When is a bone marrow transplant performed? What you need to know about bone marrow transplant - photo. Issues of organization and cost

Bone marrow transplantation as it happens is a fairly new procedure that allows you to deal with many pathologies that were previously considered incurable. Today, thanks to such a transplant, it is possible, if not saved, to extend the life of thousands of patients a year.

Such an organ has a liquid structure. It has a hematopoietic function. The bone marrow contains a huge number of pillar cells, which have the ability to constantly renew themselves. Thanks to the procedure for introducing the donor's columnar cells, further restoration of the patient's cells is possible.

The transplantation procedure should be divided into three main steps:

• Preparing the patient for transplantation;
• Direct transplant;
• period of adaptation and recovery.

When it is clear what a bone marrow transplant is, how the operation is carried out also does not hurt to find out. The procedure takes about an hour and is a process that resembles an intravenous infusion. The preparation process, as well as postoperative rehabilitation, during which new cells are engrafted, is considered to be longer and more difficult.

First of all, and this is the most important thing, it is necessary to find a suitable donor in all respects. The pillar cells of a healthy person must be genetically ideal, to make sure of this, a lot of research and blood tests are carried out.

Most often, the closest relatives (for example, a brother or sister) become donors, and sometimes just strangers who have the most suitable material. Such people are registered in the register of donors of international importance. In some cases, the material is taken from the patient himself.

Before a direct transplant is performed, the patient will need to undergo many tests that will reflect the detailed condition. It must fully comply with the parameters that are necessary to perform the operation.

After that, the elimination of diseased cells is performed. This can be done with chemotherapy or radiation therapy.

After the last procedures, a catheter is inserted into the vein, through which the introduction of new cells, as well as the necessary medications, will be carried out. It should be noted that the operation does not require operating conditions, transplantation is carried out in a simple ward. Donor cells enter the bloodstream and gradually begin to take root and multiply.

Then comes the most difficult period - adaptation. Its duration can be from 2 to weeks. For a successful run, you need:

• Organization of sterile conditions for the patient;
• Taking special drugs that help reduce the risk of rejection of donor material;
• Taking antibiotics to avoid the development of infectious complications.

At the end of the adaptation period, doctors can conclude that the operation was successful.

For a more detailed understanding of what a bone marrow transplant is, see video

As already noted, before starting such an operation, you should find a donor that is ideally matched in terms of performance. For a complete picture, it is necessary not only to know what is how does a bone marrow transplant work the procedure for the donor also needs to be understood.

The necessary donor cells are collected under local anesthesia. Punctures are made in a certain area of ​​the pelvic and femoral bones, through which the material for transplantation is taken along with blood. The volume of such a liquid can be from 950 to 2000 ml. The number of cells in the donor is restored to normal within a month. True, at the puncture sites, pains can be observed that resemble pain after a blow, but they are easily managed thanks to the use of anesthetics.

Life after bone marrow transplantation and consequences

A procedure such as bone marrow transplantation is quite difficult for a person, both physically and morally and emotionally. And not only for the patient himself, but also for his family.

After the operation, there is a strong feeling of weakness, vomiting, nausea, diarrhea and many other unpleasant consequences.

The most critical period is considered to be up to a month, when the body is weakened, it needs constant blood transfusion, antibiotics and other drugs. At this time, a person is prone to various infections and diseases. Doctors do everything possible to prevent such consequences.

After the donor's bone marrow engrafts and begins to multiply cells, the patient's condition stabilizes and he is discharged from the hospital.

But that doesn't mean everything is fine now. After discharge, a patient who has undergone bone marrow transplantation should be under constant medical supervision. Even in the future, the body is prone to infection with infectious diseases and the appearance of various complications that require prompt, timely and proper medical care.

In general, a person after transplantation notices an improvement in his condition, but the fear of the return of the disease is very strong, and sometimes develops into excessive panic. In such cases, you can not do without the help of a psychologist.

Do you understand how bone marrow transplantation works? What are the consequences after a bone marrow transplant for a donor? Leave your opinion or feedback for everyone on the forum.

TRANSFER PREPARATION MODE

A patient admitted to a bone marrow transplant department first of all undergoes chemotherapy and/or radiation for several days, which destroys his own bone marrow and cancer cells, and makes room for new bone marrow. This is called conditioning or preparatory mode.

The exact regimen of chemotherapy and/or radiation depends on the specific disease of the patient, in connection with the protocol and the preferred treatment plan of the department that performs the transplant.

Before the preparatory regimen, a small, flexible tube called a catheter is inserted into a large vein, usually in the neck. This catheter is required by medical staff to administer medications and blood products to the patient, as well as to avoid hundreds of vein punctures in the arms for blood sampling during the course of treatment.

The dose of chemotherapy and/or radiation that is given to a patient during preparation is substantially greater than those administered to patients suffering from diseases that do not require a bone marrow transplant. Patients may feel weak, nauseated, and irritable. In most bone marrow transplant centers, anti-nausea drugs are administered to patients to minimize discomfort.

BONE MARROW TRANSFER PROCEDURE

One or two days after the administration of chemotherapy and / or radiation, the bone marrow transplant itself is performed. Bone marrow is given intravenously, similar to a blood transfusion.

The transplant is not a surgical procedure. It takes place in the patient's room, not in the operating room. During a bone marrow transplant, the patient is often checked for fever, chills, and chest pain.

After the end of the transplant, days and weeks of waiting begin.

The first 2-4 weeks after a bone marrow transplant are the most critical. The high doses of chemotherapy and radiation that were given to the patient during the preparation phase destroyed the patient's bone marrow, damaged the immune system and the body's defense system.

