Bone marrow transplantation is a complex stem cell implantation procedure, the need for which is born in one of a number of diseases of the hematopoietic system. Bone marrow is a vital organ of the circulatory system that performs the function of hematopoiesis.
Without a bone marrow transplant, it is impossible to help patients with a serious damage to the immune system. Most often, the need for transplantation arises from cancer of the blood.
Malignant lesions
Most often, the decision on urgent surgery is made with leukemia (leukemia). In the people, this terrible ailment, which leaves almost no chance for the patient to recover, is called white blood. Pathology is characterized by a violation of the process of formation and renewal of blood: cells, not having time to mature, begin to immediately divide. Further stages of development do not occur. When the number of immature cells exceeds the permissible maximum, they displace healthy bodies. Leukemia can occur as:
- acute myeloid type;
- acute lymphoblastic type;
- chronic myeloid leukemia;
- plasmacytomas.
Transplantation of healthy cells is essential for lymphoma, a blood pathology that is characterized by the accumulation of tumor lymphocytes. A type of lymphoma is Hodgkin's disease, as well as non-Hodgkin types of ailment.
Other pathologies as indications for transplantation
In benign pathological processes, bone marrow transplantation may be recommended due to the high risk of the disease becoming malignant. To diseases of a non-oncological nature, for the treatment of which they resort to the use of donor biomaterial, include:
- Ailments associated with metabolic disorders. This is primarily Hunter syndrome and adrenoleukodystrophy. The latter disease is characterized by an excessive concentration of fatty acids in the cells. Hunter syndrome is a pathology in which there is an atypical accumulation of fats, proteins and carbohydrates in tissues.
- Immune Disorders First of all, we are talking about HIV infection and congenital immunodeficiency. This treatment method cannot give a 100% guarantee for recovery, but it helps to prolong the patient's life.
- Pathologies of bone marrow (Fanconi anemia, aplastic anemia), which occur with inhibition of hematopoietic functions.
- Autoimmune diseases, including lupus erythematosus, rheumatoid arthritis. The specificity of these diseases is the damage to the connective tissue and small blood vessels.
Not so long ago, radiation and chemotherapy were considered the only way to treat the above pathologies. However, each of these methods of combating oncology helps to destroy not only cancer cells, but also healthy ones. Today, the tactics of treating blood diseases have taken a different turn: after conducting intensive anti-cancer therapy courses, the affected hematopoietic bodies are replaced by healthy ones during transplantation.
Who can act as a donor
Such an operation requires the voluntary consent of a person whose genetic material is fully suitable for the recipient in need. Judging by the reviews, people think about bone marrow transplantation and providing their stem cells to patients, but many are afraid of ignorance in this matter and ignorance of the likely consequences of such complex manipulations.
You can get material for blood transplantation:
- From the patient himself during the period of remission of the disease. If the symptoms of the disease subsided and the indicators of the tests are normal, the patient is taken tissue, which they plant him with the development of relapse. This transplant is called autologous.
- From his twin (identical). This type of transplantation is called syngenic.
- From a blood relative. It is worth noting that not all people who are related to the recipient can approach the role of a bone marrow donor due to differences in the genetic code. More often the biomaterial coincides with brothers and sisters - the probability is approximately 25%. Moreover, genetic compatibility with parents is almost never encountered. Stem cell engraftment from a relative is called allogeneic.
- From a stranger (unrelated) person. If no relatives with suitable genetic data were found among relatives, they turn to national or foreign donor banks for help. We are talking about allogeneic transplantation of tissue of an extraneous donor.
Basic contraindications for donors
It also happens that a person who is ready to donate his tissues for the salvation of another is not allowed to transplant. A number of requirements are put forward to potential donors, if at least one of them does not comply, the application for donation is rejected. First of all, only an adult can provide their stem cells. A bone marrow transplant donor must be completely healthy. Especially important is the absence of the following diseases:
- autoimmune disorders;
- severe infectious pathologies;
- hepatitis B and C;
- syphilis;
- tuberculosis of any form;
- congenital or acquired immunodeficiency;
- any kind of oncology;
- mental disorders.
A pregnant woman cannot be a donor. The biomaterial is not taken in people whose age exceeds 50 years.
No chance of transplantation
By the way, stem cell replacement is also not recommended for physically weak and elderly patients. The transplantation operation is not performed for persons suffering from complex diseases of the internal organs. Contraindications to bone marrow transplantation include prolonged antibacterial or hormonal therapy.
And even with excellent health indicators of the donor and the recipient, the only serious obstacle to the procedure is the incompatibility of the biomaterial. The chances of finding a donor perfect for a bone marrow transplant are slim. Most often resort to an autologous and allogeneic method of tissue transplantation.
