Repeated bone marrow transplant. Bone marrow transplantation

Today's opportunities modern medicine allow you to cope with many pathological conditions, including those that until recently were considered completely incurable. Cancer, which is diagnosed in more than a million people all over the planet every year, is one of these diseases. For successful elimination oncological diseases may be carried out surgery, chemotherapy or radiation therapy, also effective method treatment is organ transplantation. The topic of our conversation today will be cell transplantation bone marrow, in addition, we will find out how the patient’s life develops after a bone marrow transplant.

Bone marrow is a spongy tissue found inside large bones. Certain parts of it produce stem cells, which in turn produce blood cells: leukocytes, erythrocytes and platelets. Thus, it begins precisely in the bone marrow.

Who needs a bone marrow transplant?

In leukemia, aplastic anemia and some immune deficiencies, bone marrow stem cells begin to function incorrectly. They can produce excessive quantities of low-quality (defective or immature) blood cells or such synthesis may simply decrease.

In addition, the bone marrow may suffer due to aggressive chemotherapy or radiotherapy, in which case the transplant will increase the likelihood of recovery or, at least, lengthen the period free from the disease and prolong life.

How is a bone marrow transplant performed?

A bone marrow transplant involves destroying the patient's diseased bone marrow and introducing healthy bone marrow from a donor into the patient's bloodstream. The injection procedure itself most often does not cause pain and lasts about an hour. Afterwards, the cells begin to take root little by little, and sometimes to speed up this process medications are used that stimulate the activity of the hematopoietic organ. If the transplantation was successful, the transplanted material migrates inside the cavities in the large bones, then takes root and actively produces full-fledged blood cells.

To monitor the effectiveness of the bone marrow transplant, the patient is given a daily blood test and the number of neutrophils in it is studied. If their indicator increases to 500 in three days, then the operation was successful. Engraftment of stem cells occurs in approximately twenty-one to thirty-five days.

Genetically compatible donor material can be used for transplantation. The greatest likelihood of such compatibility is observed among blood relatives, also genetic compatibility can be found in any foreign donor. Only in extreme cases can incompatible material be transplanted, which is subjected to serious processing to reduce the likelihood of rejection.

What is life like after a bone marrow transplant?

A bone marrow transplant itself is a physically, emotionally and mentally difficult procedure for both the patient and his loved ones. Transplantation leads to feelings of severe weakness, nausea, vomiting, fever, diarrhea, and others. unpleasant symptoms. Any activity requires significant effort from a person.

The first few weeks (up to a month) after the transplant are considered the most critical, because the patient’s immune system and defense system are damaged. In this case, the patient has a high tendency to bleeding and various diseases, he is given systematic blood transfusions (especially platelets) and antibiotics. To prevent rejection, the patient is given immunosuppressants.

After the transplant, doctors take all measures that can prevent the patient from becoming infected with any viruses or bacteria. Both hospital staff and visitors must wear special protective gowns, as well as masks and gloves, before entering a patient’s room.

You cannot bring into the room any food or things that can become a source of fungi and bacteria. This also applies to vegetables, fruits and flowers.
When leaving the room, the patient must put on a gown, mask and gloves. He undergoes daily blood tests to monitor the process of engraftment of the transplanted material and evaluate general state body.

Over time, the patient ceases to depend on antibacterial therapy, blood and platelet transfusions. After the bone marrow begins to function normally and produce sufficient quantity blood cells, the person is discharged from the hospital. Typically, from transplantation of material to discharge of the patient takes from four to eight weeks.

However, after this time, the patient must be under the supervision of doctors: he needs to periodically visit the doctor for at least a year. All this time, he may periodically be bothered by infectious lesions and various complications, requiring adequate and timely correction.

Most patients note that their quality of life has improved significantly after bone marrow transplantation. However, the fear of the disease returning often does not leave them. After the transplant procedure, you need, of course, to monitor your health, but if panic becomes excessive, you should definitely consult a psychologist.

A bone marrow transplant is quite difficult, but at the same time effective operation, which helps save life and get rid of many serious illnesses.

Traditional treatment

Herbs and available remedies will help improve the body's functioning and prevent diseases that require a bone marrow transplant.

For this purpose, specialists traditional medicine It is recommended to use flax seeds. Brew a couple of teaspoons of this raw material with a glass of just boiled water and leave in a thermos for a couple of hours. Take the finished product one tablespoon two or three times a day, about half an hour before meals.

