Bone marrow transplantation is a complex stem cell implantation procedure, the need for which is born in one of a number of diseases of the hematopoietic system. The bone marrow is a vital organ of the circulatory system that performs the function of hematopoiesis.
Without a bone marrow transplant, it is impossible to help patients with severe immune system damage. Most often, the need for transplantation occurs with cancer of the blood.
Malignant lesions
Most often, the decision to urgently conduct an operation is made for leukemia (leukemia). In the people, this terrible disease, which leaves practically no chance for the patient to recover, is called leukemia. Pathology is characterized by a violation of the process of formation and renewal of blood: cells, not having time to mature, begin to divide immediately. There are no further stages of development. When the number of immature cells exceeds the allowable maximum, they crowd out he althy bodies. Leukemia can occur as:
- acute myeloid type;
- acute lymphoblastic type;
- chronic myeloid leukemia;
- plasmocytomas.
Transplantation of he althy cells is essential for lymphoma, a blood pathology characterized by the accumulation of tumor lymphocytes. A variation of lymphoma is Hodgkin's disease, as well as non-Hodgkin's types of the disease.
Other pathologies as indications for transplantation
In benign pathological processes, bone marrow transplantation may be recommended due to the high risk of the disease becoming malignant. The diseases of a non-oncological nature, for the treatment of which they resort to the use of donor biomaterial, include:
- Diseases associated with metabolic disorders. First of all, it is Hunter's syndrome and adrenoleukodystrophy. The latter disease is characterized by an excessive concentration of fatty acids in cells. Hunter syndrome is a pathology in which there is an atypical accumulation of fats, proteins and carbohydrates in tissues.
- Immune disorders. First of all, we are talking about HIV infection and congenital immunodeficiency. This method of treatment cannot give a 100% guarantee of recovery, but it helps to prolong the life of the patient.
- Pathologies of the bone marrow (Fanconi anemia, aplastic anemia), which occur with oppression of hematopoietic functions.
- Autoimmune diseases, including lupus erythematosus, rheumatoid arthritis. The specificity of these diseases is the defeat of the connective tissue and small blood vessels.vessels.
Not so long ago, radiation and chemotherapy were considered the only way to treat the above pathologies. However, each of these methods of fighting cancer helps to destroy not only cancer cells, but also he althy ones. Today, the tactics of treating blood diseases has taken a different turn: after courses of intensive anticancer therapy, the affected hematopoietic bodies are replaced by he althy ones during transplantation.
Who can donate
This operation requires the voluntary consent of a person whose genetic material is completely suitable for the recipient in need. Judging by the reviews, people often think about bone marrow transplantation and providing their stem cells to patients, but many are afraid of ignorance in this matter and ignorance of the likely consequences of such a complex manipulation.
You can get material for blood cell transplantation:
- From the patient himself during the remission of the disease. If the symptoms of the disease have subsided and the test results are normal, the patient is taken tissue, which is planted in him with the development of a relapse. This transplant is called autologous.
- From his twin (identical). This type of transplant is called syngeneic.
- From a blood relative. It should be noted that not all people who are related to the recipient can be suitable for the role of a bone marrow donor due to differences in the genetic code. More often, the biomaterial coincides with brothers and sisters -the probability is about 25%. At the same time, genetic compatibility with parents is almost never found. Engraftment of stem cells from a relative is called allogeneic.
- From a stranger (unrelated) person. If there is no person with suitable genetic data among relatives, they turn to national or foreign donor banks for help. We are talking about allogeneic transplantation of tissues from an outside donor.
Main contraindications for donors
It also happens that a person who is ready to donate his tissue to save another is not allowed to transplant. A number of requirements are put forward for potential donors, if at least one of them does not meet, the application for donation is rejected. First of all, only an adult can donate their stem cells. The bone marrow transplant donor must be absolutely he althy. The absence of the following diseases is especially important:
- autoimmune disorders;
- severe infectious pathologies;
- hepatitis B and C;
- syphilis;
- tuberculosis of any form;
- congenital or acquired immunodeficiency;
- any type of oncology;
- mental disorders.
A pregnant woman cannot be a donor. Biomaterial is not collected from people over 50 years of age.
No chance of transplant
By the way, stem cell replacement is also not recommended for physically weak and elderly patients. Transplantation is not performed on people suffering fromthe most complex diseases of the internal organs. Contraindications for bone marrow transplantation include prolonged antibiotic or hormonal therapy.
And even with excellent he alth indicators of the donor and recipient, the only serious obstacle to the procedure is the incompatibility of the biomaterial. The chances of finding an ideal donor for a bone marrow transplant are slim. Most often resort to autologous and allogeneic methods of tissue transplantation.
