Bone marrow transplant (BMT) is an approach of giving very high dose chemotherapy, sometimes with whole body radiotherapy. This treatment aims to cure some types of blood cancer such as leukemia, lymphoma and myeloma. The anticancer therapies have a good chance of killing not only the cancer cells but also the stem cells in the bone marrow. BMT is an infusion of healthy bone marrow with stem cells which is administered to the patient after he successfully undergoes cancer treatment to restore regular production of new, healthy blood cells. Therefore, BMT is also called as a bone marrow rescue.
Before treating cancer, doctors withdraw a portion of bone marrow tissue rich in stem cells and re-inject into the patient later. Alternatively, stem cells may be retrieved from a donor or umbilical cord blood. Once injected, bone marrow cells find their way back into bone marrow. These cells then make new blood cells that are cancer free. With BMT after anticancer treatment, the stem cells divide into new, healthy blood cells and thus, the blood is cancer-free.
What are the different types of blood cancers?
What is lymphoma, where does lymphoma originate?
What is Non-Hodgkin’s Lymphoma, what are its types?
What are the causes of lymphoma?
What are the symptoms of lymphoma?
What are the treatment options for lymphoma?
What is Bone Marrow Transplant, is it recommended for all blood cancers?
What are the types of bone marrow transplantation?
What can be expected before and after a bone marrow transplant?
What are the steps involved in a bone marrow transplant?
What is conditioning in bone marrow transplant procedure?
What are the risks and survival rate after bone marrow transplant?
What is graft versus host disease?
What are the outcomes of a bone marrow transplant, can cancer relapse or recur?
What precautions should be taken after a bone marrow transplant?
Cancers that originate in the blood cells are referred to as “liquid tumors” or “blood cancers”. Cancer involves the bone marrow, blood cells, and the lymphatic system. The bone marrow helps regulate clotting, build bone and cartilage, blood cells regulate the flow of oxygen and carbon dioxide and the lymphatic system carries lymphatic fluid that is responsible for fighting infections, in presence of white blood cells. Most cancers on the other hand that develop within the human body are solid cancers as they originate as a solid lump of abnormal cells that grow rapidly.
Leukemia, lymphoma and myeloma are three major types of blood cancers. The three liquid tumors affect the blood-forming organs. They arise due to a genetic mutation of immature blood cells. They do not form solid tumors and are also known as hematopoietic neoplasms.
Though the liquid tumors have similarities they show an ample range of difference based on the location of cancer, appearance and progression of the disease.
Leukemia: Occurs in the blood and bone marrow. It affects the white blood cells that fight infections. Based on the type of white blood cells affected and the progression of the disease, leukemia is classified either on the basis of the type of white blood cell involved i.e
Or on the basis of the speed of progression
Myeloma: It is the disorder of the plasma cells i.e mature lymphocytes that fight infection by antibodies or immunoglobulins which is the protein responsible for immunity. The cancer cells surround the bone marrow and prevent it from producing normal cells, such as the red blood cells, white blood cells, and platelets. It is also known as multiple myeloma, as it may affect more than one site in the bone marrow.
Lymphoma– cancer occurs in the lymphatic system which affects the abnormal growth of immature lymphocytes that are unable to protect the body against infection. Lymphoma can be classified into
Lymphoma is a cancer of the lymphatic system, which comprises of the structures like the lymph nodes, spleen, thymus, bone marrow and vessels that carry the lymph fluid throughout the body. The lymphatic fluid contains white blood cells that are responsible for protection against infection and lymph nodes capture bacteria and viruses from spreading in the body.
Lymphoma originates in the lymphocytes (white blood cells). In lymphoma, there is an abnormal, rapid growth of immature lymphocytes. Due to uncontrolled growth of the immature cells, they are unable to perform the action of germ/infection-fighting.
Non-Hodgkin’s lymphoma (NHL) is the most common type of lymphoma, accounting for nearly 90% of lymphomas. NHL causes white blood cells to grow abnormally. Based on the type of white blood cell the cancer is affecting, NHL is classified as:
It is not very clear how lymphoma is caused, but researchers associate cancer with few risk factors such as:
Cancers of the blood can have similar symptoms despite of them being different diseases. Some of the symptoms experienced by a person with Lymphoma include:
In case of any visible sign or symptom, consult a physician who may refer you to hematologist or hemato-oncologist. Diagnosis is usually made by the doctor on the basis of:
The treatment options for blood cancers & lymphoma are based on the type and stage of cancer and other factors like overall health, age, and sensitivity to certain medications. Some of the treatment options that may be used in combination include:
Bone marrow transplant is a procedure wherein the normal stem cells from the bone marrow are taken, filtered and administered to the patient. It is a special therapy used for patients with certain cancers such as lymphoma, leukemia and myeloma or other blood diseases such as aplastic anemia and sickle cell anemia. Healthy bone marrow stem cells from the person’s own body or those from a matched donor are infused within the bloodstream from where they reach the bones to rebuild renewed bone marrow. Bone marrow is a spongy structure inside the bones that contains stem cells. These stem cells generate different types of blood cells such as red blood cells, white blood cells, and platelets.
