What Is a Bone

Marrow Transplant?
A bone marrow transplant is a medical procedure performed to replace bone marrow that
has been damaged or destroyed by disease, infection, or chemotherapy. This procedure
involves transplanting blood stem cells, which travel to the bone marrow where they
produce new blood cells and promote growth of new marrow.

Bone marrow is the spongy, fatty tissue inside your bones. It creates the following parts of
the blood:

red blood cells, which carry oxygen and nutrients throughout the body
white blood cells, which fight infection
platelets, which are responsible for the formation of clots
Bone marrow also contains immature blood-forming stem cells known as hematopoietic
stem cells, or HSCs. Most cells are already differentiated and can only make copies of
themselves. However, these stem cells are unspecialized, meaning they have the potential
to multiply through cell division and either remain stem cells or differentiate and mature into
many different kinds of blood cells. The HSC found in the bone marrow will make new blood
cells throughout your lifespan.

A bone marrow transplant replaces your damaged stem cells with healthy cells. This helps
your body make enough white blood cells, platelets, or red blood cells to avoid infections,
bleeding disorders, or anemia.

Healthy stem cells can come from a donor, or they can come from your own body. In such
cases, stem cells can be harvested, or grown, before you start chemotherapy or radiation
treatment. Those healthy cells are then stored and used in transplantation.

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Part 2 of 7

Why You May Need a Bone Marrow Transplant

 Bone marrow transplants are performed when a persons marrow isnt healthy enough to
function properly. This could be due to chronic infections, disease, or cancer treatments.
Some reasons for a bone marrow transplant include:

aplastic anemia, which is a disorder in which the marrow stops making new blood
cells
cancers that affect the marrow, such as leukemia, lymphoma, and multiple myeloma
damaged bone marrow due to chemotherapy
congenital neutropenia, which is an inherited disorder that causes recurring
infections
sickle cell anemia, which is an inherited blood disorder that causes misshapen red
blood cells
thalassemia, which is an inherited blood disorder where the body makes an abnormal
form of hemoglobin, an integral part of red blood cells
Part 3 of 7

What Are the Complications Associated with a

Bone Marrow Transplant?

A bone marrow transplant is considered a major medical procedure and increases your risk
of experiencing:
 a drop in blood pressure
a headache
nausea
pain
shortness of breath
chills
a fever
The above symptoms are typically short-lived, but a bone marrow transplant can cause
complications. Your chances of developing these complications depend on several factors,
including:

your age
your overall health
the disease youre being treated for
the type of transplant youve received
Complications can be mild or very serious, and they can include:

graft-versus-host disease (GVHD), which is a condition in which donor cells attack

your body
graft failure, which occurs when transplanted cells dont begin producing new cells as
planned
bleeding in the lungs, brain, and other parts of the body
cataracts, which is characterized by clouding in the lens of the eye
damage to vital organs
early menopause
anemia, which occurs when the body doesnt produce enough red blood cells
infections
nausea, diarrhea, or vomiting
mucositis, which is a condition that causes inflammation and soreness in the mouth,
throat, and stomach
Talk to your doctor about any concerns you may have. They can help you weigh the risks
and complications against the potential benefits of this procedure.

Part 4 of 7

Types of Bone Marrow Transplant

There are two major types of bone marrow transplants. The type used will depend on the
reason you need a transplant.

Autologous Transplants
Autologous transplants involve the use of a persons own stem cells. They typically involve
harvesting your cells before beginning a damaging therapy to cells like chemotherapy or
radiation. After the treatment is done, your own cells are returned to your body.

This type of transplant isnt always available. It can only be used if you have a healthy bone
marrow. However, it reduces the risk of some serious complications, including GVHD.

Allogeneic Transplants
Allogeneic transplants involve the use of cells from a donor. The donor must be a close
genetic match. Often, a compatible relative is the best choice, but genetic matches can also
be found from a donor registry.

Allogeneic transplants are necessary if you have a condition that has damaged your bone
marrow cells. However, they have a higher risk of certain complications, such as GVHD.
Youll also probably need to be put on medications to suppress your immune system so that
your body doesnt attack the new cells. This can leave you susceptible to illness.
The success of an allogeneic transplant depends on how closely the donor cells match your
own.

Part 5 of 7

How to Prepare for a Bone Marrow Transplant

 Prior to your transplant, youll undergo several tests to discover what type of bone marrow
cells you need.

You may also undergo radiation or chemotherapy to kill off all cancer cells or marrow cells
before you get the new stem cells.