Bone marrow transplantation is the most difficult intervention for the body. In addition, the procedure is very expensive. Since the predominant number of patients are not able to pay for treatment on their own, the state often comes to the rescue in this matter. But since it is impossible to provide all patients with the necessary services, a certain quota for stem cell transplantation has been established. Thanks to the introduction of a quota system, needy patients get a chance to get treatment at the best clinic absolutely free of charge, but, in fact, it is the main obstacle for patients due to the huge queue formed. In addition, the search for a donor itself takes considerable time, and for patients with such a diagnosis, every week is precious.
Donor material collection
You will learn about how bone marrow transplantation takes place after the description of the procedure for collecting donor biomaterial. Manipulation can be done in two ways. Doctors choose it, depending on medical indications forspecific donor.
The first option is to extract the required amount of tissue from the pelvic bone. To carry out the manipulation, an analysis is taken in advance, the results of which will show whether a person can endure anesthesia. Hospitalization of the donor is required a few days before the procedure. The required cells are taken under anesthesia using a syringe, which is injected into the area of high concentration of the desired biomaterial. As a rule, several punctures are made at once to obtain the necessary volume of fluid for bone marrow transplantation. How is the procedure? Almost painless and fast - the manipulation takes no more than half an hour, but for a complete recovery, the donor's body will need almost a whole month.
The second way is to take venous blood from which stem cells are extracted. During the week before the scheduled date of the manipulation, the donor must take Leucostim, a specific drug that provokes an active release of stem cells into the blood. Blood is taken from the donor, the necessary elements are separated from it and returned back through the second hand. This method of taking biomaterial takes several hours, and recovery will take no more than two weeks.
How is the operation going
In case of leukemia, bone marrow transplantation must necessarily be preceded by a course of powerful chemotherapy or radiotherapy - the so-called preparatory regimen. It lasts as long as required in each individual case. The duration of the courses determinesdoctor.
Before doing a bone marrow transplant, doctors must make sure that the recipient is ready for this kind of intervention. A couple of days before the operation, the donor and the person in need of stem cell implantation are retested. During the procedure, donor stem cells are administered parenterally to the patient.
After bone marrow transplantation, during the first month, the patient is under the close supervision of doctors, who are waiting for engraftment of foreign tissues. This period must be accompanied by antibiotics, which are necessary to prevent infection. In addition to antibiotic therapy, the recipient is given another infusion into the blood - this time it is enriched with platelets in order to prevent internal bleeding, the risk of which increases several times after stem cell implantation. Along with antibiotics, the patient is prescribed immunosuppressive drugs to prevent the body from rejecting the transplanted tissue.
What happens after a transplant
The consequence of bone marrow transplantation is often prolonged weakness, in severe cases, bleeding may develop, and malfunctions of internal organs may occur. In case of an acute reaction of the immune system to the transplant, the gastrointestinal tract, liver and skin are most often affected. Patients may complain of the following symptoms:
- nausea, sometimes with vomiting;
- appearance of small ulcers in the mouth;
- unstable psycho-emotional state;
- pustules on the skin of the back and chest;
- bloody diarrhea;
- damage to the lacrimal and salivary glands.
The staff of medical institutions that perform bone marrow transplantation for lymphoma, leukemia and other blood diseases must be sufficiently competent and able to create comfortable conditions for the rehabilitation of patients. In addition, the participation of relatives and friends is no less important in this matter.
The intake of immunosuppressants, which was mentioned above, inhibits the work of the hematopoietic organs, while significantly weakening the immune system. During the rehabilitation period after bone marrow transplantation, the body becomes very vulnerable to pathogenic microflora. If the patient has already been infected with cytomegalovirus, activation of the infection against the background of immune susceptibility is quite likely. In severe cases, pneumonia develops, which is fatal.
Russian clinics
In our country there are several medical institutions specializing in such operations. Bone marrow transplantation in Russia is carried out by highly qualified specialists in the field of hematology, oncology, transfusiology, etc.
Among the 13 clinics operating in the Russian Federation, it is worth noting:
- The Raisa Gorbacheva Institute of Pediatric Hematology and Transplantation in St. Petersburg, which is one of the largest departments. People turn here in the most hopeless cases.
- ON Clinic is an international medical center with several offices in Russia. Branches of the clinicare engaged in the diagnosis of hematological and oncological diseases requiring bone marrow transplantation.
- FGBU NMIC DGOI them. Dmitry Rogachev of the Ministry of He alth of Russia is a budget clinic located in Moscow. This institution has many years of experience. Bone transplantation is done here for patients of different ages.
Survival forecast
The recovery of the body after stem cell implantation lasts at least a year, and its success is largely determined by:
- type of transplant;
- degree of donor material compatibility;
- the course and malignancy of the disease;
- patient's age;
- general condition of the patient;
- intensity of pre-transplant radiation or chemotherapy.
The recipients suffering from hereditary pathologies of the hematopoietic system have the highest chances. With oncology, it is quite difficult to predict the further outcome, since the chances of recovery depend on the likelihood of relapse. If over the next five years it did not arise, then an insignificant fraction of the probability of its development in the future becomes obvious. This survival rate is observed in about half of the cases.