A bone marrow transplant operation is the most difficult intervention for the body. In addition, the procedure is very expensive. Since the predominant number of patients is not able to independently pay for treatment, the state often comes to help in this matter. But since it is impossible to provide the necessary services to all patients, a certain quota for stem cell transplantation has been established. Thanks to the introduction of a quota system, patients in need get a chance to undergo treatment absolutely free of charge in the best clinic, but, in fact, it is he who is the main obstacle for patients because of the huge queue formed. In addition, the search for a donor itself takes a considerable time, but every week is expensive for patients with such a diagnosis.
Collection of donor material
You will learn how bone marrow transplantation occurs after describing the procedure for collecting donor biomaterial. Manipulation can be carried out in two ways. Doctors choose it, depending on the medical indications for a particular donor.
The first option is to extract the required amount of tissue from the pelvic bone. To perform the manipulation, an analysis is taken in advance, the results of which will show whether the person can tolerate anesthesia. Donor hospitalization is required a few days before the procedure. The necessary cells are taken under anesthesia using a syringe, which is injected into the area of high concentration of the desired biomaterial. As a rule, several punctures are made at once to get the necessary volume of fluid for bone marrow transplantation. How is the procedure? Almost painless and quick - it takes no more than half an hour to carry out the manipulation, but for the donor to recover completely, it will take almost a whole month.
The second method is to collect venous blood from which stem cells are extracted. For a week before the scheduled date of manipulation, the donor should take Leukostim, a specific drug that provokes an active release of stem cells into the blood. Blood is taken from the donor, the necessary elements are separated from it, and it is returned back through the second hand. This method of taking biomaterial takes several hours, and restoration will take no more than two weeks.
How is the operation
With leukemia, a bone marrow transplant must necessarily be preceded by a course of powerful chemo- or radiotherapy - the so-called preparatory regimen. It lasts as long as required in each individual case. The duration of the courses is determined by the doctor.
Before making a bone marrow transplant, doctors must make sure that the recipient is ready for this kind of intervention. Repeated tests are taken a couple of days before surgery for a donor and a person in need of stem cell implantation. During the procedure, donor stem cells are administered parenterally.
After a bone marrow transplant during the first month, the patient is under the close supervision of doctors awaiting the implantation of foreign tissues. This period must be accompanied by the use of antibiotics, which are necessary for the prevention of infection. In addition to antibiotic therapy, the recipient is given another injection into the blood - this time it is enriched with platelets in order to prevent internal bleeding, the risk of which increases several times after stem cell implantation. Along with antibiotics, the patient is prescribed immunosuppressive drugs to prevent the body from rejecting transplanted tissues.
What happens after transplantation?
The consequence of a bone marrow transplant is often prolonged weakness, in severe cases, bleeding may develop, and malfunctions of the internal organs can occur. In the acute reaction of the immune system to a transplant, the gastrointestinal tract, liver and skin are most often affected. Patients may complain of the following symptoms:
- nausea, sometimes with vomiting;
- the appearance in the mouth of small ulcerations;
- instability of the psychoemotional state;
- pustules on the skin of the back and chest;
- bloody diarrhea;
- damage to the lacrimal and salivary glands.
The personnel of medical institutions where bone marrow transplantation is performed for lymphoma, leukemia and other blood diseases should be sufficiently competent and able to create comfortable conditions for the rehabilitation of patients. In addition, the participation of relatives and friends is equally important in this matter.
Reception of immunosuppressants, which was mentioned above, inhibits the work of the blood forming organs, while significantly weakening the immune system. In the rehabilitation period after bone marrow transplantation, the body becomes very vulnerable to pathogenic microflora. If the patient has already been infected with cytomegalovirus, activation of the infection is quite likely against the background of susceptibility of the immune system. In severe cases, pneumonia develops, which leads to death.
Russian clinics
In our country, there are several medical institutions specializing in such operations. Bone marrow transplantation in Russia is carried out by highly qualified specialists in the field of hematology, oncology, transfusiology, etc.
Among the 13 clinics operating in the Russian Federation, it is worth noting:
- The Raisa Gorbacheva Institute of Pediatric Hematology and Transplantology in St. Petersburg, which is one of the largest departments. This is addressed in the most hopeless cases.
- OH Clinics is an international medical center with several representative offices in Russia. Clinic branches are involved in the diagnosis of hematological and oncological diseases requiring bone marrow transplantation.
- FSBI NMITS DGOI them. Dmitry Rogachev Ministry of Health of Russia - a budget clinic located in Moscow. This institution has many years of experience. Here bone grafts are made for patients of different ages.
Survival forecast
The restoration of the body after stem cell implantation lasts at least a year, and its success is largely determined by:
- type of transplantation;
- degree of compatibility of donor material;
- the course and malignancy of the disease;
- age of the patient;
- general condition of the patient;
- the intensity of radiation or chemical therapy performed prior to transplantation.
The highest chances are for recipients suffering from hereditary pathologies of the hematopoietic system. With oncology, it is quite difficult to predict a further outcome, since the chances of recovery depend on the likelihood of a relapse. If during the next five years it did not arise, then an insignificant share of the probability of its development in the future becomes obvious. This survival rate is observed in approximately half the cases.