While the patient is waiting for the transplanted bone marrow to migrate into the bony cavities of the large bones, take root there and start producing normal blood cells, he is very susceptible to any infection and has a pronounced tendency to bleed. Many antibiotics and blood transfusions are given to the patient to help prevent and fight infection. Platelet transfusions help control bleeding.

Patients after allogeneic transplantation also receive additional drugs to prevent and control graft-versus-host disease.

Extraordinary measures are taken to minimize the risk of infection of the patient by viruses and bacteria. Visitors and hospital staff wash their hands with antiseptic soap and, in some cases, wear protective gowns, gloves, and masks when entering a patient's room.

Fresh fruits, vegetables, plants and bouquets of flowers should not be brought into the patient's room, as they are often sources of fungi and bacteria that are dangerous to the patient.

When leaving the room, the patient should wear a mask, gown and gloves that are a barrier against bacteria and viruses and warn others that he is susceptible to infection. Blood tests should be taken daily to determine how the new bone marrow is engrafting and assess the state of bodily functions.

After the transplanted bone marrow finally takes root and begins to produce normal blood cells, the patient gradually ceases to be dependent on the administration of antibiotics, blood transfusions and platelets, which gradually become unnecessary.

The moment the transplanted bone marrow begins to produce enough healthy red blood cells, white blood cells, and platelets, the patient is discharged from the hospital unless he develops any additional complications. After a bone marrow transplant, patients typically spend 4 to 8 weeks in the hospital.

WHAT THE PATIENT FEEL DURING THE TRANSPLANTATION

A bone marrow transplant is a physically, emotionally and mentally difficult procedure for both the patient and their loved ones.

The patient needs and should receive all the help possible to cope with all this.
Thinking "I can handle this on my own" is not the best way for a patient to endure all the hardships of a bone marrow transplant.

A bone marrow transplant is a debilitating experience for the patient. Imagine the symptoms of a severe flu - nausea, vomiting, fever, diarrhea, extreme weakness. Now imagine what it's like when all these symptoms last not for a few days, but for several weeks.

Here is a rough description of what patients experience after a bone marrow transplant during hospitalization.

During this period the patient feels very sick and weak. Walking, sitting in bed for a long time, reading books, talking on the phone, visiting friends, and even watching TV shows require more energy from the patient than he has.

Complications that can develop after a bone marrow transplant - such as infections, bleeding, rejection reactions, liver problems - can cause additional discomfort. However, pain is usually well controlled with medication.
In addition, sores may appear in the mouth, making it difficult to eat and make swallowing painful.

Sometimes there are temporary mental disorders that can frighten the patient and his family, but you need to be aware that these disorders are passing. The medical staff will help the patient cope with all these problems.
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HOW TO MANAGE EMOTIONAL STRESS

In addition to the physical discomfort associated with a bone marrow transplant, there are also emotional and mental discomforts. Some patients find that the psychological stress of this situation is even more difficult for them than the physical discomfort.

Psychological and emotional stress is associated with several factors.
First, the patient for the bone marrow transplant is already traumatized by the fact that he is suffering from a life-threatening illness.

Although the transplant gives him hope of a cure, the prospect of undergoing a lengthy, difficult medical procedure with no guarantee of success is not encouraging.

Secondly, transplant patients may feel very lonely and isolated. Special measures taken to protect patients from infection while their immune systems are compromised can make them feel cut off from the rest of the world and from almost all normal human contact.

Patients are kept in a separate isolation room, sometimes with special air-filtering equipment to remove contaminants from the air.
The number of visitors is limited and they are required to wear masks, gloves and protective clothing to limit the spread of bacteria and viruses when they visit a sick person.

When the patient leaves the room, he is required to wear gloves, a gown and a mask, which are barriers against infection.
This sense of isolation is experienced by the patient just when he needs the most physical contact and support from family and friends.

A sense of helplessness is also a common experience among bone marrow transplant patients, causing them to feel angry or resentful.
For many of them, the feeling that their life is completely dependent on outsiders, no matter how competent they may be in their field, is intolerable.

The fact that most patients are not familiar with the terminology used by the medical staff to discuss the transplant procedure also adds to the sense of helplessness. Many also feel uncomfortable when they have to depend on outside help for daily hygiene routines, such as washing or using the toilet.

The long weeks of waiting for the transplanted bone marrow to heal, for the blood tests to return to safe levels, and for the side effects to finally disappear, add to the emotional trauma.

The recovery period is like a roller coaster - one day the patient feels much better, and in the next few days he may again feel seriously ill, as he had in previous days.

HOSPITAL DISCHARGE

After discharge from the hospital, the patient continues the recovery process at home (or rents accommodation near the hospital if they live in another city) for another two to four months. A person recovering from a bone marrow transplant usually cannot return to their normal work for at least six months after the transplant.

Although the patient is doing well enough to leave the hospital, his recovery is far from over.
For the first few weeks, he still feels too weak to do anything other than sleep, sit, and walk around the house a bit. Frequent visits to the hospital are necessary to monitor his recovery, administer medications to the patient and, if necessary, administer blood transfusions.

It may take up to six months or more from the date of transplantation for the patient to return to normal activity.
During this period, the patient's white blood cells are often too low to provide sufficient protection against viruses and bacteria found in everyday life.

Therefore, contact with the general public should be limited. Cinemas, grocery stores, department stores, etc. are places that are forbidden to visit for a patient undergoing a recovery period after a bone marrow transplant. Such people should wear a protective mask when they venture out of the house.

