Bone marrow is the spongy tissue inside some of the bones in the body, including

the hip and thigh bones. Bone marrow contains immature cells, called stem cells.

Many people with blood cancers, such as leukemia and lymphoma, sickle cell anemia,
and other life-threatening diseases, rely on bone marrow or cord blood transplants
to survive.

Healthy bone marrow and blood cells are needed in order to live. When disease
affects bone marrow so that it can no longer function effectively, a marrow or cord
blood transplant could be the best treatment option; for some patients it is the
only potential cure.
Fast facts on bone marrow

Here are some key points about bone marrow. More detail is in the main article.

Bone marrow produces 200 billion new red blood cells every day, along with
white blood cells and platelets.
Bone marrow contains mesenchymal and hematopoietic stem cells.
Around 10,000 people in the US are diagnosed each year with diseases that
require bone marrow transplants.
Several diseases pose a threat to bone marrow and prevent bone marrow from
turning stem cells into essential cells.

What is bone marrow?

Bone marrow is soft, gelatinous
centers of bones. The two types
myeloid tissue, and yellow bone
bone anatomy
Long bone cross-section showing
tissue that fills the medullary cavities, the
of bone marrow are red bone marrow, known as
marrow, or fatty tissue.1
both red and yellow bone marrow.

Both types of bone marrow are enriched with blood vessels and capillaries.2

Bone marrow makes more than 200 billion new blood cells every day.8 Most blood
cells in the body develop from cells in the bone marrow.5
Bone marrow stem cells

The bone marrow contains two types of stem cells, mesenchymal and hematopoietic.

Red bone marrow consists of a delicate, highly vascular fibrous tissue containing
hematopoietic stem cells. These are blood-forming stem cells.

Yellow bone marrow contains mesenchymal stem cells, also known as marrow stromal
cells. These produce fat, cartilage, and bone.4

Stem cells are immature cells that can turn into a number of different types of
cell.

Hematopoietic stem cells in the bone marrow give rise to two main types of cells:
myeloid and lymphoid lineages. These include monocytes, macrophages, neutrophils,
basophils, eosinophils, erythrocytes, dendritic cells, and megakaryocytes or
platelets, as well as T cells, B cells, and natural killer cells.

The different types of hematopoietic stem cells vary in their regenerative capacity
and potency.

Some are multipotent, oligopotent or unipotent as determined by how many types of

cell they can create.
Pluripotent hematopoietic stem cells have the following properties:

Renewal: They can reproduce another cell identical to themselves.

Differentiation: They can generate one or more subsets of more mature cells.

The process of development of different blood cells from these pluripotent stem
cells is known as hematopoiesis.11

It is these stem cells that are needed in bone marrow transplant.

Stem cells constantly divide and produce new cells. Some new cells remain as stem
cells and others go through a series of maturing stages, as precursor or blast
cells, before becoming formed, or mature, blood cells. Stem cells rapidly multiply
to make millions of blood cells each day.10

Blood cells have a limited life span. This is around 100-120 days for red blood
cells. They are constantly being replaced. The production of healthy stem cells is
vital.12

The blood vessels act as a barrier to prevent immature blood cells from leaving the
bone marrow.

Only mature blood cells contain the membrane proteins required to attach to and
pass through the blood vessel endothelium. Hematopoietic stem cells can cross the
bone marrow barrier, however. These may be harvested from peripheral, or
circulating, blood.15

The blood-forming stem cells in red bone marrow can multiply and mature into three
significant types of blood cells, each with their own job:

Red blood cells (erythrocytes) transport oxygen around the body

White blood cells (leukocytes) help fight infection and disease. White blood
cells include lymphocytes - the cornerstone of the immune system - and myeloid
cells which include granulocytes: neutrophils, monocytes, eosinophils, and
basophils
Platelets (thrombocytes) help with clotting after injury. Platelets are
fragments of the cytoplasm of megakaryocytes, another bone marrow cell.

