BONE MARROW TRANSPLANT

Bone marrow transplant is a technique used in treating relapsed leukemias (and more recently in lymphomas and neuroblastomas). Residual tumor along with the patient’s bone marrow is destroyed by a combination of alkylating agents and total body radiation. Bone marrow previously obtained from the patient (autograft), or from a related or non-related donor (allograft), is then infused intravenously. The cells migrate from the blood stream into the bone marrow.

This technique is useful in diseases which are chemo- or radio-sensitive, where intensive treatment would increase the chances of cure, but where bone marrow toxicity limits the dose. Bone marrow can often be obtained from family members (siblings have a 1 in 4 chance of tissue compatibility). Graft rejection is rare but the marrow cells can attack the recipient’s normal cells (graft vs. host disease) causing skin and liver disease. This is reduced by removing the T-lymphocytes from the bone marrow with monoclonal antibodies.

In autografting, the marrow is taken from the patient during a remission, when it is free of demonstrable malignant cells, and frozen. There is a risk that undetected malignant cells may still be present in the marrow, which is therefore pre-treated in various ways in an attempt to eliminate malignant cells.

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