Side Effects Of Bone Marrow Transplant (Donor And Recipient)

Introduction

Bone marrow is a cushion-like soft tissue present in selected areas of a body, regions like hips, thigh, and in other large bones. The function of bone marrow is to activate stem cells and stem cells from red blood cells, white blood cells, and platelets and stores iron in the body.

Bone marrow transplant contributes to saving a person’s life from dangerous diseases leukemia, lymphoma, multiple myeloma, amyloidosis, and more. Bone marrow transplant started in the mid-90s when people used to suffer from intense tumor cancers and immune deficiency disorders. Right candidates for bone marrow transplants are:

1. Genetic disease-bearing patients
2. Bone marrow cells stopped functioning due to chemotherapy or radiation therapy effects.
3. Patients suffering from adrenoleukodystrophy 
4. With hemoglobinopathies
5. Ones who are infected with plasma cell disorder
6. Genetic disease containing humans

Side Effects Of Bone Marrow Transplant (Donor And Recipient)

Side effects depend on donor type, time of neutrophil engraftment, transplant type, age, past history of diseases, etc. 

• Bacterial and viral infections experienced for 1-2 months after Transplant.
• Gum bleeding, brushing, nose bleeding
• Swelling in the lung
• Nausea and vomiting

• Chronic Graft versus host disease – It is divided into two parts acute and chronic. Acute is mild and the person starts feeling it in 2-3 months of bone marrow transplant generally mostly seen in transplants related to donor body starts feeling some foreign substance entrance and begin to react differently skin rash, itchiness, and formation of red bumps or blisters around the skin. Acute GVHD isn’t commonly seen in adults. 
• Chronic – This may initiate after 6 months, 10 months, or even a year. 
• Less than average red blood cells counts
• Diarrhea
• Abdominal pain
• Improper digestion in stomach, small and large intestines
• Heart problems (in extremely rare cases)
• Eye related disorders like cataract and ocular GVHD usually noticed after 5-6 months of a bone marrow transplant
• Less or no formation of stem cells after 15 days known as graft failure
• Inflammation in mouth
• Acidic food caused a burning sensation
• Loss of bone 
• Saliva formation in the mouth slows down
• Liver damage
• Blood vessels get interrupted 
• Some sort of hair loss can also happen

Side effects of bone marrow transplant in children :

• Breathing problems start in children at times. Targeted ones are those children who had busulfan, Cytoxan, and carmustine during the treatment. Shortness of breath and coughing are common symptoms.
•  Runny nose
• Sweaty and pale skin if the bacterial infection is there then
• Sepsis/ septic shock – when some weird and harmful chemicals spread in the bloodstream causes sepsis. When this chemical enters the vital organs like the heart, brain, and kidneys septic shock can occur. 
• Fungal infection in lungs
• Toxoplasmosis – occurs because of gondii parasites presence
• Leaky capillary syndrome lowers blood pressure often 
• Veno occlusive disease

How Many Types Of Bone Marrow Transplant Are There?

Basically, there 2 major BMTs :

• AUTOLOGOUS BONE MARROW TRANSPLANT

In an autologous bone marrow transplant, a person’s own stem cells are taken off for the procedure. After temporarily removing stem cells from the body they are preserved for a short time in the freezer, to make them safe against dangerous chemotherapy and radiation therapy procedures, once the treatment is done again stem cells are added to the body to continue the blood cell production.

• ALLOGENEIC BONE MARROW TRANSPLANT 

The allogeneic procedure requires a donor who has some kind of bone marrow and the donor definitely should be from a family or should have some sort of blood relations with the patient. Certain tests are also available to find a compatible match. This is a very common type of blood transplant.

A donor can transfer bone marrow cells to the patient in two ways :

1. Bone marrow harvest
2. Leukapheresis

BONE MARROW TRANSPLANT PROCESS

Before the BMT process :

For a better selection of bone marrow cells according to your body, doctors can take some blood and other tests. As chemotherapy and radiation therapy are involved BMT can take 5-7 days for the procedure. Prepare yourself for the following things :

1. Explain to your boss or owner about the BMT and take sick leave for a few days.
2. Confirm Medical insurance 
3. Take liquid money as credit cards are not acceptable in some hospitals and if it is allowed still take some money along with you. 
4. Stay in a house which is near a hospital as it saves time and ambulance bills.