Once mature, these blood cells move from the marrow into the bloodstream, where
they perform important functions required to keep the body alive and healthy.7

Mesenchymal stem cells are found in the bone marrow cavity. They differentiate into
a number of stromal lineages, such as:

chondrocytes (cartilage generation)

osteoblasts (bone formation)
osteoclasts
adipocytes (adipose tissue)
myocytes (muscle)
macrophages
endothelial cells
fibroblasts.6

Red bone marrow

Red bone marrow produces all red blood cells and platelets in human adults and
around 60 to 70 percent of lymphocytes. Other lymphocytes begin life in the red
bone marrow and become fully formed in the lymphatic tissues, including the thymus,
spleen, and lymph nodes.1
Together with the liver and spleen, red bone marrow also plays a role in getting
rid of old red blood cells.
Yellow bone marrow

Yellow bone marrow mainly acts as a store for fats. It helps to provide sustenance
and maintain the correct environment for the bone to function. However, under
particular conditions, such as severe blood loss or fever, the yellow marrow may
revert to red marrow.1

Yellow marrow tends to be located in the central cavities of long bones, and is
generally surrounded by a layer of red marrow with long trabeculae (beam-like
structures) within a sponge-like reticular framework.6
Bone marrow timeline

Before birth, bone marrow first develops in the clavicle toward the end of fetal
development. It becomes active about 3 weeks later. Bone marrow takes over from the
liver as the major hematopoietic organ at 32 to 36 weeks' gestation.

Bone marrow remains red until around the age of 7 years, as the need for new
continuous blood formation is high. As the body ages, the red marrow is gradually
replaced by yellow fat tissue. Adults have an average of about 2.6 kg (5.7 lbs) of
bone marrow, about half of which is red.3

In adults, the highest concentration of red marrow is in the bones of the

vertebrae, hips (ilium), breastbone (sternum), ribs, skull and at the metaphyseal
and epiphyseal ends of the long bones of the arm (humerus) and leg (femur and
tibia). All other cancellous, or spongy, bones and central cavities of the long
bones are filled with yellow marrow.
Function
bone marrow with stem cells
Blood cell formation from differentiation of hematopoietic stem cells in red bone
marrow.

Most red blood cells, platelets, and most of the white blood cells are formed in
the red marrow. Yellow bone marrow produces fat, cartilage, and bone.

White blood cells survive from a few hours to a few days, platelets for about 10
days, and red blood cells for about 120 days. These cells must be constantly
replaced by the bone marrow, as each blood cell has a set life expectancy.

Certain conditions may trigger additional production of blood cells. This may
happen when the oxygen content of body tissues is low, if there is loss of blood or
anemia, or if the number of red blood cells decreases. If these happen, the kidneys
produce and release erythropoietin, a hormone that stimulates the bone marrow to
produce more red blood cells.

The bone marrow also produces and releases more white blood cells in response to
infections, and more platelets in response to bleeding. If a person experiences
serious blood loss, yellow bone marrow can be activated and transformed into red
bone marrow.

Healthy bone marrow is important for a range of systems and activities.

Circulatory system

The circulatory system touches every organ and system in the body. It involves a
number of different cells with a variety of functions. Red blood cells transport
oxygen to cells and tissues, platelets are carried in the blood to help blood clot
after injury, and white blood cells are transported to sites of infection or
injury.
Hemoglobin

Hemoglobin is the protein in red blood cells that gives them their color.
Hemoglobin collects oxygen in the lungs, transports it in the red blood cells, and
releases oxygen to tissues such as the heart, muscles, and brain. Carbon dioxide
(CO2), a waste product of respiration, is also removed by hemoglobin and sent back
to the lungs to be exhaled.
Iron

Iron is an important nutrient for human physiology. It combines with protein to

make the hemoglobin in red blood cells and is essential in the production of red
blood cells (erythropoiesis). The body stores iron in the liver, spleen, and bone
marrow. Most of the iron needed each day for making hemoglobin comes from the
recycling of old red blood cells.
Red blood cells

The production of red blood cells is called erythropoiesis. It takes about 7 days
for a committed stem cell to mature into a fully functional red blood cell. As red
blood cells age, they become less active and more fragile.

Aging red cells are removed or eaten up by a type of white blood cell, or
macrophage, in a process known as phagocytosis. The contents of these cells are
released into the blood. The iron released in this process is carried to either the
bone marrow for production of new red blood cells or to the liver or other tissues
for storage.

Normally, around 1 percent of the body's total red blood cells are replaced every
day. In a healthy person, around 200 billion red blood cells are produced each day.
White blood cells

The bone marrow produces many types of white blood cells. These are necessary for a
healthy immune system. They prevent and fight infections.

The main types of white blood cell, or leukocyte, are:

1) Lymphocytes

Lymphocytes are produced in bone marrow. They make natural antibodies to fight
infection caused by viruses that enter the body through the nose, mouth or other
mucous membrane, or through cuts and grazes. Specific cells recognize the presence
of foreign invaders (antigens) that enter the body and send a signal to other cells
to attack the antigens.