Bone marrow transplants take up to a week. Therefore, you must make arrangements before
your first transplant session. These can include:

housing near the hospital for your loved ones

insurance coverage, payment of bills, and other financial concerns
care of children or pets
taking medical leave from work
packing clothes and other necessities
arranging travel to and from the hospital
During treatments, your immune system will be compromised, affecting its ability to fight
infections. Therefore, youll stay in a special section of the hospital thats reserved for
people receiving bone marrow transplants. This reduces your risk of being exposed to
anything that could cause an infection.

Dont hesitate to bring a list of questions to ask your doctor. You can write down the answers
or bring a friend to listen and take notes. Its important that you feel comfortable and
confident before the procedure and that all of your questions are answered thoroughly.

Some hospitals have counselors available to talk with patients. The transplant process can
be emotionally taxing. Talking to a professional can help you through this process.

Part 6 of 7

How a Bone Marrow Transplant Is Performed

When your doctor thinks youre ready, youll have the transplant. The procedure is similar to
a blood transfusion.

If youre having an allogeneic transplant, bone marrow cells will be harvested from your
donor a day or two before your procedure. If your own cells are being used, theyll be
retrieved from the stem cell bank.

Cells are collected in two ways.

During a bone marrow harvest, cells are collected from both hipbones through a needle.
Youre under anesthesia for this procedure, meaning youll be asleep and free of any pain.

Leukapheresis
During leukapheresis, a donor is given five shots to help the stem cells move from the bone
marrow and into the bloodstream. Blood is then drawn through an intravenous (IV) line, and
a machine separates out the white blood cells that contain stem cells.

A needle called a central venous catheter, or a port, will be installed on the upper right
portion of your chest. This allows the fluid containing the new stem cells to flow directly into
your heart. The stem cells then disperse throughout your body. They flow through your blood
and into the bone marrow. Theyll become established there and begin to grow.

The port is left in place because the bone marrow transplant is done over several sessions
for a few days. Multiple sessions give the new stem cells the best chance to integrate
themselves into your body. That process is known as engraftment.

Through this port, youll also receive blood transfusions, liquids, and possibly nutrients. You
may need medications to fight off infections and help the new marrow grow. This depends
on how well you handle the treatments.
 During this time, youll be closely monitored for any complications.

Part 7 of 7

What to Expect After a Bone Marrow Transplant

The success of a bone marrow transplant is primarily dependent on how closely the donor
and recipient genetically match. Sometimes, it can be very difficult to find a good match
among unrelated donors.

The state of your engraftment will be regularly monitored. Its generally complete between
10 and 28 days after the initial transplant. The first sign of engraftment is a rising white
blood cell count. This shows that the transplant is starting to make new blood cells.

Typical recovery time for a bone marrow transplant is about three months. However, it may
take up to a year for you to recover fully. Recovery depends on numerous factors, including:

the condition being treated

chemotherapy
radiation
donor match
where the transplant is performed
Theres a possibility that some of the symptoms you experience after the transplant will
remain with you for the rest of your life

Bone marrow transplant

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A bone marrow transplant is a procedure to replace damaged or destroyed bone

marrow with healthy bone marrow stem cells.
Bone marrow is the soft, fatty tissue inside your bones. The bone marrow produces
blood cells. Stem cells are immature cells in the bone marrow that give rise to all of
your different blood cells.

Description

Before the transplant, chemotherapy, radiation, or both may be given. This may be
done in 2 ways:

Ablative (myeloablative) treatment: High-dose chemotherapy, radiation, or both are

given to kill any cancer cells. This also kills all healthy bone marrow that remains,
and allows new stem cells to grow in the bone marrow.

Reduced intensity treatment, also called a mini transplant: People receive lower
doses of chemotherapy and radiation before a transplant. This allows older people,
and those with other health problems to have a transplant.

There are 3 kinds of bone marrow transplants:

Autologous bone marrow transplant: The term auto means self. Stem cells are
removed from you before you receive high-dose chemotherapy or radiation
treatment. The stem cells are stored in a freezer. After high-dose chemotherapy or
radiation treatments, your stems cells are put back in your body to make normal
blood cells. This is called a rescue transplant.

Allogeneic bone marrow transplant: The term allo means other. Stem cells are
removed from another person, called a donor. Most times, the donor's genes must
at least partly match your genes. Special tests are done to see if a donor is a good
match for you. A brother or sister is most likely to be a good match. Sometimes
parents, children, and other relatives are good matches. Donors who are not related
to you, yet still match, may be found through national bone marrow registries.

Umbilical cord blood transplant: This is a type of allogeneic transplant. Stem cells
are removed from a newborn baby's umbilical cord right after birth. The stem cells
are frozen and stored until they are needed for a transplant. Umbilical cord blood
cells are very immature so there is less of a need for perfect matching. Due to the
smaller number of stem cells, blood counts take much longer to recover.