The patient returns to the hospital or clinic several times a week for tests, blood transfusions, and administration of other necessary medications. Eventually, he becomes strong enough to return to his normal routine and look forward to returning to a productive, healthy life.

LIFE AFTER BONE MARROW TRANSPLANTATION

It can take about a year for new bone marrow to start functioning like your own. Patients must remain in touch with the hospital at all times to detect any infections or complications that may develop.

Life after a transplant can be both exciting and unsettling. On the one hand, it's an exciting feeling to feel alive again after being so close to death. Most patients find that their quality of life has improved after the transplant.

However, the patient always remains worried that the disease may return again. In addition, ordinary innocent words or events can sometimes bring up painful memories of the transplant period, even long after full recovery.
It may take a long time for the patient to cope with these difficulties.

Yes! For most patients awaiting a bone marrow transplant, the alternative is almost certain death.
Although a transplant can be a painful time, most transplant recipients find that the prospect of returning to a full, healthy life after a transplant is worth the effort.

What is a stem cell transplant?

Today, in many cases, instead of bone marrow transplantation, transplantation of peripheral stem cells is performed. The donor, who turned out to be compatible with the patient, receives a drug for 4 days that stimulates the release of stem cells from the bone marrow into the blood. The medicine is given with a conventional subcutaneous injection. As a rule, it is well tolerated, although in rare cases there are short-term symptoms resembling a mild flu: muscle pain, weakness, slight fever.

After such preparation, blood is taken from the donor from the vein of one arm, passed through a special apparatus that filters only stem cells from the blood, and then returned to the donor through the veins of the second arm. The whole procedure lasts several hours, does not require anesthesia, and apart from some inconvenience, does not cause any harm to the donor.

In extremely rare cases, drug preparation for a stem cell transplant can cause an enlarged spleen in the donor, but the frequency of such cases is extremely low.

BONE MARROW TRANSPLANT IN ISRAEL.

Israeli hospitals have accumulated extensive experience in bone marrow transplant.
Despite the fact that the population of Israel is one and a half times less than the number of residents of Moscow, there are five centers for bone marrow transplantation in the country.

In each of them - qualified teams of doctors specializing in bone marrow transplants in adults and children. The transplant success rates and complication rates at all these centers are in line with those of the world's best departments. bone marrow transplant.

In addition to residents of Israel, these centers accept many patients from abroad for treatment, including from neighboring Arab countries with which Israel does not have diplomatic relations. Arab sheikhs prefer to go to Israel for treatment, although they can choose any hospital for treatment, and not only in the Middle East.

Naturally, many residents of Russia and the CIS countries also receive medical care in these departments.

It is known that the cost of transplants in Israel is lower than in Europe, and much lower than in the United States.
The price of a transplant depends on its type - the cheapest is autologous, when a patient becomes a bone marrow donor for himself.
The most expensive type is a transplant from a poorly compatible donor, as well as a transplant that requires preliminary cleaning of the bone marrow from cancer cells.
Bone marrow transplants in children cost one and a half to two times higher than in adults, since they require more complex and expensive procedures and treatments.
Price bone marrow transplants in Israel can be from 100 to 160 or more thousand dollars, depending on the patient's disease and the compatibility of the donor.

Modern medicine offers patients such a complex procedure as bone marrow transplantation. This is an expensive operation, the need for which arises in patients with severe pathologies that disrupt the processes of hematopoiesis. For people who have money, doctors recommend not to refuse a surgical procedure, as this is a real opportunity to save their lives.

Indications and contraindications for bone marrow transplantation will be discussed by the attending physician before the operation.

Bone marrow transplantation is prescribed for patients with leukemia and other life-threatening pathologies. Surgical intervention is carried out strictly according to indications. Before starting, the doctor should check the patient for possible contraindications. He also introduces him to all stages of the procedure and explains the rules for passing the rehabilitation period.

Before and after the operation, the patient must be under the supervision of the attending physician. He controls his condition and selects the optimal treatment that contributes to better engraftment of donor tissues.

Indications

Bone marrow transplantation should be considered for patients who have been diagnosed with the following diseases:

1. Leukemia acute or chronic;
2. Anemia of aplastic type;
3. Autoimmune pathologies;
4. Immunodeficiencies of a hereditary nature;
5. Metabolic disorders;
6. Lymphoma;
7. Some types of extramedullary neoplasms.

For which diseases this operation is performed, the patient will be told by his attending physician. Most often, transplantation is necessary in patients with neoplasms of the hematopoietic tissue, as well as in anemia.

With transplanted tissues from a donor, the patient will have a chance for life. In case of successful engraftment of the transplanted material, it begins to perform the function of the bone marrow, which was suppressed by the progressive disease.

Contraindications

Not all patients diagnosed with leukemia or other dangerous pathology are suitable for bone marrow transplantation. This is because this surgical intervention has a number of contraindications to its implementation.

It is necessary to refuse bone marrow sampling and its transplantation if there are the following contraindications:

• Acute infectious lesions of the body (HIV, syphilis, hepatitis);
• Pregnancy;
• Violation of the immune system;
• Severe pathologies of internal organs;
• Long-term use of hormonal drugs or antibiotics.

The transplant will not be carried out if there is an incompatibility between the donor and the patient. Under such circumstances, the material may not take root. Usually, doctors take tissue for transplantation from the patient or his immediate family.

Before starting the procedure, the donor is necessarily checked for the presence of various diseases. If infectious lesions are detected during the diagnosis, then the person will not be able to act as a person providing material for transplantation.

Operation types

What is a transplant, every patient who needs transplantation of biological material, in this case, bone marrow, knows. There are several types of surgical intervention, each of which has its own characteristics.

