Allogeneic bone marrow transplant

Allogeneic bone marrow transplant, also known as allogeneic stem cell transplant, is a procedure in which a bone marrow that is not producing enough healthy blood cells is replaced with healthy blood stem cells from a donor.

Symptoms

An allogeneic bone marrow transplant may be performed in the following cases:
Acute or chronic leukemia (a type of blood cancer)
Aplastic anemia (when the body stops producing enough new blood cells due to bone marrow damage)
Adrenoleukodystrophy (a hereditary condition that leads to the damage to the membrane that insulates the nerve cells in the brain)
Bone marrow failure syndromes (a group of genetic blood disorders)
Hodgkin’s or Non-Hodgkin’s lymphoma (cancer that starts in the lymphatic system)
Hemoglobinopathies (an inherited condition in which there is an abnormal structure or production of the hemoglobin molecule)
Immune deficiencies (when the body’s immune or disease-fighting system fails to work properly)
Metabolic disorders (when several conditions occur together increasing the risk of diabetes, stroke, and diabetes)
Multiple myeloma (cancer of the plasma cells, which are a type of white blood cells in the bone marrow)
Myelodysplastic syndromes (a group of disorders that disrupts blood cell production)
Neuroblastoma (a type of cancer commonly found in the adrenal glands, which are located on top of the kidneys)
Plasma cell disorders (a type of blood cancer)
Primary amyloidosis (a rare disease that occurs when the abnormal light chain proteins in the body gather on the tissues and organs)
POEMS syndrome (a rare blood disorder that damages the nerves and affects other body parts)

Diagnosis

The following diagnostic tests may be performed before an allogeneic bone marrow transplant:

1. Physical examination: The doctor checks the symptoms, medical history, and overall physical health of the patient.
2. Blood tests: The different blood parameters and some underlying medical conditions can be detected using blood tests. HLA (human leukocyte antigen) matching is a type of blood test done to check the compatibility of the patient with the donor.
3. Urine analysis: It helps in detecting underlying urinary infections.
4. Bone marrow aspiration and biopsy: The doctor removes a small quantity of fluid from the bone marrow and sends it to the laboratory for evaluation.
5. Chest x-ray: The condition of the organs in the chest region, that is, the heart and lungs can be checked by the doctor using a chest x-ray.
6. Pulmonary function tests: The lung function can be evaluated using pulmonary function tests.
7. CT scan and MRI scan: These are types of imaging tests done to obtain a clear picture of an internal organ.
8. Electrocardiogram (ECG): The electrical activity of the heart can be recorded using an ECG.
9. Echocardiogram: This test helps the doctor in obtaining a clear picture of the heart in motion and the heart valves.
10. Sinus x-rays: If sinus infections are present, they can be detected using sinus x-rays.
11. Lumbar puncture: The doctor inserts a needle in the spinal canal to collect the cerebrospinal fluid and then sends it to the laboratory for diagnostic testing.

Treatment

• After chemotherapy and radiation therapy (if required) are completed, the patient is ready for a bone marrow transplant.
• The doctor will deliver the healthy donor stem cells using an intravenous catheter (a thin tube inserted into a vein) inserted through the central line, most often in the chest region.
• The stem cells travel through the bloodstream to reach the bone marrow.
• The stem cells here produce new blood cells to replace the abnormal ones.
• This procedure is known as engraftment and may take a few weeks.
• The patient may need to stay in the hospital till his/her blood cell count return to safe levels.

Risks

The side effects of allogeneic bone marrow transplant include the following:

• Appetite loss
• Nausea
• Vomiting
• Vision problems
• Mouth soreness
• Throat soreness
• Diarrhea
• Infection
• Loss of hair
• Fatigue
• Difficulty in sleeping
• Skin irritation
• Graft rejection
• Graft failure
• Graft-versus-host disease (GVHD) 

After Procedure

• The patient will have a severely reduced number of red blood cells, white blood cells, and platelets after the transplant.
• Until the cell count of the patient goes back to its healthy range, the patient may need to take medications to prevent and treat infections. This may take as long as a year or two.
• The patient may need blood transfusions till the blood cell counts come back to normal.
• Medications like cyclosporine and methotrexate may be prescribed for many months after bone marrow transplant to prevent graft-versus-host disease (a condition in which the graft or donated cells attack the patient’s body).
• Contact your doctor immediately if you have a fever or any other signs of infection after a bone marrow transplant.
• It is normal to feel emotional fluctuations after a bone marrow transplant procedure.
• Follow-up visits with the doctor are recommended, where the doctor will monitor the patient and check the success of the bone marrow transplant procedure.