! I noticed it is very similar to my research. Of coarse there are some differences, but I just loved reading this and seeing how liked the entire world and all of science is through chemistry. I was able to how some of the ideas that we have learned this year that seemed crazy, can be applied in the real world!
-Cole K.