Autotransplantation

Bone marrow transplantation of this type is carried out only after the patient goes into remission.

Autologous donor bone marrow transplantation is not a complete transplant. This procedure refers to the supporting engraftment of stem cells or the brain. Surgical intervention of this type is optimal for patients whose disease has passed into remission. Also, autotransplantation of a healthy bone marrow may be required in the case of a pathology that does not affect the bone marrow tissue.

Such an operation often becomes necessary in the treatment of malignant neoplasms in the mammary glands, ovaries and brain.

How the transplantation works, you can find out during a visit to your doctor. The necessary material is taken from the patient and transplanted to him after special therapy. The sooner treatment is started, the higher the chances of achieving a positive result.

Where exactly and why the bone marrow is taken from the patient for transplantation can also be found out from the doctor. Doctors insist on such a sampling of material, because the transplantation of their tissues is more successful than the engraftment of donor cells.

This type of transplant is done only after the doctor is convinced that the patient is in remission. Otherwise, the operation will not give the desired result, and the person's condition can be significantly aggravated. To confirm remission, it is enough to take a tissue sample from the patient using a biopsy and examine it in the laboratory.

Autologous transplantation is done in stages:

1. The bone marrow is removed. This procedure is called extraction. As a rule, this operation does not pose a particular danger to the patient's life, since the material is taken from the patient's femurs. The sample taken must be placed in a chamber where it is stored frozen. If the disease has managed to affect the bone marrow, then at this stage the organ is cleansed of the affected cells.
2. The patient begins intensive treatment. If the bone marrow is damaged, chemotherapy is required. Sometimes doctors include radiation therapy in the course of treatment.
3. The patient needs to undergo a reverse organ transplant. Those who have passed the first steps of the procedure begin this stage. A bone marrow transplant operation is underway. This method allows you to transfuse blood into an organ and introduce it into the human body. It contributes to the rapid recovery and revival of the hematopoietic system.

This is the main method of autotransplantation. There is another option for the implementation of surgical intervention. It eliminates the need to extract the bone marrow and reintroduce it. During the operation, only stem cells are affected. This method is considered less dangerous, as it requires less time to recover the patient after the procedure.

allogeneic

Allogeneic transplantation is another treatment option for the patient. How bone marrow transplantation is done by this method is known by a doctor who specializes in such operations. It is customary to call allogeneic a procedure involving the engraftment of a donor organ.

Donor bone marrow should correspond as closely as possible to the patient's organ. Without compliance with this condition, it makes no sense to count on a favorable outcome of radical treatment.

The operation is performed after checking the patient and the donor for compatibility. This is done in a medical facility. If the donated brain is not suitable, then the patient's body will begin to reject it. It is life-threatening for a person with leukemia or other serious illness.

Specialists are trying to transplant an organ to a patient from his close relatives. Ideally, these should be siblings. In 25% of cases, their bone marrow is suitable for transplantation. If a person does not have such relatives, then they try to find suitable material in the international donor registry. A person whose sample fits the patient by 35% may be suitable for the operation. This ratio on the compatibility scale is often enough to achieve engraftment of new tissues.

How is a bone marrow transplant performed?

The delivery of preliminary tests is mandatory to assess the current state of the person and for the presence of possible contraindications to the operation.

Patients are interested in how bone marrow sampling and transplantation can take place. No less relevant are the questions of whether it will hurt the patient, how recovery should be carried out after the procedure, and what stages the rehabilitation consists of.

Successful surgery should be counted on if the patient undergoing radical treatment has no contraindications to transplantation. The specialist must take into account the age of the patient, his physical condition, as well as the stage of the course of the pathological process.

All patients underwent a series of tests before transplantation. The delivery of preliminary tests is necessary to assess the current state of the person. In addition, this minimizes the negative consequences that may occur in the patient during the operation or after it due to the presence of unidentified contraindications.

During the preliminary diagnosis, it is necessary to check the lungs, kidneys, heart and other internal organs of the patient, the function of which may affect the success of transplantation. In addition, doctors will be able to compare their initial performance with the indicators obtained after the completion of radical treatment.

The success of bone marrow transplantation in a patient with lymphosarcomas, with lymphoma and other dangerous diseases depends on the professionalism of the medical team that will be involved in the treatment of a person. Doctors and nurses must be able to recognize dangerous conditions in which the patient will need special care.

Preparing for the operation

To increase the chances of a successful operation and minimize recurrence, it is necessary to carefully prepare for a radical method of therapy. The patient is hospitalized and prescribed a course of chemotherapy or radiation. This treatment contributes to the destruction of the bone marrow and cancer cells. This frees up space in the body for the donor organ.

The mode of pre-treatment with the participation of radiation and chemotherapy directly depends on the severity of the pathological process and the planned treatment.

At the stage of preparation for the operation, during which the surgeon transplants a donor or his own organ into the patient's body, a catheter is inserted into a large vein in the patient's neck. Through it, doctors and nurses will be able to administer the necessary medicinal formulations. Also, the catheter avoids unnecessary punctures that are made throughout the therapy.

The patient is given an increased dose of drugs for radiation or chemotherapy. For patients who do not require a transplant, it is much less. In this regard, a person may feel a sharp deterioration in general well-being, irritation, nausea and severe weakness. At the discretion of the doctor, the patient is additionally administered drugs that can minimize this symptomatology.

Methodology

Approximately two days after radiation or chemotherapy, the resulting organ (they take bone marrow from a donor or the patient himself) can begin to engraft. It is introduced into the human body gradually by infusion through a vein.