Drinking tea made from strawberry leaves also has a good preventive effect. Brew a handful of such raw materials with a liter of boiling water and keep in a thermos for three hours. Sweeten the strained drink with honey and drink without restrictions.

Bone marrow is a spongy substance responsible for the constant renewal of blood and its composition. Every day, 500 billion blood cells are produced for the full functioning of a person and the smooth functioning of the body.

The bone marrow contains primary blood cells called stem cells. In the process, three types of mature cells are formed from them:

• Leukocytes;
• Platelets;
• Red blood cells;

Due to a number of diseases, the process of blood formation may be disrupted and body functions are not fully performed. If conservative therapy does not help eliminate the pathology, the patient is prescribed a bone marrow transplant.

This area of ​​medicine has been thoroughly studied by doctors academic degrees all over the world, but absolute answers to questions related to the innervation of the bone marrow have not been found.

Bone marrow transplantation (BMT) has been successfully used since 1968 in the complex treatment of immunodeficiency pathologies, hematopoietic abnormalities, as well as lymphoma and leukemia (blood cancer).

Video

For the purpose of health education, we decided to talk not only about toxic charges as such, but also about the various components of these charges, such as medical diagnoses, so that it is easier for the donor to understand what and why the money is being raised.

Transplantation or bone marrow transplant is a procedure that is used in the treatment of both adults and children suffering from leukemia (blood cancer), as well as aplastic anemia, lymphomas (such as lymphogranuomatosis or Hodgkin's lymphoma), multiple myeloma, and serious immune disorders.

Bone marrow - is a spongy tissue that is found in the sternum, skull bones, femurs, ribs and contains stem cells, from which blood cells are produced. Blood consists of white blood cells - leukocytes that protect the body from infections, red blood cells - red blood cells that carry oxygen, and platelets that allow the blood to clot.

Defective or immature blood cells fill the bone marrow and blood vessels, displace normal blood cells from the bloodstream and can spread to other tissues and organs. Large doses of chemotherapy and/or radiation therapy are required to destroy diseased blood cells and bone marrow. This treatment damages not only defective bone marrow cells, but also healthy bone marrow cells.
In a bone marrow transplant, the patient's diseased bone marrow is destroyed and the donor's healthy bone marrow is introduced into the patient's bloodstream. In a successful transplant, the transplanted bone marrow migrates into cavities in the large bones, takes root, and begins to produce normal blood cells.

If bone marrow obtained from an identical twin is used, the transplant is called syngeneic, or allogeneic if the bone marrow is obtained from a donor. In an allogeneic (i.e., non-relative) transplant, the donor bone marrow given to the patient must genetically match the patient's own as much as possible. To determine the compatibility of the donor and recipient, special blood tests are performed.

If the donor's bone marrow does not match the recipient's tissues genetically enough, it may perceive the tissues of the recipient's body as foreign material, attack and begin to destroy it. This condition is known as graft-versus-host disease (GVHD) and can be life-threatening. On the other side, the immune system the patient may destroy the transplanted bone marrow. This is called a rejection reaction (graftrejection)
In some cases, the patient may be a bone marrow donor for themselves. This is called an autologous transplant and is possible when the disease affecting the bone marrow is in remission, or when the condition requiring treatment does not affect the bone marrow (for example, breast cancer, ovarian cancer, lymphogranulomatosis, non-Hodgkin's lymphomas and brain tumors).

PREPARATION FOR TRANSPLANT

Successful bone marrow transplant possible if the patient is “healthy enough” to undergo such a serious procedure, which is a bone marrow transplant. Age, general physical state, diagnosis and stage of the disease are all taken into account when deciding whether a patient is eligible for a transplant. Before a transplant, the patient undergoes many tests.

Studies of the condition of the heart, lungs, kidneys and other vital important organs It is also used to obtain information about their baseline level, so that after bone marrow transplantation it can be compared and determined whether there has been an improvement in any function. Preliminary tests are usually performed on an outpatient basis before hospitalization.

An important role in bone marrow transplantation is played by a lot of little details, knowledge and consideration of which can very significantly affect the results of the transplant. Successful transplant bone marrow requires a highly professional medical team - doctors, nurses, support staff who have good experience in this area and are ready to immediately recognize and respond to possible problems and side effects.