The number of lymphocytes increases in response to these invasions. There are two
major types of lymphocyte: B- and T-lymphocytes.
2) Monocytes

Monocytes are produced in the bone marrow. Mature monocytes have a life expectancy
in the blood of only 3 to 8 hours, but when they move into the tissues, they mature
into larger cells called macrophages. Macrophages can survive in the tissues for
long periods of time where they engulf and destroy bacteria, some fungi, dead
cells, and other material foreign to the body.
3) Granulocytes

Granulocyte is the family or collective name given to three types of white blood
cells: neutrophils, eosinophils and basophils. The development of a granulocyte may
take two weeks, but this time is shortened when there is an increased threat, such
as a bacterial infection.
Bone marrow stores a large reserve of mature granulocytes. For every granulocyte
circulating within the blood, there may be 50 to 100 cells waiting in the marrow to
be released into the blood stream. As a result, half the granulocytes in the blood
stream can be available to actively fight an infection in the body within 7 hours
of detecting an infection.

Once a granulocyte has left the blood, it does not normally return. A granulocyte
may survive in the tissues for up to 4 to 5 days, depending on the conditions, but
it only survives for a few hours in the circulation.
4) Neutrophils

Neutrophils are the most common granulocyte. They can attack and destroy bacteria
and viruses.
5) Eosinophils

Eosinophils are involved in the fight against many types of parasitic infections
and against the larvae of parasitic worms and other organisms. They are also
involved in some allergic reactions.
6) Basophils

Basophils are the least common of the white blood cells and respond to various
allergens that cause the release of histamines, heparin, and other substances.

Heparin is an anticoagulant. It prevents blood from clotting. Histamines are

vasodilators that cause irritation and inflammation. Releasing these substances
makes a pathogen more permeable, and allows for white blood cells and proteins to
enter tissues to engage the pathogen.

The irritation and inflammation in tissues affected by an allergen is part of the

reaction seen in hay fever, some forms of asthma, hives, and in its most serious
form, anaphylactic shock.
Platelets

Bone marrow produces platelets in a process known as thrombopoiesis. Platelets are

needed for blood to coagulate and for clots to form, to stop bleeding.

Sudden blood loss triggers platelet activity at the site of an injury or wound.
Here, the platelets clump together and combine with other substances to form
fibrin. Fibrin has a thread-like structure and forms an external scab or clot.

Platelet deficiency causes the body to bruise and bleed more easily. Blood may not
clot well at an open wound, and there may be a greater risk for internal bleeding
if the platelet count is very low.
Lymphatic system

The lymphatic system consists of lymphatic organs such as bone marrow, the tonsils,
the thymus, the spleen and lymph nodes.

All lymphocytes develop in the bone marrow from immature cells called stem cells.
Lymphocytes that mature in the thymus gland (behind the breastbone) are called T-
cells. Those that mature in the bone marrow or lymphatic organs are called B-
cells.14
Immune system

The immune system protects the body from disease. It kills unwanted micro-organisms
such as bacteria and viruses that may invade the body.
How does the immune system fight against infection?

Small glands called lymph nodes are scattered throughout the body. Once lymphocytes
are made in the marrow, they travel to the lymph nodes. The lymphocytes can then
travel between each node through lymphatic channels that meet at large drainage
ducts that empty into a blood vessel. Lymphocytes enter the blood through these
ducts.

Three major types of lymphocytes play an important part of the immune system:
B-lymphocytes (B-cells)
lymphocytes
There are three types lymphocytes. T-lymphocytes, B-lymphocytes, and natural killer
cells.

These cells originate from hematopoietic stem cells in the bone marrow in mammals.

B-cells express B-cell receptors (BCRs) on the surface of the cells. These allow
the cell to attach to an antigen on the surface of an invading microbe or other
antigenic agent.

For this reason, B-cells are known as antigen-presenting cells as they alert other
cells of the immune system to an invading microbe.

B-cells also secrete antibodies which attach to the surface of infection-causing

microbes. These antibodies are Y-shaped, and each one is akin to a specialized
"lock" into which a matching antigen "key" fits. As such, each Y-shaped antibody
reacts to a different microbe, triggering a larger immune system response with the
aim of fighting infection.

In some circumstances, B-cells erroneously identify the normal cells of the human
body as being antigens that require an immune system response. This is the
mechanism that lies behind the development of autoimmune diseases such as multiple
sclerosis, scleroderma, and type 1 diabetes.
T-lymphocytes (T-cells)

These cells are so-called because they mature in the thymus, a small organ in the
upper chest, just behind the sternum (some T-cells mature in the tonsils). There
are many different types of T-cells, and they perform a range of functions as part
of adaptive cell-mediated immunity. T-cells help B-cells make antibodies against
invading bacteria, viruses, or other microbes.