This procedure may resemble a traditional blood transfusion.

As a rule, bone marrow transplantation is carried out in the patient's room. Therefore, he does not need to move to the operating room. During the procedure, the doctor must carefully monitor the general condition of the person. Particular attention is drawn to the increase in body temperature, the appearance of chills, pain in the chest and other negative reactions.

After a transfusion, the treatment of leukemia or other pathology that disrupts the functioning of the bone marrow is considered complete. What will be the prognosis of therapy, doctors cannot say right away. After the operation, they continue to monitor the patient and wait for the result.

Aftercare

After a bone marrow transplant surgery, the postoperative recovery period lasts no more than four to eight weeks.

Patients with myeloma and other pathologies (transplantation is prescribed not only for multiple myeloma) after radical treatment must undergo a full period of rehabilitation. Providing appropriate care helps improve their chances of recovery.

The most critical and unpredictable are the first 2-4 weeks after transplantation is completed. During this period, a person's condition can significantly worsen, since the preliminary preparation for the operation contributed to the destruction of his bone marrow and damage to the immune system. As a result, the patient's body is defenseless against the attacks of pathogens.

The patient must wait for the moment when the new bone marrow moves into the bone cavities and finally takes root in them. After that, he will be able to produce healthy blood cells in the human body. During this period, he is most susceptible to the development of bleeding and infection with infections. These complications can be prevented by receiving antibiotics and multiple blood transfusions.

Haplotransplantation (haploidentical transplantation) and other methods of bone marrow engraftment are not the final stage of treatment. After the procedure, the patient receives drugs that can reduce the likelihood of rejection of the donor organ.

Special measures can be taken that help reduce the risk of damage to the patient's body by pathogens. Doctors and nurses can contact him only after they thoroughly wash their hands with an antiseptic. It is not uncommon to require the use of protective clothing, masks, and gloves while in the patient's room.

It is strictly forbidden to bring fresh vegetables and fruits, flowers and various objects that can be sources of pathogenic bacteria to the patient and leave them in his room. Infection with them can result in a sharp deterioration in a person's condition.

When bone marrow transplant patients are outside the room, they must use a face mask. A patient who is outside his room exposes himself to a serious risk of contracting various infections. Therefore, it is best to stay within its limits.

Every day, nurses must collect blood from a bone marrow transplant recipient for analysis. This measure makes it possible to trace the dynamics of engraftment of donor tissues and assess the current state of the organism.

As soon as the bone marrow fully takes root, it begins to perform its main functions. The body produces blood cells, so that a person ceases to be dependent on the constant intake of medicines and blood transfusions. All these procedures cease to be vital.

If the patient's bone marrow begins to function properly, the doctor has the right to discharge him from the hospital. This measure is permissible only if no complications were identified during the rehabilitation of a person.

As a rule, after a brain transplant, patients spend no more than 4-8 weeks in the hospital.

Possible Complications

Life expectancy after surgery directly depends on the patient's compliance with all doctor's recommendations.

Complications in patients after bone marrow transplantation are not excluded. The likelihood of their development depends on many factors. These include the severity of the course of the pathological process, the condition of the patient, as well as the professionalism of the doctor who performed the operation and observed the person during the rehabilitation period.

Death is one of the complications after transplantation. It occurs in 5-10% of cases, since radical treatment requires the destruction of a person's own bone marrow, as well as a strong suppression of his immune system. These are statistics for patients who have not reached 35 years of age. In the older group, this risk increases to 30%.

The most common complication is graft-versus-host disease. GVHD worries a patient if he has received an organ transplant from a person who is not related to him. To cope with the complication, patients are prescribed drugs, the action of which is aimed at suppressing the immune system. In this case, the probability of death can increase up to 50%.

During periods of GVHD, the patient's body is highly susceptible to various infectious agents. The most dangerous for humans are:

• herpes virus;
• varicella-zoster virus;
• Epstein-Barr virus;
• Cytomegalovirus.

The action of the drug course is aimed at preventing infection with them.

Life after surgery

What can a person's life be like after a bone marrow transplant - this is the question that worries patients who need such treatment. Doctors note that this therapy leaves a certain imprint on patients. They have to change their habitual way of life and live by new rules.

A person must understand that in the next 6 months after the operation he will not be able to return to work. He will have to avoid being in crowded places. This is because even a banal visit to the store can turn into infection with infectious pathogens for him.

If the bone marrow successfully engrafts, then the life expectancy of a person after therapy becomes unlimited. The patient can live in peace, without fear of the return of the disease. People live after transplantation as long as their health allows.

Survival after radical treatment directly depends on whether the patient complies with the doctor's requirements or not. It is very important to be under the supervision of a doctor, to undergo all tests and diagnostics that allow you to trace the dynamics of improving the work of the affected system.

Where to do and how much the operation costs

On the territory of the Russian Federation, bone marrow transplantation is carried out only in large cities

Bone marrow harvesting and transplantation techniques are complex procedures that must be performed by an experienced specialist. This operation is highly costly. The patient is required to pay:

• Costs for the preparatory stages;
• Medications;
• Carrying out the procedure;
• Further observation.

In the capital of Russia, such transplants cost patients in the amount of 1 million rubles. Specialists who work in foreign clinics provide an opportunity for bone marrow transplantation for an average of 100,000 euros.

In Russia, you can get the right to a free bone marrow transplant. However, the chances of this are very low due to the limited state budget for radical therapy. Another problem is finding suitable donors among Russians. The patient has to pay for biological material from a foreign donor, since this service is not included in the state program.

