Standard Process for Bone Marrow Transplant
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Unlike solid organ transplants, the bone marrow transplant or BMT (sometimes called stem cell transplantation) procedure is relatively simple. Diagnostic tests are performed to confirm that the patient is medically eligible for BMT. Bone marrow or peripheral blood is collected via a needle inserted into the pelvic bone or a blood vessel, respectively. Both bone marrow and peripheral blood contain the stem cells that are capable of producing all of the cells made by bone marrow. The bone marrow harvest is usually performed as an outpatient procedure with the use of local anesthesia; peripheral blood stem cells are collected with a procedure called apheresis. The transplant cells may be processed in the laboratory and autologous marrow is stored by freezing. In myeloablative BMT, high doses of chemotherapy and/or radiation are given to the patient in order to destroy cancer cells or the defective bone marrow. The normal bone marrow and immune system are also destroyed. In nonmyeloablative or reduced-intensity (sometimes called "mini") BMT, low doses of chemotherapy and/or radiation that suppresses the immune system and allows the transplant to "take" are used. The bone marrow or peripheral blood transplant is delivered intravenously, like a blood transfusion, and the stem cells find their way to the bone marrow to produce new blood cells. Managing the complications of BMT, such as graft versus host disease and other infections, is the most difficult part of the process. Blood transfusions, antibiotics and other drugs help support patients until new bone marrow grows, usually within two to five weeks. Patients are cared for on one of the inpatient units, or as outpatients, depending on their health.
A critical aspect of the Bone Marrow Transplant program at Johns Hopkins is the Graft Engineering Laboratory. This laboratory processes all stem cell products for transplantation, and is a world-renowned leader in innovative approaches for improving the safety and efficacy of stem cell products.