Unlike B-cells, some T-cells engulf and destroy pathogens directly, after binding
to the antigen on the surface of the microbe.

Natural killer T-cells, not to be confused with natural killer cells of the innate
immune system, bridge the adaptive and innate immune systems. NKT cells recognize
antigens presented in a different way to many other antigens, and can perform the
functions of T-helper cells and cytotoxic T-cells. They can also recognize and
eliminate some tumor cells.
Natural killer (NK) cells

These are a type of lymphocyte that directly attacks cells which have been infected
by a virus.
Transplants

A bone marrow transplant can be used for various reasons.

It can replace diseased, nonfunctioning bone marrow with healthy functioning

bone marrow. This is used for conditions such as leukemia, aplastic anemia, and
sickle cell anemia.
It can regenerate a new immune system that will fight existing or residual
leukemia or other cancers not killed by chemotherapy or radiation.
 It can replace bone marrow and restore its normal function after high doses of
chemotherapy or radiation are given to treat a malignancy.
It can replace bone marrow with genetically healthy, functioning bone marrow to
prevent further damage from a genetic disease process, such as Hurler's syndrome
and adrenoleukodystrophy.

Stem cells are primarily located in four places:

an embryo
bone marrow
peripheral blood, found in blood vessels throughout the body
cord blood, found in the umbilical cord and collected after birth9

Stem cells for transplantation are obtained from any of these except the fetus.

Hematopoietic stem cell transplantation involves the intravenous infusion of stem

cells collected from bone marrow, peripheral blood, or umbilical cord blood.

This is used to re-establish hematopoietic function in patients whose bone marrow

or immune system is damaged or defective.17

More than 50,000 first hematopoietic stem cell transplantation procedures, 28,000
autologous transplantation procedures, and 21,000 allogeneic transplantation
procedures are performed every year worldwide, according to the first report of the
Worldwide Network for Blood and Marrow Transplantation.

This number continues to increase by 10 to 20 percent annually. Reductions in organ

damage, infection, and severe, acute graft versus host disease (GVHD) seem to be
contributing to improved outcomes.

In a study of 854 patients who had survived at least 2 years after autologous
hematopoietic stem cell transplantation (HSCT) for hematologic malignancy, 68.8
percent were still alive 10 years after transplantation.17

Bone marrow transplant is the leading treatment for conditions that threaten bone
marrow's ability to function, such as leukemia.

A transplant can help rebuild the body's capacity to produce blood cells and bring
their numbers to normal levels. Illnesses that may be treated with a bone marrow
transplant include both cancerous and noncancerous diseases.

Cancerous diseases may or may not specifically involve blood cells, but cancer
treatment can destroy the body's ability to manufacture new blood cells.

A person with cancer will normally undergo chemotherapy before transplantation.

This will eliminate the compromised marrow.

A matching donor, in most cases a close family member, then has their bone marrow
harvested and readied for transplant
Types of bone marrow transplant

Types of bone marrow transplant include:

Autologous transplant: patients receive their own stem cells taken from their
peripheral or cord blood to replenish bone marrow
Syngeneic transplant: patients receive stem cells from their identical twin
Allogeneic transplant: patients receive matching stem cells from their sibling,
parent or an unrelated donor
Haploidentical transplantation: a treatment option for the approximately 70% of
patients who do not have an HLA-identical matching donor
Umbilical cord blood: a type of allogeneic transplant. Stem cells are removed
from a newborn baby's umbilical cord right after birth. The stem cells are frozen
and stored until they are needed for a transplant. Umbilical cord blood cells are
very immature so there is less of a need for matching, but blood counts take much
longer to recover.

Tissue type

A person's tissue type is defined as the type of human leukocyte antigen (HLA) on
the surface of most of the cells of their body. HLA is a protein or marker that the
body uses to help it determine if the cell belongs to the body or not.

To check if the tissue type is compatible, doctors assess how many proteins match
on the surface of the donor's and recipient's blood cells. There are millions of
different tissue types but some are more common than others.

Tissue type is inherited, and types are passed on from each parent. This means a
relative will be more likely to have a matching tissue type.

However, if a suitable bone marrow donor cannot be found from family members,
doctors will try to find someone with a compatible tissue type on the bone marrow
donor register.
Pre-transplant tests

Several tests are performed before the bone marrow transplant, to identify any
potential problems.