On the territory of Russia, a donor brain transplant is carried out in large cities. We are talking about Moscow and St. Petersburg. A patient who needs a transplant can apply to local medical facilities.

In this article, you will find answers to the most common questions about bone marrow transplantation. They are answered by Bookimed coordinator doctor-hematologist Stanislav Ustinov.

What is bone marrow and why is it needed?

What is bone marrow?

This is the main organ of hematopoiesis, soft spongy tissue inside the bones, which contains hematopoietic stem cells. They produce the formed elements of blood:

• leukocytes (monocytes, granulocytes, etc.) - cells that protect the body from infections;
• erythrocytes - oxygen carrier cells;
• Platelets are cells whose main function is to participate in blood clotting.

What is bone marrow for?

The body uses a huge number of blood cells, and the bone marrow must constantly produce new ones in order for the blood to supply oxygen to tissues and organs and maintain immunity.

Can a person live without bone marrow?

The bone marrow is a vital organ. It produces blood cells, without which the body cannot exist. Therefore, if the functioning of the organ is impaired, the treatment is ineffective and the prognosis is unfavorable, bone marrow transplantation (BMT) is required.

The procedure is necessary when, in hematological diseases, the bone marrow is forced out by tumor cells, and when the patient is taking drugs that inhibit the activity of the organ (cytostatics, antibiotics, etc.).

Where, in what bones is the bone marrow located?

Bone marrow is located in the cavities of large tubular bones - ribs, sternum, skull, pelvis.

Why do I need a bone marrow transplant and what does it give?

What is a bone marrow transplant?

Bone marrow transplantation (BMT) is a procedure for introducing blood stem cells to a patient to replace the diseased bone marrow with a healthy one.

Does a bone marrow transplant help? What does she give?

Bone marrow transplantation gives a chance for recovery to patients with serious diseases - leukemia (blood cancer), aplastic anemia, lymphomas, multiple myeloma, and serious immune disorders.

Bone marrow transplantation does not give a 100% guarantee of a cure, but in most cases it improves the prognosis.

Is a bone marrow transplant an operation?

No. Modern methods of TCM are not considered surgical procedures. The procedure for the introduction of bone marrow is less traumatic and is carried out not in the operating room, but in the patient's ward.

For the donor, the bone marrow sampling process is also less traumatic, since only a part of the hematopoietic cells are taken from him, in most cases from venous blood.

What are the types of bone marrow transplantation and how do they differ?

At autologous transplant the patient is injected with his own, previously selected and frozen, hematopoietic cells.

During allogeneic transplant the patient is injected with hematopoietic cells from a compatible donor.

What is treated with a bone marrow transplant? When is a transplant needed? Is it always needed?

TCM is the last stage in the treatment of blood diseases with early recurrence and poor prognosis. Bone marrow transplantation is treated with:

1. Hematological disorders:
   1) anemia (Fanconi anemia, sickle cell anemia);
   2) myelodysplastic syndrome (MDS), myelofibrosis;
3) ;
4) (leukemia).
2. Bone marrow disordersafter chemotherapy and radiotherapy.
3. Immunodeficiencies.

Whether to do a bone marrow transplant in a particular case is decided by the attending physician.

Are there any contraindications for bone marrow transplantation?

Doctors do not perform a bone marrow transplant if:

1. The patient has severe liver and/or kidney dysfunction and the risk of not undergoing the procedure is high.
2. The disease, due to which the patient needs BMT, is progressing, and the body does not respond to treatment according to any protocols.

Where is bone marrow taken for transplantation?

It depends on the type of transplant - autologous or allogeneic.

In an autologous transplant, bone marrow is taken from the patient himself. Allogeneic BMT requires a donor that is compatible with the patient.

Where is bone marrow taken from for transplantation?

In 80% of cases, the doctor takes hematopoietic cells from the donor's venous blood. To do this, the donor takes a drug for 5 days that stimulates the release of stem cells into the blood.

Another method - puncture from the ilium, is used only in 20% of cases when medical stimulation is not possible.

Who can be a donor?

What are bone marrow donor and acceptor?

A bone marrow donor is a person whose bone marrow is used for transplantation. Acceptor, recipient - a patient to whom an organ is transplanted.

In autologous transplantation, cells are taken from the patient himself (donor and acceptor are the same person).

Who can be a donor?

Bone marrow donors can be:

• the patient himself (for certain diseases, for example, multiple myeloma);
• the patient's twin;
• siblings of the patient;
• parents or other relatives whose bone marrow is compatible with the patient's immune system;
• compatible donors from national and international registries.

What are the requirements for donors?

A person who meets the following criteria can become a bone marrow donor:

• age - from 18 to 55 years,
• did not suffer from hepatitis B or C, HIV infection, tuberculosis, malaria;
• does not have malignant tumors;
• does not have mental disorders;
• is not allergic to anesthesia.

How to check if a donor is compatible with a patient?

The genetic compatibility of the donor and acceptor (patient) is determined in the laboratory using a genetic study - HLA typing.

Donor and recipient donate blood for typing. During the test, specialists determine the set of genes responsible for cell compatibility and check for the presence of similar DNA regions (loci) in the chromosomes of the patient and the donor. The more similar DNA loci, the higher the compatibility.

There are two types of research - HLA-typing of high and low resolution. The methods differ in the number of sites to be tested - in the high-resolution procedure, more loci are tested. Such typing is more accurate than the low resolution procedure.

What is HLA?

HLA (Human Leukocyte Antigens, tissue compatibility antigens) are protein molecules on the surface of leukocytes that are sensitive to foreign cells. The protein recognizes foreign cells and triggers the body's immune response to infections and malignant tumors.

