Bone marrow transplantation is a procedure in which bone marrow or stem cells are taken from another person or the patient's own bone marrow and given to the recipient to treat bone marrow failure or deterioration. Bone marrow is a tissue found inside your bones where blood cells are produced. Hematopoietic stem cells found within this tissue are responsible for the production of all blood cells, such as red blood cells, white blood cells, and platelets, and form the foundation of the immune system. As one of the most important treatment methods in modern hematology and oncology, bone marrow transplantation has become a life-saving option for many previously untreatable diseases.
Working Principle of Bone Marrow Transplantation
The primary goal in bone marrow transplantation is to replace diseased or damaged bone marrow with healthy stem cells. The patient is first administered a conditioning regimen that includes high-dose chemotherapy or radiotherapy. This process eliminates diseased cells and suppresses the immune system to prevent the rejection of new cells. Subsequently, healthy stem cells are infused into the patient intravenously, where they settle in the bone marrow and begin producing new blood cells. This process is called engraftment and is usually completed within two to four weeks. Once engraftment is complete, the patient gradually begins to develop a new immune system, and the process of returning to normal life begins.
Diseases Treated with Bone Marrow Transplantation
Blood Cancers
Bone marrow transplantation is widely used in the treatment of blood cancers such as leukemia, lymphoma, and myeloma. Receiving high-dose chemotherapy or radiotherapy can destroy healthy bone marrow while killing cancer cells. Bone marrow transplantation can be used to regenerate this damaged bone marrow. Acute myeloid leukemia, acute lymphoblastic leukemia, chronic myeloid leukemia, Hodgkin and non-Hodgkin lymphoma, and multiple myeloma are among the primary indications. In these diseases, transplantation aims to completely eliminate cancer cells and prevent disease recurrence.
Bone Marrow Failure
Bone marrow failure is a condition where the bone marrow cannot produce a sufficient amount of healthy blood cells. This condition can arise due to various reasons such as aplastic anemia, Fanconi anemia, and other genetic disorders. Bone marrow transplantation can be used in the treatment of bone marrow failure and is the only curative treatment option for many patients. Transplantation performed at an early stage in young patients has high success rates.
Bone Marrow Damage and Other Diseases
Bone marrow can be damaged due to factors such as certain infections, medications, or radiation. Bone marrow transplantation can be used to regenerate and heal this damaged bone marrow. Furthermore, transplantation therapy is successfully applied in hereditary blood diseases such as thalassemia and sickle cell anemia, as well as in certain immunodeficiency syndromes. Transplantation may also be considered as a treatment option for some metabolic diseases and autoimmune disorders.
Types of Bone Marrow Transplantation
Allogeneic Bone Marrow Transplantation
This is the transplantation of bone marrow taken from another person to the recipient. It is a process where genetic similarity is as important as tissue compatibility between the recipient and the donor. Compatibility is assessed via HLA tissue typing, and donors can be found among siblings, relatives, or donor registries. In allogeneic transplants, immunosuppressive drugs may be used to increase tissue compatibility. The graft-versus-tumor effect, created by donor cells against cancer cells, increases treatment success.
Autologous Bone Marrow Transplantation
This involves harvesting the patient's own bone marrow and returning it to the patient later. In autologous transplants, the risk of tissue rejection is minimized because the patient's own cells are used. It is a frequently preferred method for multiple myeloma and certain types of lymphoma. The most important advantages are that there is no need to search for a donor and there is no risk of graft-versus-host disease.
Haploidentical and Unrelated Transplantation
When a fully matched donor cannot be found, transplantation can be performed with stem cells obtained from half-matched family members or volunteer donor registries. These methods have made significant progress in recent years, and success rates have increased.
Advantages of Bone Marrow Transplantation
- Curative treatment opportunity: Permanent recovery can be achieved in many blood diseases.
- Renewal of the immune system: A new and healthy immune system is acquired.
- Prolongation of life expectancy: Significantly increases life expectancy in otherwise untreatable diseases.
- Increasing chemotherapy efficacy: Allows for the administration of high-dose treatments.
- Improvement in quality of life: Patients can return to their normal lives after a successful transplant.
- Treatment of genetic diseases: Offers a permanent solution for hereditary blood diseases.
Treatment Process
The treatment process begins with a comprehensive evaluation. The patient undergoes detailed examinations regarding heart, lung, kidney, and liver functions. Dental examination, infection screening, and psychological evaluation are also part of this process. Once a suitable donor is identified, the conditioning regimen is applied. This regimen may vary in intensity depending on the type of disease and the patient's condition. Following the stem cell infusion, the patient is kept under close observation in an isolation room for approximately three to six weeks. During this period, daily blood tests are performed, drug treatments are strictly administered, and signs of infection are closely monitored. Discharge is planned after engraftment, but outpatient follow-up continues for a long period.
Points to Consider
Since the risk of infection is high in the post-transplant period, great attention must be paid to hygiene. In allogeneic transplants, graft-versus-host disease may develop, and this condition is closely monitored. Regular blood tests, follow-up examinations, and the regular use of prescribed medications are of critical importance. Nutrition, physical activity, and psychological support directly affect treatment success. Crowded environments should be avoided, raw foods should not be consumed, and the vaccination schedule should be rearranged. Since the first six months are particularly risky, all recommendations given during this period must be followed meticulously. Follow-up appointments should not be missed, and the transplant team should be contacted even for the slightest complaints.
As Koru Hospital, we provide safe and effective transplantation services to our patients with our experienced hematology specialists, our bone marrow transplantation unit equipped with modern technology, and our multidisciplinary team. We continue to stand by our patients at every stage of the entire process.
