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Bone marrow consists of precursor or predecessor immature cells called stem cells.

These are primitive cells that are capable of producing all types of cells.
Blood cells like RBCs, WBCs and platelets start out from young (immature) cells
called hematopoietic stem cells. Stem cells mostly live in the bone marrow where
they divide to make new blood cells. These cells mature into adult cells and then
leave the marrow into the blood stream.
A small number of stem cells also get into the bloodstream. These are called
peripheral blood stem cells.
What is a bone marrow transplant?
When the bone marrow has been destroyed by disease, chemotherapy or radiation,
the stem cells may be transplanted and restored. Depending on the source of the
stem cells this procedure may be called:

Bone marrow transplant

Peripheral blood stem cell transplant, OR

Cord blood transplant.

These three types are called hematopoietic stem cell transplant. There are 3
possible sources of stem cells to use for transplants. This includes:

bone marrow

the bloodstream (peripheral blood)

umbilical cord blood from newborns

History of bone marrow transplant


The first successful bone marrow transplant was done in 1968. After nearly two
decades, stem cells taken from circulating (peripheral) blood were transplanted with
success.
More recently, doctors have begun using cord blood from the placenta and umbilical
cords of new born babies as another source of stem cells. Today nearly 50,000 new
transplants are done each year.
When is a bone marrow transplant needed?
Stem cell transplants are used to replace bone marrow that has been destroyed by:

disease

leukemia

aplastic anemia

certain inherited blood diseases

exposure to cancer chemotherapy

cancer radiation therapy

some diseases of the immune system

In these conditions the stem cells are unable to make adequate blood cells. A stem
cell transplant may help correct these problems.
In some cancers, such as certain leukemias, multiple myeloma, and some
lymphomas, a stem cell transplant can be an important part of treatment. In these
patients high doses of chemotherapy or radiation therapy is a good therapy option
but cannot be given due to its potential to cause bone marrow suppression. So once
high doses are used a stem cell transplant is made to replenish the suppressed
marrow.
Types of bone marrow transplant
Types of bone marrow transplant include:
1. Autologous BMT Cells come from the patients own bone marrow
2. Allogeneic BMT The cells come from a matched related or unrelated donor
3. Syngeneic BMT the cells are derived from an identical twin.
Autologous stem cell transplant
In this type the patients own bone marrow cells are taken prior to the anti-cancer
procedure. These stem cells are removed, or harvested, from either bone marrow or
blood and then frozen.
After this a high dose of chemotherapy or radiation therapy is given. Once the bone
marrow is suppressed the frozen cells are thawed and replaced back within the
body.
Advantage of autologous stem cell transplant
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The advantage is that the patient gets his or her own blood cells and thus there is a
decreased risk of the bodys immune system not recognizing the cells and rejecting
them or mounting an attack on them. This is called graft rejection and rejection
makes allogenic transplants difficult.
Disadvantage of autologous stem cell transplant
The disadvantage of the process is the risk of the originally taken stem cells
carrying cancer cells that are reintroduced in the body to. This may bring the cancer
back.
What is autologous stem cell transplant used for?

This kind of transplant is mainly used to treat some leukemias and lymphomas, and
multiple myeloma. It is sometimes used for other cancers, especially in children.
In a tandem transplant, a patient gets 2 courses of high-dose chemo, each followed
by a transplant of their own stem cells. All of the stem cells needed are collected
before the first high-dose chemo treatment, and half of them are used for each
procedure.
Allogeneic stem cell transplant
In this type the stem cells do not come from the patient, but from a donor whose
tissue type is matched with the patient. The donor may be a family member, usually
a brother or sister.
The donor may be sought from a national registry as well. This may be called a MUD
(matched unrelated donor) transplant.
Cord blood transplant is another method where blood is taken from the placenta
and umbilical cord of new borns. This blood has a high number of stem cells. But the
number of stem cells in a unit of cord blood is often too low for large adults, so this
source of stem cells has so far been used more in children.
Advantage of allogenic stem cell transplant
The advantage of allogenic transplant is that the donor stem cells make their own
immune cells, which may help destroy any cancer cells in the patient.
Disadvantage of allogenic stem cell transplant
The disadvantage is the risk of graft rejection that may require lifelong use of
immunity suppressing agents.
What is allogenic stem cell transplant used for?
Allogeneic transplant is most often used to treat certain types of leukemia,
lymphomas, and other bone marrow disorders such as myelodysplasia.
Many factors play a role in how the immune system knows the difference between
self and non-self. The most important factor that is used in allogenic transplants
is called human leukocyte antigen (HLA) system.
Human leukocyte antigens are proteins found on the surface of most cells. Each
person has a number of pairs of HLA antigens (the best-known ones being A, B, C,
DR, DQ, and DP). They inherit one of each of these antigens from each of their
patents. Doctors try to match these antigens when finding a donor for a person
getting a stem cell transplant.
Syngeneic stem cell transplant
This is possible only between identical twins or triplets with similar genetic makeup.
An advantage of syngeneic stem cell transplant is that graft-versus-host disease will
not be a problem. There are no cancer cells in the transplant, either, as there would
be from an autologous transplant.