Hematology Specialist Assoc. Dr. Ender Soydan answers frequently asked questions about bone marrow transplantation as follows:
Bone marrow or stem cell transplantation; It is the process of transferring healthy stem cells from one person to another (allogeneic) or by collecting one's own (autologous) cells in advance and then transferring them to oneself.
As an allogeneic stem cell source, an HLA-compatible healthy relative or Non-relative donors, cord blood or half-matched parents, children or siblings can be used. Autologous
The stem cell source is the person himself.
In which diseases is it applied?
Stem cell transplantation can be used in leukemia, lymphoma, which have not received the expected benefit from the applied treatments.
It is a recommended treatment option for diseases such as myelodysplastic syndrome, multiple myeloma, bone marrow failure (severe aplastic anemia).
Autologous stem cell transplantation; It is a method used to administer high dose treatment. Stem
Cells are used to prevent the damage caused by high-dose treatment in the bone marrow.
The main diseases for which allogeneic stem cell transplantation is applied are:
Acute myeloid leukemia (AML). )
Chronic myelocytic leukemia (CML)
Chronic lymphocytic leukemia (CLL)
Non-Hodgkin lymphoma (HDL)
Hodgkin lymphoma( HL)
Myelo dysplastic syndrome (MDS)
Severe aplastic anemia (AAA), other conditions with bone marrow failure (Fanconianemia,
paroxysmal nocturnal hemoglobinuria, saferitroidaplasia)
The main diseases for which autologous stem cell transplantation is applied are as follows:
Multiple myeloma (MM)
Hodgkin's lymphoma
Non-Hodgkin's lymphoma
Acute myeloid leukemia (in some subgroups)
How are cells collected in bone marrow transplantation?
There are two methods of collecting stem cells from a healthy donor. The first of these is to collect stem cells from the bone marrow; In this method, the donor is put to sleep under general anesthesia in the operating room and bone marrow is collected from the donor's hip bone using special needles. The second method is to apply a growth factor to the donor, and stem cells directed from the bone marrow to the circulating blood are transferred to the donor's arm via an apheresis
device. It is a method of collecting bone marrow from the veins.
How is bone marrow transplantation performed?
Stem cells are given to the patient through a vascular access. For this, veins are usually used, called central and non-catheter
Internally placed apparatus is used.
What are the stages of bone marrow transplantation?
We can divide the process in the transplant unit into three stages. The first stage is the treatment process that we call "preparation regime"
. During this period, a treatment appropriate to the patient's disease and age is selected. Treatment duration varies depending on the protocol applied. In summary, the preparation regimen has three main purposes
: Destroying undetectable disease cells in the patient, emptying the patient's bone marrow to make room for donor cells, and suppressing the patient's immune system
preventing it from reacting to donor cells. Second stage; is the administration of stem cells.
The third stage is the proliferation of the donor's stem cells in the recipient's bone marrow.
Patients are followed up in the transplant clinic after being discharged from the transplant unit. Follow-up frequencies
Although it varies depending on the situation, it is adjusted to be once a week or once every two weeks in the first 3 months. Checks are made once a month until the first year is up. In the future
Control periods are determined according to the patient's condition.
What are the problems that may occur after bone marrow transplantation?
One of the problems encountered in the early and late periods after transplantation is graft versus host. disease
(GVHD). This is a war initiated by the donor's immune system cells against the recipient and
causes damage to various tissues of the body. The most frequently damaged tissues are skin, liver and stomach-< br /> is the intestinal system. It occurs with skin rash, itching, nausea in the gastrointestinal tract, vomiting, diarrhea and deterioration in liver tests. 30-40% in transplants from HLA fully compatible sibling donors; It is seen in 60-70% of transplants from unrelated donors.
The second important problem is that the given stem cells cannot settle and proliferate in the recipient bone marrow. It is evaluated by looking at blood
values and In this case, re-transplantation becomes a priority.
Disease recurrence, that is, the re-emergence of the disease after transplantation, is another problem.
Opportunistic infections are common after transplantation. For this reason, it is very important for patients to pay attention to methods of protection from infection
.
What are the problems that may be encountered in the late period after bone marrow transplantation?
The problems that may be encountered after bone marrow transplantation are sometimes They are long-lasting and can cause psychological difficulties as well as physical difficulties, making it difficult for the patient to return to normal
life. Problems that may be encountered in the following years are:
Hormonal imbalances
Thyroid dysfunction
Cataract
Skeletal-muscular system complaints
Skin changes
Hair and scalp changes
Osteoporosis
Reproductive system changes
Secondary cancers
In what cases should a physician be consulted?
Fever
Shortness of breath
Nausea, vomiting
Diarrhea
In the body redness and itching
Headache
Blurred vision
Burning and bleeding in urine
Sore in the mouth
Redness in the catheter area, pain
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