A stem cell transplant is usually done after chemotherapy and radiation is complete.
The stem cells are delivered into your bloodstream usually through a tube called a
central venous catheter. The process is similar to getting a blood transfusion. The
stem cells travel through the blood into the bone marrow. Most times, no surgery is
needed.

Donor stem cells can be collected in 2 ways:

Bone marrow harvest: This minor surgery is done under general anesthesia. This
means the donor will be asleep and pain-free during the procedure. The bone
marrow is removed from the back of both hip bones. The amount of marrow
removed depends on the weight of the person who is receiving it.

Leukapheresis: First, the donor is given several days of shots to help stem cells
move from the bone marrow into the blood. During leukapheresis, blood is removed
from the donor through an IV line. The part of white blood cells that contains stem
cells is then separated in a machine and removed to be later given to the recipient.
The red blood cells are returned to the donor.

Why the Procedure is Performed

A bone marrow transplant replaces bone marrow that is either not working properly
or has been destroyed (ablated) by chemotherapy or radiation. Doctors believe that
for many cancers, the donor's white blood cells may attack any remaining cancer
cells, similar to when white cells attack bacteria or viruses when fighting an
infection.

Your doctor may recommend a bone marrow transplant if you have:

Certain cancers, such as leukemia, lymphoma, myelodysplasia, and multiple

myeloma

A disease that affects the production of bone marrow cells, such as aplastic anemia,
congenital neutropenia, severe immune system illnesses, sickle cell anemia, and
thalassemia

Had chemotherapy that destroyed your bone marrow

Risks

A bone marrow transplant may cause the following symptoms:

Chest pain

Drop in blood pressure

Fever, chills, flushing

Funny taste in the mouth

Headache

Hives

Nausea

Pain

Shortness of breath

Possible complications of a bone marrow transplant depend on many things,

including:

The disease you are being treated for

Whether you had chemotherapy or radiation before the bone marrow transplant and
the dosages of such treatments

Your age

Your overall health

How good of a match your donor was

The type of bone marrow transplant you received (autologous, allogeneic, or

umbilical cord blood)

Complications may include:

Anemia

Bleeding in the lungs, intestines, brain, and other areas of the body

Cataracts

Clotting in the small veins of the liver

Damage to the kidneys, liver, lungs, and heart

Delayed growth in children who receive a bone marrow transplant

Early menopause

Graft failure, which means that the new cells do not settle into the body and start
producing stem cells

Graft-versus-host disease (GVHD), a condition in which the donor cells attack your
own body

Infections, which can be very serious

Inflammation and soreness in the mouth, throat, esophagus, and stomach, called
mucositis

Pain

Stomach problems, including diarrhea, nausea, and vomiting

Before the Procedure

Your health care provider will ask about your medical history and do a physical
exam. You will have many tests before treatment begins.

Before transplant, you will have 1 or 2 tubes, called catheters, inserted into a blood
vessel in your neck or arms. This tube allows you to receive treatments, fluids, and
sometimes nutrition. It is also used to draw blood.

Your provider will likely discuss the emotional stress of having a bone marrow
transplant. You may want to meet with a counselor. It is important to talk to your
family and children to help them understand what to expect.

You will need to make plans to help you prepare for the procedure and handle tasks
after your transplant:

Complete an advance care directive

Arrange medical leave from work

Take care of bank or financial statements

Arrange care of pets

Arrange for someone to help with household chores

Confirm health insurance coverage

Pay bills

Arrange for care of your children

Find housing for yourself or your family near the hospital, if needed

After the Procedure

A bone marrow transplant is usually done in a hospital or medical center that

specializes in such treatment. Most of the time, you stay in a special bone marrow
transplant unit in the center. This is to limit your chance of getting an infection.

Depending on the treatment and where it is done, all or part of an autologous or

allogeneic transplant may be done as an outpatient. This means you do not have to
stay in the hospital overnight.

How long you stay in the hospital depends on:

How much chemotherapy or radiation you received

The type of transplant

Your medical center's procedures

While you are in the hospital, you will be isolated because of the increased risk of
infection. The health care team will closely monitor your blood count and vital signs.

While you are in the hospital you may:

Receive medicines to prevent or treat infections, including antibiotics, antifungals,

and antiviral medicine

Need many blood transfusions

Be fed through a vein (IV) until you can eat by mouth and stomach side effects and
mouth sores have gone away
Be given medicines to prevent GVHD

After you leave the hospital, be sure to follow instructions on how to care for
yourself at home.