Tests include:

tissue typing and a variety of blood tests

chest X-ray
pulmonary function tests
CT or CAT scans
heart function tests including an electrocardiogram and echocardiogram (ECG)
bone marrow biopsy
skeletal survey

In addition, a complete dental exam is needed before a bone marrow transplant, to

reduce the risk of infection. Other precautions will also be taken before the
transplant to reduce the patient's risk of infection.
Harvesting bone marrow
iliac crest
The concentration of red marrow is highest in the bones of the hips (ilium). The
doctor will insert a needle into the bone and withdraw some of the bone marrow,
which is then stored and frozen.

Bone marrow can be obtained for examination by bone marrow biopsy and bone marrow
aspiration.

Bone marrow harvesting has become a relatively routine procedure. It is generally

aspirated from the posterior iliac crests while the donor is under either regional
or general anesthesia.17

It can also be taken from the sternum, and from the upper tibia in children,
because it still contains a substantial amount of red bone marrow.

The doctor will insert a needle into the bone, usually in the hip, and withdraw
some of the bone marrow. It is then stored and frozen.
Guidelines established by the National Marrow Donor Program (NMDP) limit the volume
of bone marrow removed to 15 mL/kg of donor weight. A dose of 1 X 103 and 2 X 108
marrow mononuclear cells per kilogram are required to establish engraftment in
autologous and allogeneic marrow transplants, respectively.

Complications related to bone marrow harvesting are rare. They involve problems
related to anesthesia, infection and bleeding.

Another way to evaluate bone marrow function is to give certain drugs that
stimulate the release of stem cells from the bone marrow into circulating blood.
The blood sample is then obtained, and stem cells are isolated for microscopic
examination. In newborns, stem cells may be retrieved from the umbilical cord.
How is bone marrow transplanted?

Before the transplant, chemotherapy, radiation, or both may be given. This may be
done in two ways:

Ablative (myeloablative) treatment: High-dose chemotherapy, radiation, or both

are given to kill any cancer cells. This also kills all healthy bone marrow that
remains, and allows new stem cells to grow in the bone marrow
Reduced intensity treatment, or a mini transplant: Patients receive lower doses
of chemotherapy and radiation before a transplant. This allows older patients and
those with other health problems to have a transplant.

A stem cell transplant is usually done after chemotherapy and radiation are
complete.

The infusion of either bone marrow or peripheral blood is a relatively simple

process that is performed at the bedside. The bone marrow product is infused
through a central vein through an IV tube over a period of several hours.
Autologous products are almost always cryopreserved; they are thawed at the bedside
and infused rapidly over a period of several minutes.17

After entering the bloodstream, the hematopoietic stem cells travel to the bone
marrow. There, they begin to produce new white blood cells, red blood cells, and
platelets in a process known as engraftment. Engraftment usually occurs 2 to 4
weeks after transplantation.4

Minimal toxicity has been observed in most cases. ABO-mismatched bone marrow
infusions can sometimes lead to hemolytic reactions. Dimethyl sulfoxide (DMSO),
which is used for the cryopreservation of stem cells, may give rise to facial
flushing, a tickling sensation in the throat, and a strong taste in the mouth (the
taste of garlic). Rarely, DMSO can cause bradycardia, abdominal pain,
encephalopathy or seizures, and renal failure.

To avoid the risk of encephalopathy, which occurs with doses above 2 g/kg/day of
DMSO, stem cell infusions exceeding 500 mL are infused over 2 days, and the rate of
infusion is limited to 20 mL/min.

Doctors regularly check blood counts. Complete recovery of immune function can take
several months for autologous transplant recipients and 1 to 2 years for patients
receiving allogeneic or syngeneic transplants.

Blood tests will confirm that new blood cells are being produced and that any
cancer has not returned. Bone marrow aspiration can also help doctors determine how
well the new marrow is working.4
Risks
Complications associated with HSCT include both early and late effects.17

Early-onset problems include:

mucositis
hemorrhagic cystitis
prolonged, severe pancytopenia
infection
GVHD (Graft versus host disease)
graft failure
pulmonary complications
hepatic veno-occlusive disease
thrombotic microangiopathy

Late-onset problems include:

chronic GVHD
ocular effects
endocrine effects
pulmonary effects
musculoskeletal effects
neurologic effects
immune effects
infection
congestive heart failure
subsequent malignancy

Major risks include increased susceptibility to infection, anemia, graft failure,

respiratory distress, and excess fluid, which can lead to pneumonia and liver
dysfunction.