That's why right choice clinic for bone marrow transplantation is essential to obtain the desired result. In clinics that specialize in bone marrow transplantation, the transplantation program necessarily includes providing emotional and psychological support before, during and after transplantation.

RECEIVING BONE MARROW FROM A DONOR

Transplantation now saves thousands of lives every year, but unfortunately, almost 70 percent of those in need of a transplant do not undergo it because they cannot find a compatible donor.

There is only a 35% chance that a patient will have a sibling whose bone marrow is a good match. If the patient does not have a suitable relative for a transplant, a donor may be found in an international bone marrow donor registry, or an incompletely compatible bone marrow transplant may be used. Regardless of whether the bone marrow from the donor or the patient or relative is used for transplantation, The bone marrow harvesting procedure is performed in the operating room, usually under general anesthesia. This contributes minimal risk and minimizes discomfort.

While the patient is under anesthesia, a special needle is inserted into the cavity femur legs or ilium pelvis. The amount of bone marrow required for a bone marrow transplant depends on the size of the patient and the concentration of bone marrow cells in the material taken. Typically, 950 to 2000 milliliters of a mixture consisting of bone marrow and blood are taken. Although this amount seems large, it actually represents only about 2% of a person's bone marrow volume, and a healthy donor's body replenishes it within four weeks.

After the bone marrow harvesting procedure, the donor may feel some discomfort at the puncture site, the pain is usually similar to that which occurs after strong fall on ice and is mostly relieved with painkillers. The donor is usually discharged from the hospital the next day and can return to normal activities within the next few days.
In autologous transplantation, the harvested bone marrow is frozen and stored at -80 to -196 degrees Celsius until the date of transplantation. It can be cleaned first to extract the remaining cancer cells, which cannot be identified under a microscope.

In an allogeneic transplant, the bone marrow can be processed to extract T cells to reduce the risk of graft-versus-host disease. The bone marrow is then transferred directly to the patient's room for intravenous administration.

PREPARATION REGIME FOR TRANSPLANTATION

In the process of preparing the patient in large vein Usually a small flexible tube called a catheter is inserted in the neck area. This catheter is required to administer medications and blood products to the patient, to take blood tests during the course of treatment, and also to avoid hundreds of punctures of the veins in the arms.

While in the bone marrow transplant unit, the patient undergoes chemotherapy and/or radiation for several days, which destroys his own bone marrow and cancer cells and makes room for new bone marrow. This is called conditioning or preparatory mode. The dose of chemotherapy that is given to the patient during preparation is significantly higher than the doses that are administered to patients suffering from diseases that do not require a bone marrow transplant. Patients may feel weak, nauseated and irritable. To minimize discomfort, most bone marrow transplant centers administer anti-nausea medications to patients.

BONE MARROW TRANSPLANT PROCEDURE

The bone marrow transplant procedure itself is performed one to two days after chemotherapy and/or radiation. The bone marrow is given intravenously, similar to a blood transfusion. The transplant is not a surgical procedure, so it is performed in the patient's room rather than in the operating room. During a bone marrow transplant, the patient is often checked for fever, chills, and chest pain.

A bone marrow transplant is a physically, emotionally and mentally difficult procedure for both the patient and his loved ones. The patient needs and should receive the best possible help to cope with all this. Imagine the signs severe flu- nausea, vomiting, fever, diarrhea, extreme weakness. Now imagine what it's like when all these symptoms last not for a few days, but for a few weeks.

After the transplant is completed, days and weeks of waiting begin, during this period the patient feels very sick and weak. Walking, sitting in bed for long periods of time, reading books, talking on the phone, visiting friends and even watching television require more energy from the patient than he has. Complications that may develop after a bone marrow transplant, such as infections, bleeding, rejection reactions, and liver problems, may cause additional discomfort. In addition, sores may appear in the mouth, making it difficult to eat and painful to swallow. However, pain is usually well controlled with medication. Sometimes there are temporary mental disorders, which can frighten the patient and his family, but one must realize that these disorders are temporary.