Outlook (Prognosis)

How well you do after the transplant depends on:

The type of bone marrow transplant

How well the donor's cells match yours

What type of cancer or illness you have

Your age and overall health

The type and dosage of chemotherapy or radiation therapy you had before your
transplant

Any complications you may have

A bone marrow transplant may completely or partially cure your illness. If the
transplant is a success, you can go back to most of your normal activities as soon as
you feel well enough. Usually it takes up to 1 year to recover fully, depending on
what complications occur.

Complications or failure of the bone marrow transplant can lead to death.

Alternative Names

Transplant - bone marrow; Stem cell transplant; Hematopoietic stem cell transplant;
Reduced intensity nonmyeloablative transplant; Mini transplant; Allogenic bone
marrow transplant; Autologous bone marrow transplant; Umbilical cord blood
transplant; Aplastic anemia - bone marrow transplant; Leukemia - bone marrow
transplant; Lymphoma - bone marrow transplant; Multiple myeloma - bone marrow
transplant

References
Bashir Q, Champlin R. Hematopoietic stem cell transplantation. In: Niederhuber JE,
Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff's Clinical Oncology.
5th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 30.

Heslop HE. Overview of hematopoietic stem cell transplantation. In: Hoffman R,

Benz EJ Jr, Silberstein LE, Heslop HE, Weitz JI, Anastasi J, eds. Hematology: Basic
Principles and Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 104

What is a Stem Cell Transplant (Bone Marrow

Transplant)?
Approved by the Cancer.Net Editorial Board, 01/2016

A stem cell transplant is a treatment for some types of cancer. For example, you might have one if you have leukemia, multiple myeloma, or some
types of lymphoma. Doctors also treat some blood diseases with stem cell transplants.

In the past, patients who needed a stem cell transplant received a bone marrow transplant because the stem cells were collected from the bone
marrow. Today, stem cells are usually collected from the blood, instead of the bone marrow. For this reason, they are now more commonly called
stem cell transplants.

Why are bone marrow and stem cells important?

A part of your bones called bone marrow makes blood cells. Marrow is the soft, spongy tissue inside bones. It contains cells called
hematopoietic stem cells (pronounced he-mah-tuh-poy-ET-ick). These cells can turn into several other types of cells. They can turn into more
bone marrow cells. Or they can turn into any type of blood cell.

Certain cancers and other diseases keep hematopoietic stem cells from developing normally. If they are not normal, neither are the blood cells that
they make. A stem cell transplant gives you new stem cells. The new stem cells can make new, healthy blood cells.

Types of stem cell transplant

The main types of stem cell transplants and other options are discussed below.

Autologous transplant. Doctors call this an AUTO transplant. This type of stem cell transplant may also be called high-dose
chemotherapy with autologous stem cell rescue.

In an AUTO transplant, you get your own stem cells after doctors treat the cancer. First, your health care team collects stem cells from
your blood and freezes them. Next, you have powerful chemotherapy, and rarely, radiation therapy. Then, your health care team
thaws your frozen stem cells. They put them back in your blood through a tube placed in a vein (IV).

It takes about 24 hours for your stem cells to reach the bone marrow. Then they start to grow, multiply, and help the marrow make
healthy blood cells again.

Allogeneic transplantation. Doctors call this an ALLO transplant.

 In an ALLO transplant, you get another persons stem cells. It is important to find someone whose bone marrow matches yours. This
is because you have certain proteins on your white blood cells called human leukocyte antigens (HLA). The best donor has HLA
proteins as much like yours as possible.

Matching proteins make a serious condition called graft-versus-host disease (GVHD) less likely. In GVHD, healthy cells from the
transplant attack your cells. A brother or sister may be the best match. But another family member or volunteer might work.

Once you find a donor, you receive chemotherapy with or without radiation therapy. Next, you get the other persons stem cells
through a tube placed in a vein (IV). The cells in an ALLO transplant are not typically frozen. So, doctors can give you the cells as
soon after chemotherapy or radiation therapy as possible.

There are 2 types of ALLO transplants. The best type for each patient depends his or her age and health and the type of disease being
treated.

Ablative, which uses high-dose chemotherapy

Reduced intensity, which uses milder doses of chemotherapy

If your health care team cannot find a matched adult donor, there are other options. Research is ongoing to determine which type of transplant
will work best for different patients.

Umbilical cord blood transplant. This may be an option if you cannot find a donor match. Cancer centers around the world use
cord blood.

Parent-child transplant and haplotype mismatched transplant. These types of transplants are being used more commonly.
The match is 50%, instead of near 100%. Your donor might be a parent, child, brother, or sister.