A mismatch between donor and recipient tissues can lead to an immune reaction
between cells of the host and cells of the graft.

When graft cells attack host cells, the result is a dangerous condition called
graft-versus-host disease (GVHD), which may be acute or chronic and may manifest as
a skin rash, gastrointestinal illness, or liver disease. The risk of GVHD can be
minimized through careful tissue matching.

Even when a donor antigen match is identical, roughly 40 percent of recipients

still develop GVHD, rising to 60 to 80 percent when only a single antigen is
mismatched. Because of the danger of this complication, autologous transplants are
more commonly performed.

Bone marrow transplantation was not previously recommended for patients aged over
50 years, due to a higher mortality and morbidity rate and an increased incidence
of GVHD in those over the age of 30 years. However, many transplant centers have
performed successful bone marrow transplantations in patients well beyond the age
of 50 years.

There is little risk to those who donate, because they generate new marrow to
replace that which has been removed. There is, however, a slight risk of infection
and a reaction to anesthesia can occur with any surgical procedure.
Diseases
blood smear showing neutrophil, white blood cell and leukemia
Blood smear showing neutrophil, white blood cell and leukemia.

As bone marrow affects many body systems, a problem can result in a wide range of
diseases, including cancers that affect the blood.
A number of diseases pose a threat to bone marrow because they prevent bone marrow
from turning stem cells into essential cells.

Leukemia, Hodgkin's disease, and other lymphoma cancers are known to damage the
marrow's productive ability and destroy stem cells.

A bone marrow examination can help diagnose:1

leukemia
multiple myeloma
Gaucher disease
unusual cases of anemia
other hematological diseases.

A growing number of diseases can be treated with hematopoietic stem cell transfer
(HSCT).

More than half of autologous transplantations are done to treat multiple myeloma
and non-Hodgkin lymphoma. Most allogeneic transplants are performed for hematologic
and lymphoid cancers.

Every 4 minutes in the United States, someone receives a diagnosis of blood cancer.
A bone marrow transplant is often the best chance for survival.

Around 30 percent of patients can find a matching donor in their families, but 70
percent, or around 14,000 each year, rely on marrow donated by someone unrelated.

Autologous HSCT is currently used to treat:

multiple myeloma
non-Hodgkin lymphoma
Hodgkin lymphoma
acute myeloid leukemia
neuroblastoma
germ-cell tumors
autoimmune disorders, such as systemic lupus erythematosus and systemic
sclerosis
amyloidosis

Allogeneic HSCT is used to treat:

acute myeloid leukemia

acute lymphoblastic leukemia
chronic myeloid leukemia
chronic lymphocytic leukemia
myeloproliferative disorders
myelodysplastic syndromes
multiple myeloma
non-Hodgkin lymphoma
Hodgkin lymphoma
aplastic anemia
pure red cell aplasia
paroxysmal nocturnal hemoglobinuria
fanconi anemia
thalassemia major
sickle cell anemia
severe combined immunodeficiency (SCID)
Wiskott-Aldrich syndrome
 hemophagocytic lymphohistiocytosis
genetic disorders relating to metabolism, such as mucopolysaccharidosis
Gaucher disease, metachromatic leukodystrophies, and adrenoleukodystrophies
epidermolysis bullosa
severe congenital neutropenia
Shwachman-Diamond syndrome
Diamond-Blackfan anemia
leukocyte adhesion deficiency

HSCT may also help treat:17

breast cancer, although this is not confirmed

testicular cancer, in some patients at the early stage
some genetic immunologic or hematopoietic disorders

Bone marrow transplants are sometimes needed after certain treatments, such as
high-dose chemotherapy and radiation therapy, used to treat cancer. These
treatments tend to damage healthy stem cells as well as destroying cancer cells.
What to know about leukemia
What to know about leukemia
A stem cell transplant can help treat leukemia
Read now
Bone marrow tests

Bone marrow tests can help diagnose certain diseases, especially those related to
blood and blood-forming organs. Testing provides information on iron stores and
blood production.1

Bone marrow aspiration uses a hollow needle to remove a small sample (about 1 ml)
of bone marrow for examination under a microscope.

The needle is usually inserted into the hip or sternum in adults and into the upper
part of the tibia (the larger bone of the lower leg) in children and suction is
used to extract the sample.

Bone marrow aspiration is typically performed when indicated by previous blood

tests and is particularly useful in providing information on various stages of
immature blood cells.
Donation
stem cells
It is blood stem cells, rather than the bone marrow itself, which are necessary for
the treatment of blood cancers and other diseases.

There are two main types of bone marrow donation.