BONE MARROW ENVIRONMENT

The first 2-4 weeks after a bone marrow transplant are the most critical. While the transplanted bone marrow migrates into the bone cavities big bones, takes root there and begins to produce normal blood cells, it is very susceptible to any infection and has a pronounced tendency to bleed. Platelet transfusion helps fight bleeding. Patients after an allogeneic transplant receive the same additional medications, allowing to prevent and control graft-versus-host disease. To help prevent and control infection, and to minimize the patient's risk of contracting viruses and bacteria, the patient is given a variety of antibiotics and blood transfusions. Visitors and hospital staff wash their hands with antiseptic soap and, in some cases, wear protective gowns, gloves and masks when entering a patient’s room. These rules are followed by the patient himself, when leaving the room, he must wear a mask, gown and gloves, which are a barrier against bacteria and viruses, and warn others that he is susceptible to infection. Fresh fruits, vegetables, plants and bouquets of flowers are prohibited from being brought into the patient’s room, as they are often sources of fungi and bacteria that pose a danger to the patient.

Blood tests should be taken daily to determine how the new bone marrow is engrafting and to assess the status of body functions. After the transplanted bone marrow has finally taken root and begins to produce a sufficient number of healthy red blood cells, white blood cells and platelets, the patient gradually ceases to be dependent on the administration of antibiotics, blood transfusions and platelets, which gradually become unnecessary. If not developed, any additional complications the patient is discharged from the hospital. After a bone marrow transplant, patients typically spend 4 to 8 weeks in the hospital.

HOW TO CANDLE EMOTIONAL STRESS

In addition to the physical discomfort associated with a bone marrow transplant, there is also emotional and mental discomfort. Some patients find that the psychological stress of this situation is even more severe for them than the physical discomfort.

Psychological and emotional stress is associated with several factors:

First, the patient undergoing a bone marrow transplant is already traumatized by the fact that he is suffering from a life-threatening disease. Although the transplant gives him hope of a cure, the prospect of undergoing a long, severe medical procedure, which does not guarantee success, is not encouraging.

Second, transplant patients can feel quite lonely and isolated. Special measures taken to protect patients from infection while their immune systems are compromised can make them feel cut off from the rest of the world and from almost all normal human contact. This sense of isolation is experienced by the patient precisely when he needs physical contact and support from family and friends as much as possible.

Feelings of helplessness are also a common experience among bone marrow transplant patients, causing them to feel angry or resentful. For many, the feeling that their lives are completely dependent on strangers, they also feel awkward when they have to depend on outside help in daily hygiene procedures, such as washing or using the toilet.

The recovery period is like a roller coaster - one day the patient feels much better, and the next few days he may feel seriously ill again. Waiting for blood tests to return to safe values ​​and for side effects finally disappeared, increases emotional trauma.

DISCHARGE FROM HOSPITAL

After discharge from the hospital, the patient continues the recovery process at home for an additional two to four months and is unable to return to his normal job, due to at least, in the next six months after transplantation. To monitor the recovery, the patient needs frequent visits to the hospital in order to administer to the recovering medications and, if necessary, administer blood transfusions. Although the patient feels well enough to leave the hospital, his recovery process is far from complete. During the first few weeks, he still feels too weak to do anything other than sleep, sit, and take a short walk around the house. For up to six months or more from the date of transplantation, the patient's white blood cell count is often too low to provide sufficient protection against viruses and bacteria encountered in everyday life, so contact with the general public must be limited. A person recovering from a bone marrow transplant is prohibited from visiting movie theaters, grocery stores, department stores, etc. Such people must wear a protective mask when they venture out of the house.

LIFE AFTER BONE MARROW TRANSPLANTATION

It can take up to a year for the new bone marrow to start functioning like its own. Life after a transplant can be both exciting and stressful. On the one hand, it is an exciting feeling to feel alive again after being so close to death, on the other hand, the patient always remains worried that the disease may return again. In addition, ordinary innocent words or events can sometimes trigger painful memories of the transplant period, even after long time after full recovery. It may take a long time for the patient to overcome these difficulties, although most patients find that their quality of life improves after the transplant.

IS IT WORTH IT?

Yes! For most patients awaiting a bone marrow transplant, the alternative is almost certain death.

Although a transplant can be an agonizing period, most transplant survivors find the prospect of returning to full function healthy life After the transplant it's worth all the effort.

Donor. Questions and answers:

Q: How is a bone marrow or hematopoietic stem cell donor found?