Choosing a transplant

Your doctor will recommend an AUTO or ALLO transplant based mostly on the disease you have. Other factors include the health of your bone
marrow and your age and general health. For example, if you have cancer or other disease in your bone marrow, you will probably have an ALLO
transplant. In this situation, doctors do not recommend using your own stem cells.

Choosing a transplant is complicated. You will need help from a doctor who specializes in transplants. So you might need to travel to a
center that does many stem cell transplants. Your donor might need to go, too. At the center, you talk with a transplant specialist and have an
examination and tests. Before a transplant, you should also think about non-medical factors. These include:

Who can care for you during treatment

How long you will be away from work and family responsibilities

If your insurance pays for the transplant

Who can take you to transplant appointments

Your health care team can help you find answers to these questions.

How a transplant works

The information below tells you the main parts of AUTO and ALLO transplants. Your health care team usually does the steps in order. But
sometimes certain steps happen in advance, such as collecting stem cells. Ask your doctor what to expect before, during, and after a transplant.
AUTO transplant timeline

Part 1: Collecting your stem cells

A doctor puts a thin tube called a transplant catheter in a large vein. The tube stays in until after the transplant. Your health
care team will collect stem cells through this tube and give chemotherapy and other medications through the tube.

You get injections of a medication to raise your number of white blood cells. White blood cells help your body fight infections.

Your health care team collects stem cells, usually from your blood.

Time: 1 to 2 weeks

Where its done: Clinic or hospital building. You do not need to stay in the hospital overnight.

Part 2: Transplant treatment

You get high doses of chemotherapy, and rarely, radiation therapy.

Time: 5 to 10 days

Where its done: Clinic or hospital. At many transplant centers, patients need to stay in the hospital for the duration of the transplant, usually
about 3 weeks. At some centers, patients receive treatment in the clinic and can come in every day.

Part 3: Getting your stem cells back

Doctors call this the stem cell transfusion. Your health care team puts your stem cells back in your blood through the transplant
catheter.

Time: Each infusion usually takes less than 30 minutes. You may receive more than 1 infusion.

Where its done: Clinic or hospital.

Part 4: Recovery

You take antibiotics and other drugs. You get blood transfusions through your transplant catheter if needed. Your health care
team helps with any transplant side effects.

Time: approximately 2 weeks

Where its done: Clinic or hospital. You might be staying in the hospital or you might not.

ALLO transplant timeline

Part 1: Collecting stem cells from your donor

The health care team gives your donor injections of a medication to increase white cells in the blood, if
the cells are collected from blood. Some donors will donate bone marrow in the operating room during
a procedure which takes several hours.

Time: Varies based on how the stem cells are collected

Where its done: Clinic or hospital

Part 2: Transplant treatment

You get chemotherapy with or without radiation.

Time: 5 to 7 days

Where its done: Many ALLO transplants are done in the hospital.

Part 3: Getting the donor cells

Doctors call this the stem cell transfusion. Your health care team puts the donors stem cells in your blood through the
transplant catheter. It takes less than 1 hour. The transplant catheter stays in until after treatment.

Time: 1 day

Where its done: Clinic or hospital.

Part 4: Recovery

You take antibiotics and other drugs. This includes medications to prevent graft-versus-host disease. You get blood transfusions
through your catheter if needed. Your health care team takes care of any side effects from the transplant.

After the transplant, patients visit the clinic frequently at first and less often over time.

Time: Varies

For an ablative transplant, patients are usually in the hospital for about 4 weeks in total.

For a reduced intensity transplant, patients are in the hospital or visit the clinic daily for about 1 week.

Milestones of successful transplant

The words successful transplant might mean different things to you, your family, and your doctor. Below are 2 ways to measure transplant
success.

Your blood counts are back to safe levels. A blood count is the number of red cells, white cells, and platelets in your blood. A transplant
makes these numbers very low for 1 to 2 weeks. This causes risks of:

Infection from low numbers of white cells, which fight infections

Bleeding from low numbers of platelets, which stop bleeding

Tiredness from low numbers of red cells, which carry oxygen

Doctors lower these risks by giving blood and platelet transfusions after a transplant. You also take antibiotics to help prevent infections. When
the new stem cells multiply, they make more blood cells. Then your blood counts improve. This is one way to know if a transplant is a success.
It controls your cancer. Doctors do stem cell transplants with the goal of curing disease. A cure may be possible for some cancers, such as some
types of leukemia and lymphoma. For other patients, remission is the best result. Remission is having no signs or symptoms of cancer. After a
transplant, you need to see your doctor and have tests to watch for any signs of cancer or complications from the transplant.