The Medical Minute: Seven Things to Know About Bone Marrow Transplants

HERSHEY, Pa. – Inside your bones, a spongy substance called marrow produces the red and white blood cells and platelets you need to stay alive and healthy. When blood cancers and certain genetic conditions damage this marrow, it prevents these blood-making factories from functioning effectively.

That’s when you need a bone marrow transplant, an infusion of healthy blood stem cells that can regenerate healthy marrow. Because bone marrow resides throughout the body and constantly regenerates, the transplant process can be easier for both donors and recipients than other types of organ transplants.

Below, Dr. Witold Rybka, director of the Bone Marrow Transplantation Program at Penn State Hershey Cancer Institute, shares a few things to know about bone marrow transplants.

What conditions can require a bone marrow transplant?

Ninety-five percent of bone marrow transplants are used to support treatment of blood cancers. Treatments for such cancers often damage the body’s bone marrow so much that doctors must replace the marrow in order to continue treating the disease. In 5 percent of transplants, marrow is used to reestablish damaged bone marrow from an inherited blood disorder.

What are the most common types of bone marrow transplants?

For an autologous transplant, the patient can bank his or her own stem cells before undergoing intensive treatment for certain diseases such as lymphoma, Hodgkin’s lymphoma or multiple myeloma. The patient’s body can then use its own banked stem cells to regenerate healthy marrow once treatment is complete. Other transplants are allogeneic, meaning that the patient must receive matching stem cells from a sibling, family member or unrelated donor.

What are the odds of finding a match within one’s own family?

The chance of finding a full match is one in four, so the larger your family, the better chance you have of finding a match among your relatives. Given the size of most American families, most donors must use an unrelated match from a registry of more than 17 million living donors worldwide.

Statistically, how many people who need a bone marrow transplant get one?

Because the majority of banked cord blood and stem cells comes from donors in Europe and North America, the chances of a Caucasian patient finding a match within the registry is 85 percent. For those of other ethnicities, the likelihood is 60 percent, although organizations such as Be the Match are working to recruit donors in other demographic communities so they can extend their services to more ethic populations.

Is it painful to donate bone marrow?

For some types of bone marrow transplants, the marrow must still be harvested from the donor’s pelvic spine under anesthesia. In many cases though, a device extracts blood from the donor, spins out the white cells in a process called leukapheresis, and then returns the rest of the blood to the donor. Donors receive injections four days in a row to stimulate marrow production. On the fifth day, they connect to the machine for three to four hours to have the marrow removed from their blood. Because stem cells and marrow are replenishing resources, the donor’s body typically makes up the difference very quickly — within a couple weeks — and the donors have no lasting side effects.

How does someone receive a bone marrow transplant? How successful are the transplants?

Bone marrow is given through an infusion. For a full match, the success rate is more than 99 percent. If the marrow is not a full match, the chance of rejection rises to 10 to 15 percent. Penn State Hershey is participating in a national trial to explore whether partial matches can become a viable alternative for marrow transplants.

What is the process for becoming part of the bone marrow donor registry?

Potential donors can get tested to be part of the registry with a simple scraping of the tissue on the inside of their mouth. If they are a match for someone in need, the registry contacts them to see if they are still interested in donation. If so, they collect a confirmatory specimen to verify the donor’s identity and do more in-depth testing. If chosen, the donor is notified and again asked if they are willing to get a physical exam and blood tests before making the appointment to donate.

The Medical Minute is a weekly health news feature produced by Penn State Milton S. Hershey Medical Center. Articles feature the expertise of Penn State Hershey faculty physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.

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