What are the prime things you should know about bone marrow transplant?

What is a bone marrow transplant (BMT)?

A bone marrow transplant (BMT) replaces damaged or diseased bone marrow with healthy stem cells. Transplant Surgeons perform this procedure to treat cancers like leukaemia, lymphoma, and multiple myeloma, as well as severe blood disorders such as aplastic anaemia or sickle cell disease.

They extract healthy stem cells from the patient (autologous transplant) or a donor (allogeneic transplant). Before the transplant, they destroy the faulty bone marrow using chemotherapy or radiation therapy. This step clears space for the new cells to settle and produce healthy blood components.

After infusion, the transplanted cells migrate to the bone marrow to generate new red and white blood cells and platelets. This process restores the immune system and blood production, enabling the body to fight infections and function normally. Recovery takes months, requiring close monitoring and immune system support to prevent complications like infections or graft-versus-host disease (GVHD).

What parts of the blood does BMT generate?

A bone marrow transplant (BMT) generates the three main components of blood:

• Red Blood Cells (RBCs) – Carry oxygen from the lungs to the tissues and remove carbon dioxide.
• White Blood Cells (WBCs) – Defend the body against infections and foreign invaders.
• Platelets – Help in blood clotting to stop bleeding and heal wounds.

BMT restores the ability to produce these cells, ensuring proper oxygen transport, immunity, and clotting functions.

THREE decades after BMT

What is the role of Hematopoietic stem cells, or HSCs?

Hematopoietic Stem Cells (HSCs) are the blood-forming stem cells. They reside in the bone marrow and produce all types of blood cells. Their primary roles include:

• Generating Blood Cells – HSCs differentiate into red blood cells, white blood cells, and platelets, ensuring continuous blood production.
• Self-Renewal – They replicate and preserve a steady population to sustain lifelong blood cell formation.
• Immune System Support – HSC-derived white blood cells help the body fight infections and diseases.
• Wound Healing and Clotting – By producing platelets, they prevent excessive bleeding and aid in tissue repair.

In a bone marrow transplant (BMT), transplanted HSCs restore blood cell production in patients with damaged or diseased bone marrow. The bone marrow transplant (BMT) process enables the body to produce sufficient white blood cells, platelets, and red blood cells, preventing infections, bleeding disorders, and anaemia. Healthy stem cells can originate from a donor or the patient. When using the patient's stem cells, the Transplant Surgeon collect them before initiating chemotherapy or radiation therapy. These healthy cells are then preserved and later used for transplantation.

Why Do Patients Need Bone Marrow Transplants?

Transplant Surgeons perform bone marrow transplants (BMTs) to replace damaged or diseased bone marrow with healthy stem cells. Patients need this procedure when their bone marrow fails to produce enough healthy blood cells due to disease, chemotherapy, or genetic conditions.

• Treating Blood Cancers – Conditions like leukaemia, lymphoma, and multiple myeloma destroy BMTs' ability to produce healthy blood cells. A BMT restores normal blood formation and helps the body recover after intensive cancer treatments.
• Correcting Blood Disorders – Diseases like aplastic anaemia, sickle cell disease, and thalassemia impair blood-cell production. A bone marrow transplant (BMT) replenishes the bone marrow, enabling it to produce healthy red blood cells, white blood cells, and platelets.
• Rebuilding the Immune System – Patients receiving high-dose chemotherapy or radiation therapy lose their immune cells, making them vulnerable to infections. A BMT helps rebuild immunity and prevents life-threatening infections.
• Replacing Defective Bone Marrow – Some genetic disorders, such as severe combined immunodeficiency (SCID) or Fanconi anaemia, weaken the bone marrow. A BMT replaces faulty stem cells with healthy ones, restoring proper blood function.

This life-saving procedure allows the body to produce healthy blood cells, strengthen immunity, and improve overall health.

What are the Types of Bone Marrow Transplant?

Transplant Surgeons perform bone marrow transplants (BMTs) using three main approaches, depending on the source of the stem cells. Each type serves specific medical conditions and treatment goals.

• Autologous Transplant Surgeons collect the patient's healthy stem cells before chemotherapy or radiation. They store these cells and reinfuse them after treatment. This method helps patients recover from high-dose therapies while reducing the risk of immune rejection.
• Allogeneic Transplants use stem cells from a donor, often a family member or a matched unrelated donor. This transplant replaces diseased bone marrow and introduces a healthy immune system, making it productive for blood cancers and genetic disorders.
• Umbilical Cord Blood Transplant surgeons extract stem cells from umbilical cord blood collected at birth. These young stem cells adapt swiftly to a body and carry a lower risk of immune rejection, making them useful when a matched donor is unavailable.

Each method restores blood cell production and helps the body fight infections, anaemia, and bleeding disorders.

How do the experts perform the Bone Marrow Transplant?

Transplant Surgeons perform a bone marrow transplant (BMT) in multiple stages to ensure a successful procedure. They follow a structured process that includes patient preparation, stem cell collection, conditioning treatment, transplantation, and recovery.

