What to Expect From a Bone Marrow Transplant

High Angle View Of Person During Bone Marrow Donation
Dani Blanchette / EyeEm / Getty Images

A bone marrow transplant is an often lifesaving procedure in which stem cells are removed from bone marrow, filtered, and given back either to the same person or a donation recipient. Bone marrow transplants can be used to treat or even cure certain diseases related to underproduction of stem cells or unhealthy stem cells in the body, such as aplastic anemia and leukemia.

Reasons for a Bone Marrow Transplant

Bone marrow is found in larger bones in the body, such as the pelvic bones. It is the manufacturing site for stem cells, also called hematopoietic stem cells. These are pluripotential, meaning that they are the precursor cells that can evolve into the different types of blood cells, such as white blood cells, red blood cells, and platelets. If something is wrong with the bone marrow, or the production of blood cells is decreased, a person can become very ill or die.

Bone marrow transplants are typically done in patients with:

  • Cancers such as leukemia, lymphoma, and multiple myeloma, in which bone marrow produces abnormal blood cells
  • Bone marrow diseases like aplastic anemia, in which bone marrow stops producing blood cells needed for the body

In addition, bone marrow transplants are being evaluated for many disorders, ranging from solid tumors to other non-malignant disorders of the bone marrow, as well as for multiple sclerosis and sickle-cell disease.

Who Is Not a Good Candidate? 

You may be turned down for a bone marrow transplant under the following circumstances:

  • You have an uncontrolled infection.
  • You have severe cardiac, vascular, kidney, liver, or lung disease.
  • You suffer from disabling psychosis.
  • You are over age 75.

A total of 21,696 hematopoietic cell transplantations were performed in the United States in 2016. Of these, 4,847 (22%) were unrelated transplants. One-fifth of these (20%) used bone marrow as the source.

Types of Bone Marrow Transplants

There are two primary types of bone marrow transplants: autologous and allogeneic. Your doctor will recommend one or the other based on the type of disease you have, as well as the health of your bone marrow, your age, and overall health. For example, if you have cancer or another disease (such as aplastic anemia) in your bone marrow, using your own stem cells is not recommended.

Autologous Bone Marrow Transplant

The Greek prefix auto- means "self." In an autologous transplant, the donor is the person who will also receive the transplant. This procedure, also known as a rescue transplant, involves removing the stem cells from your bone marrow and freezing them. You then receive high-dose chemotherapy followed by an infusion of the thawed out frozen stem cells.

This type of transplant may be used to treat leukemias, lymphomas, or multiple myeloma.

Allogeneic Bone Marrow Transplant

The Greek prefix allo- means "different" or "other." In an allogeneic bone marrow transplant, the donor is another person who has a genetic tissue type similar to the person needing the transplant.

Haploidentical Bone Marrow Transplant

With this type of allogeneic transplant, healthy, blood-forming cells from a half-matched donor replace the unhealthy ones. A half-matched donor is exactly what it sounds like: one who matches exactly half of your tissue traits.

Non-Myeloablative Bone Marrow Transplant

In a non-myeloablative bone marrow transplant, a.k.a. mini-bone marrow transplant, lower doses of chemotherapy are given that do not completely wipe out or "ablate" the bone marrow as in a typical bone marrow transplant. This approach may be used for someone who is older, or otherwise might not tolerate the traditional procedure.

In this case, the transplant works differently to treat the disease as well. Instead of replacing the bone marrow, the donated marrow can attack cancerous cells left in the body in a process referred to as graft versus malignancy.

Other Stem Cell Transplants

A bone marrow transplant is one of three types of stem cell transplants. In a transplant called peripheral circulating blood cell transplant (PBSC), a process called apheresis is used to remove stem cells from the blood, rather than bone marrow. Stem cells may also be obtained from cord blood banks, which store blood from a baby's umbilical cord shortly after birth.

Recipients and Donors

Tissue types are inherited, similar to hair color or eye color, so it is more likely that you will find a suitable donor in a family member, especially a sibling. Siblings are suitable donors 25% of the time.