The first involves the removal of bone marrow from the back of the pelvic bone.

The second, more common method, is called peripheral blood stem cell (PBSC)
donation. This involves filtering stem cells directly from the blood. It is these
blood stem cells, rather than the bone marrow itself, which are necessary for the
treatment of blood cancers and other diseases.

When an individual joins a bone marrow donation registry, they are agreeing to
donate using whichever method the patient's doctor deems appropriate.

In terms of costs, the expense of making a blood marrow donation is usually covered
by either the NMDP or the patient's medical insurance. Donors never pay for
donating, and they are never paid to donate.
The risk to a donor is minimal. Over 99 percent of donors make a full recovery
after the procedure. With blood marrow donation, the major risk involves the use of
anesthesia during the procedure itself.

With PBSC donation, the procedure itself, which involves filtering blood through a
machine, is not considered dangerous.

The chance of finding a suitable bone marrow donor ranges from 66 to 93 percent,
depending on ethnicity.
Who can donate bone marrow8

The following are some general guidelines for bone marrow donation as recommended
by the National Marrow Donor Program (NMDP).

The guidelines aim to protect the health and safety of the donor and the recipient.
Donors are encouraged to contact their local NMDP center for specific details and
to discuss donations with their health care team.

To be listed in the registry, potential donors must be healthy and between the
ages of 18 and 60 years.
If matched with a person needing a transplant, each donor must pass a medical
examination and be infection-free before donating.
People who used medications can normally donate bone marrow, as long as they
are healthy and any medical conditions they have are under control at the time of
donation.

Acceptable medications include birth control pills, thyroid medication.

antihistamines, antibiotics, prescription eye drops, and topical medications, such
as skin creams. Antianxiety and antidepressant drugs are allowed as long as the
condition is under control.

Donate is not possible:

during pregnancy
by anyone using intravenous drugs that are not prescribed by a doctor
if the person has had a positive blood test for hepatitis B or hepatitis C
by those with specific medical conditions, such as most types of cancer or
certain heart conditions

People with Lyme disease, malaria, or recent tattoos or piercings should wait at
least a year before donating bone marrow.
How is a bone marrow match determined?

After registering to donate, the person will undertake an HLA-typing test, which is
used to match up patients with potential donors.

Their HLA type will then be added to a database of potential donors, and a doctor
will search the registry to try to find a match for their patient.

The proteins in the blood cells will be compared to see if they are similar to
those of the recipient. The potential donor will be contacted if there is a match.

The more similar the donor's tissue type is to the patient's, the better the chance
of the patient's body accepting the transplant.

Bone Marrow Donors Worldwide (BMDW) is a collective database of 59 registries in 43

countries, and 37 cord blood registries from 21 countries; 26.35 million potential
stem cell donors and 687 thousand cord blood units were available as of September
2015.19,20 Preliminary searches through the NMDP routinely also explore the BMDW.
What happens when donating bone marrow?

The following studies are routinely performed on hematopoietic stem cell donors:

history and physical examination

serum creatinine, electrolyte, and liver function studies
serologic studies for cytomegalovirus (CMV), herpes viruses, HIV RNA, anti-HIV
antibodies, hepatitis B and C viruses, human T-cell lymphotropic virus-1/2 (HTLV-
I/II), and syphilis (VDRL); in autologous donations, CMV and VDRL testing are not
required
ABO blood typing
HLA typing
chest radiography
Electrocardiography (ECG)

Donating peripheral blood stem cells (PBSC)

Before a person can donate PBSC, they will need to undergo daily injections of a
medication called filgrastim in the five days running up to the procedure. This
medication draws stem cells from the bone marrow, so the donor will have more of
them circulating in their blood.

Donating PBSC involves a procedure known as apheresis. This is when blood is taken
from the body using a catheter inserted in one arm and passed through a machine,
filtering out the stem cells, along with platelets and white blood cells. The
remaining blood (consisting mainly of plasma and red blood cells) then flows back
into the body through a vein in the other arm.

The procedure is completely painless and is similar to donating plasma. PBSC

donation will usually require between two and four sessions, each lasting 2 to 6
hours.

PBSC donation does not require anesthesia. The medication that is given to
stimulate the mobilization (release) of stem cells from the marrow into the
bloodstream may cause bone and muscle aches, headaches, fatigue, nausea, vomiting,
or difficulty sleeping. These side effects usually stop within 2 to 3 days of the
last dose of the medication.
Donating bone marrow

If a person is donating actual bone marrow instead of PBSC, there is no need for
the filgrastim injections. Bone marrow donation is a surgical procedure, carried
out in the operating room, which requires anesthesia and is, therefore, completely
painless. The entire procedure takes between 1 and 2 hours.

