Bone marrow transplantation

What is bone marrow transplantation and how does it work?

Allogeneic hematopoietic transplantation is one of the components of treatment for selected hematological diseases – most commonly acute myeloid leukemia, myelodysplastic syndrome, acute lymphoblastic leukemia and aplastic anemia.
The principle is to transfer hematopoietic cells from a healthy donor into the patient's body; after being trapped in the bone marrow, these stem cells begin to produce blood platelets, red and white blood cells. The latter ones, which are a fundamental component of the immune system, should perform immune surveillance in the recipient's body, that is, prevent remaining tumor cells from growing. A prerequisite for the engraftment of donor hematopoiesis in the recipient's body is significant suppression of their immune system function, which is achieved before transplantation by administering chemotherapy (usually weekly), and in selected diseases (acute lymphoblastic leukemia) simultaneously with whole-body irradiation. This therapy should, ideally, also help eliminate remaining tumor cells.
The graft – nowadays in most cases hematopoietic cells, very rarely bone marrow – is introduced into the recipient's body intravenously and the act itself does not differ much from a transfusion of red blood cells or platelets.
Subsequently, it takes approximately 2 – 3 weeks for donor hematopoiesis to start functioning ("engraftment") – so this is a period when, due to the lack of all types of blood cells, there is an increased risk of infections or bleeding, and as a consequence of chemotherapy, the digestive tract is also often damaged with possible nausea, vomiting and diarrhea.
From engraftment to discharge from the transplant stay, one must expect approximately 7 - 10 days, which are used for overall rehabilitation and ensuring safe use of tablet medication. To ensure the success of transplantation, it is essential to administer immunosuppressants for a certain period, that is, drugs that generally reduce the function of the immune system; the reason for their use is both to prevent rejection of the graft and to reduce the risk of unwanted high activity of the graft against the recipient's body cells.

What side effects should be expected during the transplantation process?

Preparatory chemotherapy may be accompanied by nausea, which, however, occurs more frequently – together with diarrhea – in the period between transplantation and engraftment of donor hematopoiesis. In this period, harmful effects of chemotherapy or radiation on organs (liver, kidneys, central nervous system) may rarely occur. The engraftment phase of donor hematopoiesis may be accompanied by fever, bone, joint, muscle pain or rash.
After discharge and also in the period of early convalescence (approximately 6 months), the most prominent symptom is fatigue and very frequent and potentially dangerous symptoms of increased immune activity of the donor's white blood cells against the recipient's body, that is, the so-called graft-versus-host reaction. The patient is always strictly warned upon discharge about its typical manifestations and the necessity to report them immediately to the outpatient treating physician, just as regime measures for the early post-transplant period are discussed, including measures concerning diet.

Patient indication for transplantation and selection of an appropriate donor

The indication for allogeneic transplantation is determined by the attending hematologist, who sends the request for its performance (including other necessary documentation) electronically to the specified address at ÚHKT. Approval of the indication is subject to the consent of members of a commission of experts established for this purpose and is a condition for initiating the search for an optimal donor, that is, a donor with the highest possible match of so-called HLA markers on tissue cells.
If the patient does not have a healthy and age-appropriate HLA-matched sibling (25% chance), then in the selection process an HLA-matched donor from international registries comes into consideration, if not available, then a less matched family donor. The process of finding a donor and preparing for transplantation (i.e., performing necessary laboratory and imaging examinations) takes approximately 3 – 5 months, during which pretransplant treatment of the underlying disease continues.
At the same time, there will be a consultation with a physician and nurse from the transplant team, where the patient is acquainted with the course and regime measures during hospitalization and is also provided with a list of items recommended for the stay (available for download here).

ÚHKT is a center that performs approximately 80 allogeneic transplantations per year, which is the most in the Czech Republic. The first allogeneic transplantation was performed there in 1986.

The hematopoietic transplantation process is not simple, but our team of doctors, nurses and other specialists is prepared to help you manage everything.