Half-matched donors usually include a person's mother, father, or child. Parents are always a half-match for their children. Siblings have a 50% chance of being a half-match for each other.

Many people receive bone marrow from family members and, because of this, do not need to be considered alongside others seeking a non-related person's donation.

If a family member does not match the recipient, or there are no related donor candidates, the National Marrow Donor Program Registry database can be searched for an unrelated individual whose tissue type is a close match. It is more likely that a donor who comes from the same racial or ethnic group as the recipient will have the same tissue traits. Currently, Caucasians more commonly donate marrow, hence being Caucasian yourself makes it more likely you'll find a close match. Those who are less likely to find a close bone marrow match will have much better luck seeking a cord blood donation; these stem cells are more "flexible," as it were, when it comes to matching with recipients. Your transplant team will keep you up to date on how things are proceeding with your particular match and likely wait time.

Most people between the ages of 18 and 60 who are in good health can become a donor. You will have to give a blood sample and fill out a form. The National Marrow Donor Program website can help potential donors get started.

Before the Transplant

Once your insurance company has authorized your transplant, you will need to have several tests before undergoing the actual transplant. These include:

You will also meet with a social worker, along with your caregiver(s), to discuss emotional and practical aspects of the transplant, such as how long you will stay in the hospital and who will care for you once you're home.

Finally, you will have a central line implanted. This is a small tube inserted into the large vein in the chest or neck, just above the heart. It makes it easier for your healthcare providers to administer medications, take blood samples, and perform transfusions. It will also reduce the number of needle pokes you’ll need.

Once you have received pre-transplant testing and had your central line inserted, you will have what's called a "preparative" or "conditioning" regimen in order to prepare your body for the transplant itself. You will receive high-dose chemotherapy and/or radiation therapy to destroy any cancerous cells throughout the body and make room for the new cells. The regimen may take two to eight days and will purposefully destroy your immune system so it can't attack the donated cells after the transplant.

Side effects during this time are the same as with any chemotherapy or radiation treatment and may include nausea, vomiting, low white cell count, mouth sores, and hair loss.

The Donation Process

In a bone marrow harvest, stem cells are collected directly from the bone marrow. The donor will go to the operating room and, while asleep under anesthesia, a needle is inserted into either the hip or the breastbone to retrieve bone marrow.

According to the National Marrow Donor Program, common side effects of marrow donation that may occur within two days (in order of likelihood) include back or hip pain, fatigue, throat pain, muscle pain, insomnia, headache, dizziness, loss of appetite, and nausea.

The median time to full recovery for a marrow donation is 20 days.

Transplant Process

Once a person's original bone marrow is destroyed, the new stem cells are injected intravenously, similar to a blood transfusion. If your cells arrive frozen, the nurse will thaw them in a heated water bath at your bedside. The cells are preserved with a chemical called dimethylsulfoxide (DMSO) that protects the cells during the freezing and thawing process. This preservative will cause your room to have an odor for a day or two.

When ready, the cells are infused through your central line into your bloodstream. They then find their way to the bone and start to grow and produce more cells, a process known as engraftment.

You will be given medications to prevent a possible reaction to the preservative in the stem cells or bone marrow. These medications may make you sleepy during the procedure. Your vital signs will be checked often and you will be closely observed by your nurse. You may also have a bad taste in your mouth, feel a tickle in your throat, or experience coughing during the infusion.

Following the transplant, your blood counts will be monitored daily. You will be informed of your results, and transfusions of blood and platelets will be given as needed.

Complications

The most critical time is usually when the bone marrow is destroyed so that few blood cells remain. Destruction of the bone marrow results in greatly reduced numbers of all of the types of blood cells (pancytopenia).

Without white blood cells, there is a serious risk of infection, so you will be isolated and hospital staff will use infection precautions. Low levels of red blood cells (anemia) often require blood transfusions while waiting for the new stem cells to begin growing. Low levels of platelets (thrombocytopenia) in the blood can lead to internal bleeding.