Specific rooms are given to the patients who are undergoing BMT to help them with healthy and quick recovery. 

For a better selection of bone marrow cells according to your body, doctors can take some blood and other tests. As chemotherapy and radiation therapy are involved BMT can take 5-7 days for the procedure. Prepare yourself on the following things :

1. Explain to your boss or owner about the BMT and take sick leave for a few days.
2. Confirm Medical insurance 
3. Take liquid money as credit cards are not acceptable in some hospitals and if it is allowed still take some money along with you. 
4. Stay in a house which is near a hospital as it saves time and ambulance bills.

Specific rooms are given to the patients who are undergoing BMT to help them with healthy and quick recovery. 

During the BMT process:

The process is equivalent to the blood transfusion process. When the patient is going with an allogenic method then a donor is required. 

During the allogeneic procedure, hospital stays will be more because the patient will be taking cells from a donor. During autologous treatment, a hospital stay will be less, and cells are infused to the needed area directly from a stem cell bank. While taking cells from a donor, the doctor uses a needle in the hip region to make it less painful doctor gives anesthesia to the donor. 

• Four-five shots are given to the donor, to make it move from bone marrow into the bloodstream. 
• Then blood is passed on to the intravenous line and then detaches stem cells containing WBC.
• Port will be placed on the right side of your chest and then steadily stem cells enter into the heart of the patient.
• Gradually stem cells enter in the different parts of the body.

Recovery period of the Bone Marrow Transplant

 

• If allogeneic procedure is conducted then success rate relies on donor-patient’s genetic compatibility. 
• Typically the recovery period takes 3-4 months, overall recovery can take 10-2 months or more.
• Recovery time also depends on several factors like chemotherapy, radiation therapy, resting hours, area of transplantation (sensitive area usually needs more time), surgery and surgeon.

Donor Requirements For Bone Marrow Transplant

• Stem cells should not be different from the patient’s stem cells. To confirm, tests like HLA 

And tissue typing is done.

HLA Test – Broadly known as the human leukocyte antigen test, its work is to check the antigens of the donor, during this test antibodies are also searched. A donor’s vein syringe is inserted to take some blood samples. 

Tissue typing test – Some blood cells (typically WBC) of donor and some of the patients are combined to check the matching level.

• Donors age below 18 and above 60, not allowed.
• Weight should be healthy and BMI should be above 22 and below 40.
• If a donor is HIV positive or contaminated with AIDS, he/she cannot donate bone marrow cells.
• A person with intense arthritis-like septic, rheumatoid, psoriatic, osteoarthritis, and reactive arthritis you cannot donate BMT cells.
• A donor should be free from allergies (mild and severe both)
• Frequent asthma attacks in donors aren’t a perfect fit for this.
• If diabetes is very high and for years one should avoid becoming a BMT cell donor.
• If treatment is undergoing Tuberculosis, the doctor will eliminate you from the BMT cell transfer procedure.
• If a donor had tattoos and piercings with sterilized tools he/she can be a good donor.
• Pregnant or breastfeeding women do not match the criteria.
• If a donor is clear from cancer then yes he/she can be the right match.
• Healthy BP patients can donate.

FAQs :

1. What is hematopoiesis and what’s its role in bone marrow transplant?

The production of fresh mature blood cells directly from stem cells is known as haematopoiesis. This process continues from an embryo in mother’s womb till the adult stage. Out of two types of bone marrow, red coloured stays in contact with haematopoiesis and yellow doesn’t. Red bone marrows, haematopoietic cells are capable enough of developing numerous blood cells, like, RBCs, platelets and WBCs.

    2. Is donating bone marrow painful?

During the process, no it doesn’t hurt because general anesthesia and sedatives are given to the donor to prevent inconvenience and pain but after the donating process one can feel dizziness, fatigue, muscle ache and hip pain. 

 

     3. What to do if one is pregnant during allogeneic bone marrow            transplant?

If possible do not mix up both because risks like premature birth and miscarriage increases, apart from this other major complications like infertility ( unable to have children in the future) can also takes place. However, enough fluid intravenous management may reduce the risk of foetal distress.