What is involved in a Bone Marrow Transplant?

When one's blood factory goes out of order, we called he or she has blood disease. One of these disease is called Leukaemia or blood cancer. They are various types of Leaukaemia. One way to control this cancer is to go through chemotherapies. After the chemotherapy, the cancer cells might be kept to an acceptable level. We call this situation that the patient has entered complete remission (CR). This is still not equivalent to a cure, we can only say that the cancer is now under control. However, for some cases of Leukaemia, there is a high chance that the cancer will come back again (relapse). The best way to reduce a relapse is to do a bone marrow transplant BMT) or stem cell transplant (SCT). BMT and SCT are quite similar except that in SCT the stem cells from the donor are harvested from the donor's peripheral blood while in BMT, they are harvested from bone marrow.

I am fortunate to have matching stem cell from one of my sisters. Her stem cells are harvested and stored in the hospital blood bank in May, 2006. This type of transplant which involve sibling (brothers or sisters) donor is called allogeneic transplant.

It is quite amazing to most people that bone marrow transplant does not involve a surgery operation like other kinds of transplant. It is definately not cutting off a portion of bone marrow (spongy material in the bone) from the donor and then insert it into the host (recepient) bone.

The general procedure for a bone marrow transplant is as follow:

1. Harvest donor stem cell
2. Donor goes through a few days of very strong chemotherapy - taking either oral or itravenous chemotherapy drug for a few days, to destroy the function of the host blood factory. After this the host could not produce blood anymore.
3. After that, the donor stem cells are transfused through the vein to the host blood circulation system.
4. The stem cells will then be able to find it ways into the host bone marrow and starts to generate the blood of the donor type, a process which we called engraft. If the donor has a different blood group than the host's, the host blood group will change to the donor's blood group. We also can say that the host is now to have same immune system with the donor, a blood system which is free of cancer cell.

The risks involved in the transplant:

1. Organ failure due to chemo drug.
2. Infections especially while waiting for the donor stem cell to engraft. At this period the white cell count will be almost none, which means that the body lost its immune system compeletely.
3. Graft-versus-host disease (GVHD) , the immune cell of the donor attack the host organs. Someone also call this rejection - which is not very true. A mild GVHD is good to indicate that the transplant is successful. Some drugs such as cyclosporin or methotrexate are used to control GVHD. They are immunosuppresive agent which will also cause the host to have low immune system and prone to infections.
4. The infused donor stem cell fail to generate blood or to engraft.

We trust our Lord Jesus to lead me and protect me from all these and other unforeseen risks. I will take his promise fully, "I shall not die, but live, and declare the works of the LORD." Psalm 118:7