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What Is Bone Marrow and Stem Cell Transplantation?

In a bone marrow transplant your diseased bone marrow – the spongy material found inside bones that produces red blood cells, white blood cells and platelets – is destroyed, and healthy marrow-derived stem cells are infused into the bloodstream. In a successful transplant, the new bone marrow migrates to the cavities of the large bones, engrafts and begins producing normal blood cells. Blood-producing cells are also known as hematopoietic stem cells.

Transplantation can be a successful treatment for a variety of cancers, including:

  • Acute and chronic leukemia
  • Lymphoma
  • Non-Hodgkin lymphoma
  • Hodgkin disease
  • Multiple myeloma
  • Solid tumors, including breast cancer, ovarian cancer and germ cell tumors
  • Some noncancerous blood diseases
  • Aplastic anemia, preleukemia and other marrow failure states
  • Rare inherited and acquired disorders, such as thalassemia, amyloidosis and autoimmune diseases

When the procedure is called stem cell transplantation, the hematopoietic stem cells are collected from the blood. If the procedure is called bone marrow transplantation, the hematopoietic stem cells are collected from the bone. A transplant can be carried out by using a patient's own hematopoietic stem cells (autologous transplant) or a donor's hematopoietic stem cells (allogeneic transplant).   

The transplant process begins with the collection of hematopoietic stem cells. The collection of stem cells from blood is an outpatient procedure that consists of obtaining stem cells after placing an intravenous catheter and processing blood through a special machine in the apheresis unit. The collection of stem cells from the bone, or bone marrow harvest, consists of obtaining stem cells from the back of the hip (iliac crest) under general or spinal anesthesia. If the healthy stem cells are coming from a donor's bone, the donor will be admitted to the hospital for a 24-hour observation period.

Once the collection of stem cells is complete, patients undergo a preparative regimen that consists of high-dose chemotherapy to eliminate any cancer cells in their body. This regimen can be administered on an inpatient or outpatient basis.

Next, the collected stem cells are infused (transplanted) through an intravenous catheter. This is followed by a short window of seven to 10 days in which the patient's blood counts are very low because their marrow was destroyed by the preparative regimen and it takes time for the newly infused stem cells to produce blood. There is a high risk of infection when the white blood cells are low and of bleeding when the platelets are low. Patients generally need blood and platelet transfusions until their blood production recovers. Side effects depend upon the type of preparative regimen used, the type of transplant (autologous or allogeneic) and the medical condition of the patient.

At Siteman, we assess and discuss the risks and benefits of transplantation with every patient to determine whether a transplant is the most appropriate treatment. Our treatment team offers transplantation as part of a full spectrum of treatment options tailored to each patient's specific needs.

To learn more about the entire transplant process, including what happens before and after the procedure, please watch our patient education video series on allogeneic transplant and autologous transplant.