O: Each person inherits a unique genotype from their parents. Naturally, first of all, a potential donor is looked for among the patient’s closest relatives. The probability that siblings can serve as a donor for each other is about 25%. In general, no more than 30% of patients have potential related donor. If there is no related potential donor, a search for an unrelated donor is carried out. There is an international computerized database of potential unrelated donors, which contains tissue typing data for about 6 million people from around the world. Upon receiving a request to find a donor, the computer system reports the availability of suitable potential donors. Then medical institution, leading treatment, contacts the donor registry, whose database contains the data specific person, who expressed preliminary readiness to become a donor. The donor registry independently contacts the donor, carries out an “activation” procedure, as a result of which the donor is either recognized as suitable for transplantation and agrees to it, or refuses or is declared unfit as a result of a thorough medical examination. If one potential donor is not suitable for transplantation, another donor is sought.

Q: By what criteria is it determined whether a donor is born or not?

A: Proteins called antigens are found on the surface of white blood cells and other tissues of the human body. There are specific antigens called HLA-A, HLA-B and HLA-DR. It is their coincidence between the donor and recipient that determines the success of bone marrow or hematopoietic stem cell transplantation. Naturally, people of the same race, ethnicity and national origin have a higher chance of matching as a donor.

Q: What are the chances that a potential unrelated donor will be found?

O: Since many countries around the world are making great efforts to both state level, and at the level public organizations to increase the number of potential unrelated donors and include all racial and ethnic groups. About 80% of all patients have at least one potential donor at the preliminary search stage. This percentage is constantly growing (in 1991 it was 41%). It is important to add that of these 80%, not all can serve as real donors, and for the remaining 20%, transplantation can nevertheless often be successfully performed from a donor who is not a perfect match. , but only partially.

Q: What happens if a donor is found?

A: If the preliminary search has identified this person as a potential donor, he or she will be contacted using the contact information provided at the stage of the preliminary conclusion of the Donation Agreement. The potential donor is subjected to medical examination and undergoes special tests to study compatibility with the patient in more detail. After which the potential donor signs a donation agreement. At this point, he should be absolutely confident in his decision, since the patient at this stage may already be preparing for transplantation and undergoing the appropriate procedures.

Q: Can a potential donor refuse to donate and what are the consequences?

A: As a volunteer, a potential donor is under no obligation. Sometimes a potential donor who is suitable in all respects may decide not to become a real donor. There are a number of reasons not to donate, including ill health, the investment of time and effort, and fear of the risk of complications or painful procedures. Donation imposes serious obligations on a person, since the decision of the potential donor depends on human life. Changing your decision at the last minute can lead to fatal consequences For a patient waiting for donor bone marrow, the consequences of such a decision are explained to the potential donor repeatedly and from the very beginning. Most potential donors go all the way, having weighed the pros and cons and understanding the importance of their decision not only for the patient, but also for themselves.

Q: Who can become a potential donor of hematopoietic stem cells?

A: Any person aged 18 to 55 years who has never had hepatitis B or C, tuberculosis, malaria, AIDS, malignant diseases, mental disorders. From a potential donor, 5 ml of blood is taken from a vein for tissue typing and everything is checked except last point. Concerning mental health, a certificate from a mental health center will not be required from the donor.

Q: Do I have to pay anything to become a donor? Or, on the contrary, will he be paid?

O: Neither one nor the other. Anonymity, voluntariness and gratuitousness are what any donor movement is built on and form the basis for the creation of the Hematopoietic Stem Cell Donor Register. Although, of course, almost all Registers try to encourage donors who donate hematopoietic stem cells for a patient and thus save a person’s life.

Q: Tell us about the procedure for collecting hematopoietic stem cells?

O: There are two options. You donate either some of your bone marrow or stem cells from your bloodstream. The choice usually depends on the donor, but in rare cases, it is dictated by medical necessity.
If a donor donates bone marrow, a puncture is performed under general anesthesia. pelvic bone, and then a surgical needle is taken required amount bone marrow. The procedure takes about 30 minutes. The donor's bone marrow is completely restored within a few weeks. After this procedure, the donor spends 1-2 days in a specialized hospital under the supervision of a doctor.
If the donor donates peripheral blood cells, then a few days before donating blood, you need to start taking a special drug Filgrastim, which promotes the release of stem cells from the bone marrow into the blood. This is because stem cells are taken from the bloodstream through a process called apheresis, where blood from a vein in one arm is passed through special device for the separation of hematopoietic stem cells and returns to the bloodstream through a vein in the other arm. Of course, this procedure is performed under sterile conditions. You need to spend 5-6 hours in a relatively motionless state, but there is no need for hospitalization or anesthesia. Recovery of the taken cells takes place in 7-10 days.