1. Patient Evaluation and Preparation

Transplant Surgeons check overall health, blood counts, and organ function to determine eligibility for a BMT.

Doctors conduct tests to find a suitable match if the transplant requires donor stem cells.

2. Stem Cell Collection

• In an autologous transplant, the transplant surgeon extracts healthy stem cells from the patient’s blood or bone marrow before chemotherapy or radiation. Doctors store these cells for later transplantation to restore blood cell production.
• Transplant Surgeons collect stem cells from a matched donor’s blood or bone marrow in an allogeneic transplant.
• In an umbilical cord blood transplant, Transplant Surgeon transplants stem cells collected from preserved umbilical cord blood to restore healthy blood cell production.

3. Conditioning Treatment

Transplant Surgeons administer high-dose chemotherapy or radiation therapy to destroy the diseased bone marrow. This step eliminates cancerous or defective blood cells, suppresses the immune system to prevent rejection, and creates space for new stem cells to grow.

4. Transplantation

Transplant Surgeons infuse healthy stem cells into the bloodstream through an intravenous (IV) line, similar to a blood transfusion. These cells travel to the bone marrow and start generating new blood cells.

5. Recovery and Monitoring

Transplant surgeons closely monitor the patient for signs of engraftment, where the transplanted stem cells begin producing healthy blood cells. They provide immune system support, medications to prevent infections, and transfusions if necessary. Recovery takes weeks to months, depending on the patient’s response.

This carefully controlled process restores healthy blood cell production, boosts immunity, and improves overall health.

What is Leukapheresis?

Leukapheresis is a medical procedure that separates and removes white blood cells (leukocytes) from a patient’s or donor’s blood. Transplant Surgeons perform this procedure to collect stem cells for a bone marrow transplant, reduce excessive white blood cells in blood cancers, or prepare patients for specific treatments.

How Does Leukapheresis Work?

• A Transplant Surgeon inserts a catheter or needle into a vein to draw blood.
• A special machine separates white blood cells from the rest of the blood components.
• The machine returns red blood cells, platelets, and plasma to the body through another vein.
• Surgeons may use the collected white blood cells for a transplant, further treatment, or disposal, depending on the medical necessity.

Why Do Transplant Surgeons Perform Leukapheresis?

• Stem Cell Collection – Transplant Surgeons use leukapheresis to collect hematopoietic stem cells (HSCs) for a bone marrow transplant (BMT).
• Treating Blood Cancers – In conditions like leukaemia, where white blood cell counts are dangerously high, leukapheresis helps reduce the number of abnormal cells.
• Cell Therapy Preparation – Leukapheresis prepares patients for CAR-T cell therapy, a cutting-edge treatment for certain cancers.

This procedure ensures that patients receive the right balance of blood cells for effective treatment and recovery.

Happy patient after BMT

What to Expect After BMT?

After a bone marrow transplant (BMT), patients go through a critical recovery phase that requires close monitoring, immune system support, and lifestyle adjustments.

1. Hospital Stay and Initial Recovery

• Transplant Surgeons monitor blood counts, organ function, and signs of engraftment, where transplanted stem cells begin producing new blood cells.
• Patients receive medications to prevent infections, manage pain, and reduce complications like graft-versus-host disease (GVHD).
• Some may need blood transfusions until their bone marrow starts working accurately.

2. Immune System Rebuilding

• The immune system remains weak for months, making patients vulnerable to infections.
• Transplant surgeons may prescribe antibiotics, antiviral, and antifungal drugs for protection.
• Patients must avoid crowded places, practice strict hygiene, and follow dietary restrictions to prevent infections.

3. Engraftment and Blood Cell Production

• Engraftment usually occurs within 2 to 4 weeks, but full recovery takes several months to a year.
• Blood tests track red blood cells, white blood cells, and platelets to ensure normal production.

4. Managing Side Effects

• Patients may experience fatigue, nausea, mouth sores, or digestive issues as the body adjusts.
• Transplant Surgeons provide supportive care to ease discomfort and promote healing.

5. Long-Term Monitoring and Follow-Up

• Regular check-ups help Transplant Surgeons detect late complications or relapse of the disease.
• Some patients may need booster vaccinations to restore immunity.

With proper medical care, lifestyle precautions, and support, most patients regain strength and gradually return to normal activities.

A bone marrow transplant (BMT) restores healthy blood cell production in patients with blood cancers, genetic disorders, and bone marrow failure. Transplant Surgeons perform this procedure using autologous, allogeneic, or umbilical cord blood transplants.

They prepare patients with chemotherapy or radiation, infuse healthy stem cells, and monitor recovery to ensure successful engraftment. The procedure strengthens the immune system, prevents infections, and improves overall health. Patients require long-term follow-up, immune support, and lifestyle adjustments for a complete recovery. With advancements in medical science and proper post-transplant care, BMT offers a life-saving treatment and a chance for long-term survival.