Definition and Overview

A bone marrow transplant consultation is a pre-transplant discussion between a patient and blood specialist called hematologist-oncologist.

The bone marrow is the spongy and fatty substance found inside the bones, especially those of the legs and the hip. Although a part of it serves as a conduit for the circulatory system, one of its primary roles is to produce blood cells, which go through a cycle where they eventually mature and die and replaced by immature cells.

Problems arise when they do not mature and the marrow continues to produce new, immature ones. This leads to a massive volume of immature cells that make the immune system weak.

A bone marrow transplant is considered when the blood disorder is severe that it can no longer be treated using other options such as medications or chemotherapy. Some studies also show that it may help manage inflammatory bowel disease (IBD).

Who Should Undergo and Expected Results

Three types of people may undergo a bone marrow transplant consultation:

Patients

The consultation is normally intended to determine whether the patient, who can be a child or an adult, is eligible for a transplant. If the patient is being a considered a candidate for the procedure, the doctor will determine the best type of transplant based on the patient’s age, lifestyle, health condition, disease, and genetics or family history. Options include (1) autologous (the stem cells come from the patient), (2) allogenic (stem cells come from a donor) and (3) the stem cells are derived from a child’s umbilical cord.

The doctor will also discuss the possible risks and complications of the procedure. Although bone marrow transplants are helpful, they don’t always guarantee a 100% cure rate. In fact, in other situations, they don’t work at all. The transplantation may also introduce serious complications like graft-versus-host disease (GVHD), where the newly transplanted cells cause damage to the body. Others risk factors include infection, allergic reactions, headaches, dizziness and nausea. Some may also have difficulty breathing and eating, as well as develop fertility issues.

Donor

A donor is needed for allogenic transplants. The patient may look for their own donors, or they can refer to a bone marrow registry. Many of the donors are relatives and direct family members. Because the transplant can also have some effects on the donor, they also have to go through a consultation.

Caregiver

It usually takes a year before bone marrow transplant patients fully recover and they are required to make regular follow-ups for at least five years after the procedure. During this time, the patient will require a caregiver, who can be a family member, relative, spouse, or friend who are also encouraged to attend the consultation so they’ll know what to expect and to receive crucial information on how to properly care for the patient.

How Does the Procedure Work?

The consultation is composed of many appointments and steps. The first step is to determine whether the patient is eligible for the transplantation. If he is, he is referred to the hospital’s transplant program.

Under the transplant program, the patient and the doctor will discuss:

  • Pre-transplant tests, which include screening for infectious diseases, organ function exam, chest X-ray and image scans like PET and CT
  • Actual transplant procedure
  • Preparation for the transplant
  • Cost of the procedure
  • Possible risks and complications
  • Expected results of the procedure
    If the patient is to undergo an allogenic transplant, the donor will also undergo a number of tests and bone marrow matching. If the immediate family members, relatives, and friends are not a match, the transplant program will bring in a coordinator who will help the patient look for a match in the bone marrow registry.

Possible Risks and Complications

A consultation may cause frustration and disappointment for the patient, which can be the case if he happens to be ineligible for the transplant. Patients who have become too ill may no longer have the energy to travel to attend these consultations, more so undergo tests. Further, not all hospitals have a transplant program, which could mean more expenses for the patient as he may need to travel and even book accommodation for every doctor's visit.

References:

  • Bashir Q, Champlin R. Hematopoietic stem cell transplantation. In: Niederhuber JE, Armitage JO, Doroshow JH, et al., eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2013:chap 30.

  • Heslop HE. Overview of hematopoietic stem cell transplantation. In: Hoffman R, Benz EJ Jr, Silberstein LE, Heslop HE, Weitz JI, Anastasi JI, eds. Hematology: Basic Principles and Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 104.

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