Q: What is Filgrastim?

A: Filgrastim has been used for 10 years to increase the production of leukocytes (white blood cells) in immunocompromised patients so they can more effectively fight infection. It is similar to naturally produced human body substance. For the past few years, it has been given to healthy donors before bone marrow transplants to increase the amount in the bloodstream.

Q: Is there a risk to the donor's health?

O: Bone marrow donation - surgical procedure, associated with minimal risk. Serious complications are rare. They can be caused by individual reactions to anesthesia; cases of infection and reactions to the insertion of a surgical needle have been recorded. After bone marrow collection, the donor may experience painful sensations in the operated area for some time. A hematopoietic stem cell donor may experience bone pain, muscle pain, nausea, insomnia, and fatigue from the drug taken before surgery. The most common side effects are headache and bone pain. These painful sensations go away immediately after the stem cells are collected. During apheresis, some donors complain of tinnitus due to the use of an anticoagulant to prevent blood clotting. At the end of the procedure, these effects gradually disappear.

Q: Can I become a donor only for my relatives or friends?

A: The database includes potential unrelated donors who are willing and ready to help any patient. If you want to undergo typing only to help a specific person, inform us of your intention, and your data will not be entered into the general donor database. When taking blood, you can ask your doctors for a copy of the immunological typing results.

Q: Can my parents sign a donation agreement for me and why can only people over 18 be a donor?

A: International standards require that the volunteer be an adult. We are talking about a surgical operation, and the person undergoing it must give his consent to it, having previously read all the necessary information. A parent or guardian is not authorized to sign a donation agreement, because unrelated donation is a voluntary procedure that does not bring any benefits to the donor. Not we're talking about and about saving his life.

Q: Why can’t I become a donor if I am over 55 years old?

O: The number of years is not the only indicator of physiological age, but we are forced to rely on age when determining donor eligibility. There is a slight increase in risk with age side effects during anesthesia. Studies have shown that patients who received hematopoietic stem cells from elderly donors have slightly worse cure rates. Age restrictions are thus aimed both at maximizing the safety of the donor and at ensuring best treatment to the patient.

(c) http://www.cumc.columbia.edu/dept/medicine/bonemarrow/bmtinfo.html
http://turmed.com.ua/peresadka-kostnogo-mozga

Which patients and in what cases can it help?

The answer to this question is formed gradually - based on scientific research and more than 50 years of clinical practice experience.

Bone marrow transplantation can have a positive effect in the following diseases:

• Leukemia in both adults and children (not all types);
• Hodgkin's disease (lymphogranulomatosis) and patients with lymphomas, but not Hodgkin's disease (non-Hodgkin's lymphomas);
• Testicular cancer (some cases);
• Other diseases for which transplantation and experimental treatments are known to have a beneficial effect.

It has been proven that a bone marrow transplant containing stem cells can restore normal hematopoiesis in more than 40 malignant diseases.

The main goals of bone marrow transplantation: why is a transplant needed?

1. For malignant tumors – restoration of hematopoietic functions after treatment with high doses of chemotherapy and radiation therapy(More than 75% of transplants are performed for malignant diseases);
2. In pathological, but not tumor hematopoiesis, replacement of diseased bone marrow with healthy bone marrow.

In the presence of malignant tumors, the use of chemotherapy allows the existing cancer cells to be destroyed. For other diseases, chemotherapy is needed to destroy the patient's bone marrow damaged by the disease so that the transplanted new healthy bone marrow can take root well.

In order to destroy damaged blood and bone marrow cells, chemotherapy and/or radiation therapy must be used in very large doses. With such procedures, not only diseased cells are destroyed, but also cells not affected by the disease. Likewise, powerful chemotherapy used to treat some lymphomas and other cancers destroys bone marrow cells.

Such treatment without bone marrow transplantation is generally not applicable, since the body loses the ability to produce blood cells, which it absolutely needs. And only the opportunity that emerged, immediately after destructive treatment, to replace the lost cells with healthy ones, capable of again producing blood cells (bone marrow - a substance that produces blood, or stem cells - precursors in the bone marrow, which, developing, turn into blood cells) opened up the possibility of using such an aggressive – very high doses, but life-saving treatment.