Bone marrow transplant can be used to treat leukemia, lymphoma and myeloma; however, it may not be always the recommended option. Since bone marrow transplant is carried out after a very high dose of chemotherapy or radiotherapy, there may be risks and complications out of bone marrow transplant that can even be fatal and life-threatening. Hence, case selection for transplant may depend on various factors like:
Based on where the stem cells are taken from, bone marrow transplant are of three types;
Before the bone marrow transplantation, tests are carried out and conditioning process will take place where cancer cells are destroyed and the body is prepared to receive new stem cells. After the conditioning process, the bone marrow is then infused into the bloodstream using a central line, where they begin to develop new healthy stem cells. The patient is monitored for several days or even months to check on the condition and stability of the body. Few complications such as nausea and diarrhea after the transplant or those related to chemotherapy can be expected that can be managed by relevant medications.
Preparation: Before a patient undergoes bone marrow transplantation, a series of tests may be conducted to determine the status of the patient’s health. To assess whether or not the donor cells will match with those of the recipient, the donor’s blood is tested by a procedure called human leukocyte antigen testing (HLA testing).
Stem cell collection:
Pre-transplant conditioning: In patients being treated for cancers (lymphoma and blood cancers), before the commencement of bone marrow transplantation, the patient is subjected to undergo chemotherapy with or without radiotherapy.
Stem cell infusion: A few days after conditioning, patients receive an intravenous infusion of stem cells. These cells travel in blood and settle in the bone marrow. The infusion may take a few minutes or a few hours based on the volume of stem cells being delivered.
Engraftment: The donated cells root themselves in the bone marrow and begin producing blood cells that are cancer-free. It takes around 10 days to several weeks for the successful engraftment and new blood cell production.
Recovery: The patient undergoes stringent follow-ups for the next 100 days on a daily or weekly basis in order to control infections and other complications. Also, it takes almost a year for the blood count to normalize and the new immune system to work well.
Pre-transplant conditioning is a preparative phase where the patient is treated for complete eradication of cancer by means of chemotherapy. This conditioning process is done to destroy cancer cells and to reduce the immunity for better compatibility with new stem cells to be transplanted. The reduced immunity ensures that the recipient’s body doesn’t attack the donor cells as foreign body. The use of chemotherapy or radiation as conditioning therapy is based on the health condition of the patient and the type of transplant to be conducted. This preparative phase leaves the patient highly vulnerable to infections. In some cases, the patients undergo a reduced intensity regimen.
There are few precautions that need to be taken before a bone marrow transplant is carried out. The health status of the patient needs to be monitored, in case the bone marrow is taken from another person, certain tests are to be conducted to ensure that there is a match in the bone marrow of a donor and a recipient.
Some other complications or risks that can arise from a bone marrow transplant include;
The patient is at highest risk within 100 days of transplant. One year survival rate after bone marrow transplant is 62%, as per Memorial Sloan Kettering Cancer Center, as of March 2012. With advancements in transplant technology, there has been a higher success rate in bone marrow transplant over the years.
Graft versus host disease (GVHD) is a complication after a bone marrow transplant. It usually occurs in an allogeneic stem cell transplant, where the donor’s stem cells recognize the host’s tissues as a foreign entity and attack them. GVHD can occur any time after stem cell transplantation. Acute GVHD occurs after the first month of transplantation and chronic GVHD occurs develops very much later after transplantation.
The bone marrow transplant is considered to be a procedure with a good success rate over the years. For some blood cancers, there has been a success rate as high as 85%. Older age is a poor prognostic factor for survival after a bone marrow transplant. The outcomes of a bone marrow transplant vary from person to person, some show very fewer side effects of bone marrow transplantation; on the other hand, some patients may show numerous complications.
The higher production of lymphocytes reduces the chances of recurrence of lymphoma after stem cell transplantation. Studies have shown that bone marrow transplantation in patients above 45 years of age shows a greater risk of relapse.
It may take several months for a body to regain energy and adapt with new stem cells. Therefore, few precautionary steps are necessary after a bone marrow transplant:
Incidence of blood cancer or liquid tumour has been increasing over the years in various age groups. Lymphoma, a type of blood cancer compromises the immune-system of the body, reduces the oxygen regulation as well as clotting factor of the body. Various treatment plans have shown promising outcomes with bone marrow transplant showing a good success rate. However, precautionary measures are equally important in preventing risks and complications of bone marrow transplant.
We hope we were able to address your queries related to Lymphoma. If you wish to know more about lymphoma and its treatment, you can request for a call back and our experts will call you and answer all your queries.
About Author –
Dr. Ganesh Jaishetwar, Consultant Hematologist, Hemato-Oncologist & Bone Marrow Transplant Physician
MD, DM (Clinical Hematology), BMT, TMC, FACP, Fellow in Bone Marrow Transplantation (Canada)
Dr. Ganesh Jaishetwar has successfully completed more than 60 blood & bone marrow transplants at Yashoda Hospitals. His expertise and special interests include treatment for Blood cancers (Leukemia, Lymphoma & Multiple Myeloma, MDS, Myeloproliferative disorders), blood disorders (Anemia, Thallasemia, Aplastic anemia etc.), immunodeficiency disorders.
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