Engraftment of donor bone marrow is possible only when the HLA of the donor and recipient are as compatible as possible.

How is a donor searched for a bone marrow transplant?

Once a hematologist has determined that a procedure is necessary, a matched donor for a bone marrow transplant is sought from the patient's relatives.

First of all, genetic compatibility with the patient's siblings is studied. If they are not available or their hematopoietic cells are not suitable for transplantation, doctors consider transplantation from one of the patient's parents.

According to statistics, only 20-30% of patients have a suitable related blood stem cell donor. If a bone marrow transplant from a relative is not possible, the clinic sends a request to a national or international bone marrow donor bank. A potentially compatible donor is found through a computer registry, then the results of his genetic testing are compared with the results of testing the patient. If the HLAs are compatible, doctors prepare the donor and recipient for transplantation.

How does the transplant work for the donor and the patient?

How is bone marrow taken from a donor for transplantation?

The collection of blood stem cells from the bone marrow is carried out by two methods:

1. From a donor's blood (more common and modern way)

A few days before the bone marrow is taken, the donor starts taking a drug that stimulates the release of hematopoietic cells into the blood. On the day of sampling, he spends 3-5 hours in a chair for blood sampling.

During the procedure, blood from a vein in one arm passes through a stem cell separator (cell separator) and returns through a vein in the other arm.

1. From the ilium

The doctor makes a puncture in the pelvic area and with a syringe with a needle takes the required amount of bone marrow. The procedure is performed under anesthesia and takes 30-60 minutes.

How is the preparation for TCM going?

Before the procedure, the patient must undergo preparation for transplantation - conditioning. It is carried out for the following purposes:

1. Destroy the maximum number of tumor cells (for cancer).
2. Suppress the immune system so that the transplanted bone marrow can successfully take root.

The preparation includes high-dose chemotherapy and/or whole-body exposure to low-dose radiation. The doctor selects the method depending on the patient's condition and the type of transplantation.

The preparation stage takes on average about 1 week.

How is a bone marrow transplant performed?

The transplant itself is less traumatic and resembles a regular blood transfusion. However, BMT requires careful preparation, strict adherence to the stages of the procedure and sterility requirements.

Bone marrow transplantation is done in several stages:

Within a month after the procedure, the patient may feel nausea and weakness. When the blood counts improve, he is transferred from the sterile box to the standard ward for the next 4-8 weeks.

What examination should be done before bone marrow transplantation?

Pre-transplant screening includes:

• General and biochemical blood tests. With their help, the doctor detects a malfunction in the liver and kidneys.
• CT, MRI or (positron emission computed tomography), which allow you to assess the patient's condition and identify the presence of distant foci of the disease.
• Cell compatibility test (for allogeneic transplantation).

What are the results and consequences of TCM?

What is the danger of bone marrow transplantation for the donor and the patient? Are there risks and side effects?

What will happen to the donor after bone marrow transplantation, what are the consequences?

Transplantation is safe for the donor, because only 2-5% of the bone marrow is taken from him, and within a month he is completely restored. Possible complications include reaction to anesthesia. A few days after the procedure, the donor may feel weak and dizzy.

Consequences of the transplant for the patient

Before transplantation of donor blood stem cells, the patient's own bone marrow is destroyed. Because of this, all hematopoietic processes in his body stop, and may occur:

1. Infections - due to an insufficient number of leukocytes.
2. High risk of bleeding - there are not enough platelets in the blood to stop it.
3. Hypoxia (oxygen starvation) due to a reduced number of red blood cells. As a result - nausea, vomiting, weakness.

Sourasky Clinic's response time is 2 days.

Germany

For bone marrow transplantation, patients from Russia, Ukraine, Belarus, Bulgaria, Kazakhstan, Great Britain and the United Arab Emirates choose.

Bone Marrow Transplant Doctor at Helios Clinic

TCM at the Helios clinic is performed by Dr. He leads
Center for bone marrow transplantation and has already performed more than 1,000 transplants.

Helios clinic response time is 5 days.

Italy

According to Bookimed, bone marrow transplantation is chosen by patients from Ukraine, Russia, and Belarus.

Accepts both adults and children for treatment. It performs autologous transplantation and bone marrow transplantation from related and unrelated donors. The San Rafael Clinic has access to national and international donor registries. Every year, about 140 TCM procedures are performed here, 60% of them are allogeneic.

Bone Marrow Transplant Doctor at San Rafael Hospital

In most cases, the procedure is performed by a hematologist, head of the Bone Marrow Transplant Center. He has 37 years of experience in the treatment of blood disorders.

The response time of the San Rafael clinic is 5 days.

➤ Bookimed coordinating doctors will select for you clinic and doctors who specialize in bone marrow transplantation. We will take into account the specifics of the medical case, your needs and wishes. You'll get individual treatment program with the cost and will be able to plan the budget of the trip in advance.

➤ Bookimed is an international service for the selection of medical solutions and organization of treatment in more than 25 countries. Every month our medical coordinators help 4,000 patients. Our mission is to provide everyone with the necessary medical solution and help at all stages: from choosing a clinic and organizing a trip to returning home. We stay in touch with you 24/7 so that your path to health is simple and comfortable.

➤ Bookimed services are free for patients. The selection of a solution and the organization of a trip do not affect your bill for treatment.

Leave a request to get a consultation with a Bookimed coordinating doctor.

To get a consultation

The bone marrow is the most important hematopoietic organ. It is a semi-liquid fatty substance and is found in soft, spongy tissue within the bone marrow cavities. The bone marrow produces so-called stem cells, from which three types of blood cells are subsequently formed: leukocytes, platelets and erythrocytes. In the treatment of various benign and malignant blood diseases, it is sometimes necessary bone marrow transplantation.