Even with a bone marrow transplant, one cannot be absolutely sure that the disease is gone forever. But this operation can increase the likelihood of recovery. Or the period of healthy life increases, for many patients life is extended.

On the other hand, bone marrow transplantation is usually used only when other treatment methods cannot be used or are ineffective, because this operation is not safe and is difficult for patients to tolerate. During hematopoietic stem cell transplantation, high risk complications, which prevents the expansion of the range of indications for the use of bone marrow transplantation.
As a result, doctors resort to bone marrow transplantation when there is either a chance to avoid relapse (return) of the tumor, or when treatment has already been carried out, but a result that ensures remission has not been obtained.

Even if you have a disease that is included in the list of those that can benefit from a bone marrow transplant, not every cancer patient can undergo such an operation.

Who can benefit from a bone marrow transplant?

There are criteria for patient “suitability”, depending on the intended type of bone marrow transplantation.

1. Treatment has already been carried out malignant tumor usual doses chemotherapy and were received positive results from such treatment. It is unlikely that one can expect an effect from high-dose treatment if there was no success with conventional cancer chemotherapy.
2. Bone marrow transplantation can only be performed on a fairly young patient who is this moment Overall I feel not bad. Autologous transplantation, as a rule, is attempted in patients no older than 65 years of age; and for allogeneic transplantation, the patient must be even younger, usually no older than 50 years. Stem cell transplants, which have slightly lower risks, can be done in older patients.
3. It is important that during transplantation there is no cancerous lesion in the bone marrow graft (those cells that are replanted). The body does not need new cancer cells at all. If such cells are found in bone marrow obtained from a patient, even in minimum quantity, then before bone marrow transplantation it needs to be cleaned - special methods are needed.
4. For

Bone marrow transplantation, if other treatment methods are ineffective, can be a salvation for many people with leukemia. This procedure is difficult in its consequences, requires long-term rehabilitation on the verge of life and death and is associated with great risk.

Bone marrow - soft fabric inside the skeletal bones, producing various blood cells from basal stem cells. Stem cells in the bone marrow are in a state of endless division and subsequent differentiation into red blood cells, white blood cells and platelets, after which they enter the bloodstream. In this way, dead blood cells are replenished, as well as their deficiency associated with blood loss.

The process of hematopoiesis is one of the basic system-forming processes occurring in the body. A defect in this process inevitably leads to fatal outcome for several months.

There are a number of diseases that belong to the class of oncological diseases that have a destructive effect on the formation of blood and lymph cells: leukemia, lymphosarcoma, hematosarcoma, lymphocytomas and others. The specific medical name for these diseases is hemoblastosis. In everyday life the name “blood cancer” has been assigned to them.

Hemoblastoses do not represent a physical tumor localized in any place in the body. Initially, it is one immature (undifferentiated) cell located in the bone marrow, which begins to divide at tremendous speed. These cells exist in isolation from the body system, work exclusively for themselves, without participating in general vital functions. important processes. By creating huge colonies, they take away nutrition from healthy cells and gradually displace them. Spreading through the bloodstream throughout the body, they settle in all internal organs, forming their own colonies in them. These metastases adapt to new fabric, may behave independently and requires alternative chemotherapy.

Despite the fact that hematological malignancies refer to several diseases that affect different types cells, with the progression of these diseases, the clinical boundary between them is erased. Over time, non-bone marrow hemoblastoses (lymphocytomas, lymphosarcoma) metastasize to the bone marrow.

Treatment of hemoblastosis involves standard oncological treatment, including chemotherapy and radiotherapy, designed to destroy malignant cells.

Bone marrow transplantation is indicated as the last option to overcome the disease. The operation is high risk and requires a long recovery period. The operation is usually performed in at a young age, not recommended for elderly, weakened people, with serious illnesses internal organs because of possible complications and a high probability of death.

Types of transplantation

Bone marrow transplant surgery is called transplantation according to the expected result. The process itself is not at all similar to transplantation or transplantation in the sense in which these terms are understood by most people. There is no autopsy and no bone marrow is directly transplanted.