In 96 percent of cases, a general anesthetic is used, which means the donor will be
unconscious for the entire procedure. In a small number of cases a local anesthetic
will be used, which simply numbs the area the bone marrow is taken from. In this
situation, the person will be awake throughout the procedure.

The person lies on their stomach. The doctors will make an incision about a quarter
of an inch in length on both sides of the pelvic bone. They then insert special,
hollow needles into the bone, through which they draw the liquid marrow. The
incisions do not normally require stitches.

After the procedure, the donor will stay in a recovery room until they regain
consciousness. Once they can eat, drink and walk, they will be able to leave.
Recovery

After donation, complete recovery may take a couple of days, especially if surgery
was involved.

People who donate bone marrow often experience headaches, fatigue, muscle pain,
back or hip pain, bruising around the incision site, and difficulty walking. This
may persist for up to 2 days, or as long as several weeks.

A person who donates PBSC is unlikely to experience any side effects following the
donation, other than bruising at the needle site. Recovery time is almost
immediate.

After donation, bone marrow replaces itself within 4 to 6 weeks.

Outcome

The outcome of bone marrow transplant depends on:

the type of transplant

how closely the cells match
what type of condition the patient has
the patient's age and overall health
the type and dosage of chemotherapy or radiation therapy used before transplant
any complications

A patient whose condition is stable or in remission has a better chance of a good

outcome compared with someone who has a transplant in a later stage or with
relapsed disease. Young age at time of transplant also improves the chances.

Transplants for nonmalignant diseases tend to have more favorable outcomes, with
survival rate of 70 to 90 percent if the donor is a matched sibling, and 36 to 65
percent if the donor is unrelated.

Transplants for acute leukemia in remission at the time of transplant have survival
rates of 55 to 68 percent if the donor is related, and 26 to 50 percent if the
donor is unrelated.

A bone marrow transplant may completely or partially cure illness. If the

transplant is successful, individuals can go back to most normal activities as soon
as they feel well enough. Full recovery normally takes up to a year.

Related coverage
Bone marrow cancer: What you need to know In this article, learn about the types of
bone marrow cancer, including multiple myeloma, leukemia, and lymphomas. Treatments
include chemotherapy, stem cell therapy, and radiation therapy. The outlook depends
on the stage at diagnosis, how aggressive the cancer is, and individual factors.
Find out more. Read now
What is the difference between leukemia and lymphoma? Leukemia and lymphoma are
both types of blood cancer that affect the white blood cells. There are some
similarities between the two conditions, but the origins, causes, diagnosis, and
treatments are different. In this article, learn about the differences between
leukemia and different types of lymphoma here. Read now
What is leukopenia? Leukopenia is a condition where a person has a reduced number
of white blood cells and an increased risk of infection. Learn more. Read now
How to increase red blood cell count A low red blood cell count, or anemia, can
cause many symptoms and complications, including fatigue and weakness. People can
increase their red blood cell count through simple lifestyle changes, such as
exercising, limiting alcohol, and eating nutrient-rich foods. Learn more here,
including when to see a doctor. Read now
What is the first sign of multiple myeloma? Spotting the early signs of multiple
myeloma means it is easier to treat the disease. However, this type of cancer has
no cure and can lead to other conditions developing. Treatment options depend on
the individual case. Learn more about the signs of multiple myeloma, and when to
see a doctor, here. Read now
email
share
Stem Cell Research
Blood / Hematology
Cancer / Oncology
Additional information

Article last updated by Yvette Brazier on Fri 15 December 2017.

Visit our Stem Cell Research category page for the latest news on this subject,
or sign up to our newsletter to receive the latest updates on Stem Cell Research.

All references are available in the References tab.

References
Citations
Latest news

Dementia risk higher in those who eat more trans fats

Dementia risk higher in those who eat more trans fats
Women and men at risk of different obesity-related conditions
Women and men at risk of different obesity-related conditions
Yogurt, fiber, and lung cancer: What's the link?
Yogurt, fiber, and lung cancer: What's the link?
Exercising before breakfast may be most healthful choice
Exercising before breakfast may be most healthful choice
Could turmeric help solve the antibiotic resistance crisis?
Could turmeric help solve the antibiotic resistance crisis?

Popular in: Stem Cell Research

New stem cells could be 'universally transplanted'

Honeybees may hold the secret to stem cell youth