Bone marrow transplant: types and their features

A bone marrow transplant or transplant is a complex surgical procedure in which healthy bone marrow with normal stem cells is transplanted to patients with various diseases. Most often, this procedure is performed on children with various types of leukemia. During a bone marrow transplant procedure in children, the cells of the old brain are destroyed, and the transplanted healthy cells begin to migrate. If successful, they take root, and then begin to produce viable blood cells.

Depending on what material is used for bone marrow transplantation, there are three types of it:

• allogeneic;
• isogenic;
• autologous.

In the first case, biological material from a donor is used. In this case, the donor bone marrow should correspond as closely as possible to the patient's bone marrow. In order to determine how compatible the recipient and donor are, special blood tests are carried out at the Bone Marrow Transplant Center. When the donor's bone marrow does not fully match the recipient's bone marrow, the latter's body can identify the transplanted biomaterial as foreign, and a rejection reaction will begin, then the patient's immune system will begin to destroy the cells received from outside. A reaction called "graft-versus-host" is also possible. In this case, the immune system begins to fight with its own cells, considering them to be foreign and thereby causing serious harm to the patient's health and even threatening his life.

The ideal donors for bone marrow transplantation in children are the recipient's siblings. Sometimes children and their parents, as well as other blood relatives, have good compatibility. If it is not possible to find a donor from among relatives, then you can use a special registry - database (WMDA), which includes information about potential bone marrow donors from all over the world.

If bone marrow transplantation is performed in children, then the ideal donor option is the identical twin of the recipient, who is genetically absolutely identical to him. This type of bone marrow transplant is called isogenic.

Sometimes a patient can be a bone marrow donor for himself. This is the third type of transplant - autologous. In this case, the bone marrow is removed from the patient before radiation therapy or chemotherapy, placed in a freezer and subjected to cryopreservation. After chemical or radiation therapy, the removed biomaterial is transplanted back to the patient for the purpose of subsequent regeneration of normal blood cells.

When is a bone marrow transplant indicated?

In some diseases, stem cells do not function properly. For example, people with leukemia produce an excessive number of immature or defective blood cells, and in the case of aplastic anemia, the production of normal, viable cells is sharply reduced. Immature or defective cells gradually crowd out healthy blood cells from the bloodstream and spread quite quickly in the human body. In this case, the patient is shown a bone marrow transplant. The price of such a procedure is quite high, and although it does not give a 100% guarantee of a successful outcome of the disease, nevertheless, such an operation greatly increases the patient's chance of recovery.

Bone marrow transplantation is indicated for diseases accompanied by dysfunction of the immune system or bone marrow. Most often, such operations are performed with the following malignant blood pathologies:

• acute and chronic forms of leukemia;
• myelodysplastic syndromes;
• juvenile myelomonocytic leukemia;
• diseases of plasma cells;
• various types of lymphomas.

Bone marrow transplantation is also used for non-malignant diseases:

• congenital metabolic disorders;
• congenital and acquired pathologies of the immune system;
• congenital diseases of erythrocytes;
• various autoimmune diseases.

How is a bone marrow transplant performed?

The success of such a serious procedure as bone marrow transplantation largely depends on the general well-being of the patient. The age of the patient, and his physical condition, and the diagnosis, and the stage of the disease also matter. Before the operation, the patient is carefully checked for his readiness for this surgical procedure.

Bone marrow transplantation involves several stages:

1. A few days before the operation, the patient is hospitalized for a preparatory course of intensive chemical or radiation therapy, the purpose of which is to destroy their own stem cells. Transplantation can be carried out only after massive destruction of the patient's bone marrow.
2. At the second stage, the Bone Marrow Transplantation Center performs direct implantation of healthy stem cells through a catheter inserted into a large vein. This manipulation resembles a simple blood transfusion and lasts about an hour. The stem cells injected into the blood then enter the bone marrow, settle there and gradually take root. To reduce the risk of an allergic reaction or anaphylactic shock during the transplant process, the patient is prescribed antihistamine and anti-inflammatory drugs shortly before the operation.
3. Stem cells do not start functioning immediately after transplantation. It will take some time for them to get used to the new conditions. During this period, when the patient's bone marrow is completely destroyed, and the transplanted stem cells have not yet adapted, the immune system is very weakened, since there are not enough white blood cells in the blood to fight infections. That is why at this stage, complete isolation of the patient is required in order to prevent possible infection, and a preventive course of antibiotic treatment is also necessary.
4. Successful engraftment of the transplanted bone marrow becomes noticeable by the patient's well-being. It noticeably improves, the elevated body temperature drops to normal, other alarming symptoms disappear. At this stage, preventive measures aimed at preventing complications are important.
5. Subsequent engraftment of the bone marrow can last quite a long time. Sometimes it takes years. During this period, the general condition of the patient continues to improve, the immune system is restored. At this stage, the patient should be under medical supervision.

The price of a bone marrow transplant depends on many factors that vary from patient to patient at different stages of the procedure. For example, the protocol of chemotherapy and the cost of drugs, the number of days of hospitalization, unexpected diagnostic procedures, and so on.

Prognosis after transplantation

The rehabilitation period after bone marrow transplantation usually lasts about one year and depends largely on:

• type of transplant;
• the degree of compatibility between the recipient and the donor;
• characteristics of the disease and type of cancer;
• the age of the patient and his general health;
• the intensity of radiation or chemical therapy before transplantation.