The operation is preceded by a fence bone tissue from the donor or from the patient himself. In the first case, the transplantation is considered allogeneic, in the second – autologous. Finding a suitable donor whose tissue will be compatible with the patient’s tissue is very problematic. There are donor banks (in the form of databases) at foreign clinics. The use of donor bone marrow can account for a fifth of the cost of the entire operation. It is much cheaper to use bone marrow from siblings and other immediate family members. The issue of compatibility in these cases also arises.

The formal division into autologous and allogeneic transplantation methods has no significance for the bone tissue sampling procedure itself, which takes place under general anesthesia. With the help of several punctures, up to 5% of the bone marrow is pumped out of the pelvic or femur bone.

Stem cells can be collected from the patient's or donor's peripheral blood. In this case, a catheter is inserted into the brachial vessel, from which blood flows into a special machine where stem cells are filtered. The blood, after being filtered, flows through a catheter on the other arm back to the donor.

If we consider oncological diseases of the blood in general, it has been proven that the use of material obtained by the allogeneic method is more reliable: high relapse-free survival, lower risk of relapse.

However, for some types of blood cancers, such as multiple myeloma, autotransplantation has been shown to offer a better prognosis.

How is the transplant performed?

Transplantation occurs as follows:

• A few days before the operation, the patient is hospitalized. With the help of a course of chemotherapy and radiation therapy in significant dosages, the patient’s own bone marrow cells, including cancer cells, which are the majority, are destroyed.
• After complete destruction of the patient's own bone marrow, intravenous administration purified material consisting of stem cells. These stem cells must take the place of the destroyed bone marrow cells and begin producing blood cells.
• The process of engraftment of transplanted cells takes up to 4 weeks.

Possible consequences

After the operation, the following consequences are possible:

• The most important consequence of bone marrow stem cell transplantation is the absence of hematopoietic function in the patient for several weeks. This dangerous period for the patient, mainly because his body is not able to fight the aggressive external environment, the attacks of which are normally repelled by protective blood cells. A patient without bone marrow is defenseless against the slightest breath of wind.
• The blood clotting function is completely deteriorating.
• Due to intensive radiation and chemotherapy, patients are extremely weak. Side effects may occur: fever, nausea, vomiting, dysfunction of internal organs, the appearance of ulcers on the mucous membranes and skin.
• There is a risk that the donor cells will be rejected by the body.
  In order to minimize negative consequences transplantation is carried out complex therapy wide range drugs. However, this does not always save.

Is relapse possible?

Relapse after bone marrow transplantation is possible and the likelihood is high. In general, for all hemoblastoses average relapses range from 40% to 80% depending on the stage of the disease.

When re-transplanting bone marrow, the time interval between the first transplant and the occurrence of relapse is critical. The longer this period, the more likely relapse-free survival is. In cases where this period is less than a year, mortality after re-transplantation is high. Relapse-free survival in these cases does not exceed 20% within three years.

Cost of transplantation in Russia

Bone marrow transplantation operations in Russia began to be performed relatively recently. First of all, it should be noted here that the Institute of Pediatric Hematology and Transplantology named after. R.M. Gorbacheva.

This procedure is high-tech and is carried out free of charge in accordance with quotas. There is the possibility of a paid operation without a queue. The cost of the procedure is about 2 million rubles.

Transfer abroad and approximate cost

A bone marrow transplant abroad will cost much more than in Russia. It is worth noting that the practice of carrying out such operations abroad has a more serious basis, due to the fact that similar operations have been carried out in Germany, for example, for several decades.

Israel

Israeli oncology medicine has proven itself well. There are bone marrow transplant clinics in every major city. medical center. There is a separate oncology center in Tel Aviv.

The cost of transplantation is 130-220 thousand dollars, of which 50 thousand will be the selection of a donor and work with him.

Germany

It is known that for Russians who can afford it, German clinics are the classic choice for bone marrow transplantation. For example, in Germany, the wife of the last Secretary General of the USSR, Raisa Maksimovna Gorbacheva, was treated for leukemia.

Today, the cost of a transplant, including a two-month hospitalization, averages 250 thousand euros.

Belarus

Bone marrow transplantation in Belarus costs from 50 to 180 thousand dollars. This might be a good option considering the price and proximity.

As in Russia, Belarusian oncologists specialize in pediatric bone marrow transplantology.

Ukraine

In Ukraine there is a Bone Marrow Transplant Center located in Kyiv, as well as a number of other clinics in various Ukrainian cities. The cost of the procedure will average about 100 thousand dollars.