A common complication affecting patients receiving donor bone marrow is graft versus host disease (GvHD). This occurs when white blood cells (T cells) in the donated cells attack tissues in the recipient; this can be life-threatening. To prevent this, you will be given immunosuppressive drugs for an indefinite period of time.

There is a possibility that high-dose chemotherapy, as well as a number of other medications required during transplant, can cause a decrease in the ability of your lungs, heart, kidney, or liver to function. These organ toxicities are usually mild, temporary, and reversible.

However, sterility is a potential complication of high-dose chemotherapy. Although most patients who undergo a transplant will be infertile afterward, those who do not wish to become pregnant should not assume they cannot. The normal precautions for avoiding unwanted pregnancies need to be practiced.

After the Transplant

The time for your bone marrow to engraft and start to work to make new white cells, red cells, and platelets differs depending on the type of transplant you receive. That said, it usually takes two to three weeks for your white blood cell count to be high enough to be discharged from the hospital after a bone marrow transplant.

You are at high risk for infection at this time, so you will need to take precautions such as:

  • Taking antibiotics, antiviral, and antifungal medications, as well as granulocyte colony-stimulating factors (G-CSF) as prescribed by your doctor
  • Avoiding interactions with other people
  • Practicing proper hygiene
  • Avoiding plants and flowers, which can harbor bacteria
  • Avoiding certain foods

Your white blood cell count may be in the normal range when you are discharged from the hospital, but your immune system may not function normally for as long as one year. Here are some guidelines to help you stay free from infection:

  • Make sure hands are washed after touching an animal, before and after meals, before preparing food, after using the toilet, and before taking medications. (If you must change a baby's diaper, wear disposable gloves and wash your hands immediately afterward.)
  • Avoid large crowds and people with infections or colds for at least one month.
  • Avoid swimming in oceans, lakes, public pools, rivers, or hot tubs for three months.
  • Talk to your doctor before receiving any immunizations.

It is also worth taking your temperature at the same time once or twice a day so that you can a rise in temperature, which may be an early indicator of infection.

Call your doctor immediately if you experience any of the following symptoms:

  • A temperature greater than 100.5 degrees F
  • A persistent cough
  • Chills with or without fever or that occur after your central line is flushed
  • Nausea and vomiting
  • Persistent pain
  • Diarrhea, constipation, or pain with bowel movements
  • Shortness of breath
  • Redness, swelling, drainage, or tenderness at your catheter site
  • Pain, burning, or increased frequency of urination
  • Sores in the mouth or throat
  • Any sore or wound that does not heal
  • Any unusual vaginal discharge or itching
  • Exposure to chickenpox
  • Sudden bruises or hives
  • Headache that persists or any severe headache
  • Blurry vision
  • Persistent dizziness

Prognosis

The goal of a bone marrow transplant is to cure disease. A cure may be possible for some cancers, such as some types of leukemia and lymphoma, but for others, remission is the best result. Remission refers to a period in which there are no signs or symptoms of cancer.

After a transplant, you'll need to see your doctor and have tests to watch for any signs of cancer or complications from the transplant. Some patients will experience a relapse of their disease even after a transplant.

There is no overall survival rate for bone marrow transplants, as survival depends on numerous factors, including your age, your specific disease, how close of a match the healthy stem cells are, and your overall health prior to the transplant.

The National Marrow Donor Program has a directory of transplant centers with data on each one's one-year survival rate.

Support and Coping

A bone marrow transplant can be a very physically and emotionally demanding experience. Most hospitals and transplant centers will offer support services for you as well as your loved ones as you go through the process.

The National Marrow Donor Registry/Be the Match Support Center offers individual, peer, and group support programs, as well as referrals to other support resources.

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Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Health Resources & Services Administration. Blood Stem Cell. Donation and Transplantation Statistics.

  2. Be the Match. HLA Matching.

  3. Be the Match. Donating Bone Marrow.

  4. Leukemia & Lymphoma Society. Fertility.

Additional Reading