Bone marrow transplant

Description:
Bone marrow is a soft fatty tissue found inside bones. It produces blood cells (red blood cells, platelets , and white blood cells). When the patient develops disease of the blood cells ( anemias , leukemias, or lymphomas) or when cancer treatment ( chemotherapy and radiation therapy ) damages or destroys the bone marrow, a transplant with healthy bone marrow can save the patient's life. Patients need bone marrow transplants because they have dangerously low white blood cells (which are needed to fight infection) as a result of cancer treatments or have cancer of the blood cells.

Bone marrow transplant patients are usually treated in specialized centers and the patient stays in a special nursing unit (bone marrow transplant unit: BMT) to limit exposure to infections.

Donated bone marrow must match the patient's tissue type. It can be taken from the patient, a living relative (usually a brother or a sister: allogeneic), or from an unrelated donor (found through the national marrow donor program which lists more than 700,000 potential donors). Donors are matched through special blood tests called HLA tissue typing (see HLA antigens ).

Bone marrow is taken from the donor in the operating room while the patient is deep asleep and pain-free (under general anesthesia). Some of patient's bone marrow is removed from the top of the hip bone (iliac crest). The bone marrow is filtered, treated, and transplanted immediately or frozen and stored for later use. Bone marrow transplant is transfused into the patient through a vein (IV line) and is naturally transported back into the bone cavities where it grows quickly to replace the old bone marrow.

Indications:
Bone marrow transplant may be recommended for:

Bone marrow transplant surgery is not recommended for:



What to Expect After:
Bone marrow transplant prolongs the life of a patient who would otherwise die.
Relatively normal activities can be resumed as soon as the patient feels well enough and after consulting with the doctor. However, vigorous physical activities should be avoided.

The other significant problems with a bone marrow transplant are those of all major organ transplants--finding a donor and the cost of the surgery. The donor is usually a sibling with compatible tissue. The more siblings the patient has the more chances to find the right donor.

Convalescence:
The hospitalization period is from 4 to 6 weeks, during which time the patient is isolated and under strict monitoring because of the increased risk of infection. Move the legs often to reduce the risk of deep venous thrombosis . The patient will require attentive follow-up care for 2 to 3 months after discharge from the hospital. It may take 6 months to a year for the immune system to fully recover from this procedure.

Risks:
Risks for any anesthesia are:

Risks for any surgery are:

Additional risks:
The major problem with bone marrow transplants (allogeneic type) is graft-versus-host disease ; the opposite of the graft rejection problems seen in other transplants ( transplant rejection ). The transplanted healthy bone marrow cells tend to attack the patient's (host) cells as though they were foreign organisms. In this case, drugs to suppress the immune system ( immunosuppression medications) must be taken indefinitely, weakening the body's ability to fight infections.

Cost:
The costs of any surgery varies significantly between surgeons, medical facilities, and regions of the country. Patients who are younger, sicker, or need more extensive surgery will require more intensive and expensive treatment.

The approximate cost for a bone marrow transplant varies from $190,000 to $410,000 depending on the cross-matching between the recipient and the donor (for example, allogenic related, autologous, and allogenic unrelated).

Surgery charges can be separated into five parts: 1) the surgeon's fee, 2) the anesthesiologist's fee, 3) the hospital charges, which includes nursing care and the operating room, 4) the medications, and 5) additional charges.

1. Surgeon's fee: variable
2. Anesthesiologist's fee: averages $350 to $400 per hour
3. Hospital charges: basic rate averages $1,500 to $1,800 per day (more for the intensive care unit (ICU) or private rooms)
4. Medication charges: $200 to $400
5. Additional charges: assisting surgeon, treatment of complications, diagnostic procedures (such as blood or Xray exams), medical supplies, and equipment use.

Insurance coverage for surgery expenses depends on many factors and should be explored for each individual instance.


A small amount of bone marrow is removed during a bone marrow aspiration. The procedure is uncomfortable, but can be tolerated by both children and adults. The marrow can be studied to determine the cause of anemia, the presence of leukemia or other malignancy, or the presence of some