What Is the Bone Marrow?
The bone marrow is the spongy tissue found inside the bones. It specializes in producing special cells called hematopoietic stem cells (blood stem cells) that can turn into different types of blood cells.
Blood stem cells can also be found in the blood that is moving throughout your body. But its origin is in the bone marrow.
Stem cells are unique cells that can make copies of themselves and also change (differentiate) into different types of cells that your body needs. The rest of our body cells are differentiated and can only make copies of themselves.
However, blood stem cells are unspecialized and can turn into red blood cells, white blood cells, and platelets.
These blood cells are essential, and each one has a different role:
- Red blood cells are responsible for transporting oxygen throughout the body. They also take carbon dioxide to the lungs to be exhaled. When these cells are diminished, your child can suffer from anemia.
- White blood cells are the core of the immune system. They fight infections caused by viruses and bacteria that can make your child sick.
- Platelets are the blood cells that form clots to stop bleeding.
What Are the Different Types of Bone Marrow Transplants?
Depending on the stem cells donor, there are different modalities with precise indications and benefits.
Stem cells for an autologous transplant are extracted from your own child’s body.
Sometimes, cancer is treated with high-dose chemotherapy or radiation therapy. This type of treatment can permanently damage stem cells. Hence, doctors remove your child’s stem cells from the blood or bone marrow before the cancer treatment begins.
Then, after your child completes the protocol, the stem cells are returned to his/her body, restoring the immune system. This procedure is also called an AUTO transplant or stem cell rescue.
Stem cells for an allogenic transplant come from another person, called a donor. This is also called an ALLO transplant.
The donor’s stem cells are injected into the patient after completing chemotherapy or radiation therapy.
The benefit of an ALLO transplant is that your child may have a “graft-versus-cancer cell effect.” In this case, the new stem cells target and destroy the recipient’s cancer cells that are still in the body.
This is the primary mode ALLO transplants work to treat cancer.
Umbilical cord blood transplant.
In this type of allogeneic transplant, stem cells from umbilical cord blood are used.
The umbilical cord connects the fetus and mother before birth. After the baby is born, the umbilical cord is cut, and mothers can donate it.
Then, the blood from these cords is frozen and stored in a cord blood bank and can later be used for a bone marrow transplant.
How Are a Donor and Recipient Matched for ALLO Transplants?
Complications and Risks of a Bone Marrow Transplant
It’s important that, as a parent, you’re aware of both the risks and possible benefits before treatment begins.
Always talk with the transplant team and treating physician about what to expect before, during, and after the bone marrow transplant.
One of the most feared complications is graft-versus-host disease (GVHD). This can be a serious and life-threatening complication of a stem cell transplant.
GVHD occurs when the child’s immune system reacts against the recipient’s tissue in allogeneic transplants. Then, the transplanted cells start to attack the other cells in the body.
GVHD risk is greater if the stem cells come from an unrelated donor, but it can happen to any patient who gets a bone marrow transplant from a donor.
Acute GVHD usually happens earlier, during the first months after the transplant. It typically affects the skin, digestive tract, or liver.
Chronic GVHD typically develops later and can affect many organs.
BONE MARROW TRANSPLANT SPECIALISTS AT SANT JOAN DE DÉU CHILDREN’S HOSPITAL (BARCELONA, SPAIN)
Bibliography – More recent publications:
Survival analysis of hematopoietic stem cell transplantation in children with primary immunodeficiency in Spain. Badell I, González M, Martínez AM, Sánchez de Toledo J, Olivé MT, González ME, Elorza I, Díaz de Heredia C.
Results of hematopoietic stem cell transplantation in hemoglobinopathies: thalassemia major and sickle cell disease. Elorza I, Olivé T, Dapena JL, Llort A, Sánchez de Toledo J, Díaz de Heredia C.
Subsequent malignancies after long-term follow-up of pediatric hematopoietic stem cell transplantation. Sisinni L, Gich I, Torrent M, Badell I.
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