Leukemia is one of the common types of blood cancer that occurs in the blood-forming tissue of the bone marrow. It leads to the overproduction of abnormal white blood cells, which hampers the body’s ability to fight infection, transport oxygen, and prevent bleeding.
This results from genetic changes in the DNA. However, the exact cause of these changes is still unknown; certain factors that may trigger this include genetics, environmental exposure, and prior cancer treatments.
Various treatment options like chemotherapy, radiation therapy, targeted therapy, bone marrow transplant, etc., are available. However, among them, bone marrow transplant offers a potentially curative approach, i.e., complete remission, especially for patients with aggressive or relapsed forms of leukemia.
What is Bone Marrow and Why is it Important?
Bone Marrow is a soft, spongy tissue found inside some bones, such as the hips and thighs. That spongy tissue contains stem cells, which proliferate and differentiate into different blood cells.
The following are the blood cells that are developed by the stem cells:
- Red blood cells: To carry oxygen throughout the body
- White blood cells: To fight against infections
- Platelets: Help stop bleeding
Certainly, the bone marrow gets damaged due to some blood disorders, like leukemia, or high doses of chemotherapy or radiation therapy.
However, in leukemia, the normal functioning of the body is affected by the rapid overproduction of abnormal white blood cells, which crowd out normal blood cells.
Bone Marrow Transplant for Leukemia: How It Works
A bone marrow transplant (BMT) is a procedure where the damaged bone marrow is replaced by healthy bone marrow. Thus, this results in the production of normal blood cells and continues the normal functioning of the body. Therefore, BMT is a common treatment for leukemia and a few other blood disorders.
Based on the patient’s conditions, types of leukemia, or donor availability, different types of bone marrow transplants are available:
- Autologous Transplant: This type of transplant uses your healthy stem cells. It is usually done when leukemia is under control and hasn’t affected your bone marrow.
- Allogeneic Transplant: In this method, stem cells are obtained from a matched donor, such as siblings or someone from a donor registry. These donor cells can help fight any remaining cancer cells.
- Haploidentical Transplant: In this, stem cells are obtained from a half-matched family member, like a parent or child. It widens the donor pool significantly.
- Umbilical Cord Blood Transplant: This uses stem cells from donated umbilical cord blood. It allows for more flexibility in finding a match, but recovery might take a bit longer because there are fewer cells available.
What Type of Leukemia can be treated with a Bone Marrow Transplant?
Bone marrow transplant is not for all patients with leukemia; however, it is only provided by considering the following points if:
- The leukemia is high-risk or aggressive
- The patient has relapsed after initial treatment
- The leukemia is resistant to standard treatments like chemotherapy or radiation therapy
- Genetic markers or chromosomal abnormalities indicate a poor prognosis
- Patient’s age, overall health, and organ function
Bone Marrow Transplant can be used to treat the following types of leukemia:
- Acute Myeloid Leukemia (AML)
- Acute Lymphoblastic Leukemia (ALL)
- Chronic Myeloid Leukemia (CML)
- Myelodysplastic Syndromes (MDS)—a pre-leukemic condition
Tests Required Before Bone Marrow Transplant
Before the procedure, your doctor first asks you to undergo some comprehensive evaluations to ensure fitness for transplant:
- Complete Blood Count (CBC)—To evaluate overall blood health
- Bone marrow biopsy – To assess the extent of disease
- HLA typing – To find a compatible donor
- Heart and lung function tests – Such as EKG, echocardiogram, and pulmonary function
- Infection screening – For conditions like hepatitis B and C, HIV, CMV, EBV, and tuberculosis
- Psychological assessment – To check mental and emotional preparedness
- Nutritional evaluation—To ensure your proper nutrition for recovery and immune support
Donor Search and Matching Process for Bone Marrow Transplant
Finding the right donor is crucial for a successful transplant. A Human Leukocyte Antigen (HLA) test is performed to match the patient with:
- A family member (most often a sibling)
- An unrelated donor via national/international registries
- A haploidentical donor (half match, such as a parent)
- Cord blood banks, in case of no suitable adult donor
If all the test results confirm that you’re a suitable candidate, your doctor will then proceed to plan the transplant process.
Bone Marrow Transplant Procedure Step-by-Step
The following is the complete bone marrow transplant procedure:
- Conditioning (Prep Phase)
High-dose chemotherapy, radiation, or both are used to destroy cancerous cells and suppress the immune system to prevent rejection.
- Stem Cell Infusion
Stem cells are infused into the bloodstream intravenously. The process is painless and similar to a blood transfusion.
- Engraftment Phase
Stem cells migrate to the bone marrow and begin producing new blood cells. Blood counts are monitored daily.
- Post-Transplant Monitoring
Patients stay in protective isolation or sterile rooms to avoid infection. Supportive care includes antibiotics, antivirals, transfusions, and nutrition support.
Also Read:- Bone Marrow Transplant Cost in India
Recovery After Bone Marrow Transplant for Leukemia
The recovery after a bone marrow transplant for leukemia is a gradual process that may take from a few months to a year or more. The timeline and experience vary depending on the type of transplant, overall health, and how well the new cells engraft.
In the initial weeks, patients are at high risk for infections due to low immunity and may need to stay in a sterile hospital environment. Over the next few months, frequent checkups, blood tests, and supportive care help monitor complications like graft-versus-host disease (GVHD), infections, and delayed cell recovery.
The complete recovery of the immune system will take about a year. Therefore, proper nutrition, emotional support, and close medical follow-up are essential to achieving a successful long-term recovery.
What Are the Risks & Complications After Bone Marrow Transplant?
Undergoing a bone marrow transplant (BMT) is a major procedure that may lead to several risks and complications. However, the intensity and type of complications vary depending on the type of transplant, the patient’s health, and whether it’s an autologous or allogeneic transplant.
The following are the complications that may occur after a bone marrow transplant:
- Graft-versus-host disease (GVHD) can occur in allogeneic transplants
- Increased risk of infections due to a weakened immune system
- Organ damage (liver, lungs, heart, kidneys) from chemotherapy or radiation therapy
- Mucositis, causing painful sores in the mouth and digestive tract
- Bleeding and anemia due to low blood cell counts
- Infertility, often caused by high-dose chemotherapy or radiation
- Higher long-term risk of developing secondary cancers
- Possibility of disease relapse or delayed recovery after transplant
What is the Outlook After Bone Marrow Transplant for Leukemia?
After the bone marrow transplant, you need to get an extensive, complete body and blood checkup to see if your blood count has come up to the normal range or if other functions of the body are normal or not.
If the blood count and functioning of the body are normal, then a bone marrow transplant is considered a success. However, in some cases, even after a successful BMT, the leukemia may return; that condition is known as relapse. If leukemia comes back, doctors may suggest options like targeted therapy, donor cell infusion (DLI), or possibly another transplant, depending on your health and condition.
Regular follow-ups and early treatment are crucial for better long-term recovery after a bone marrow transplant.
Key Takeaway
When combined with chemotherapy or radiation, a bone marrow transplant (BMT) offers a strong chance of remission for leukemia patients. Early detection, expert care, and a supportive environment greatly improve outcomes. With advancements in bone marrow transplants in India, many patients now have access to high-quality treatment at affordable costs, leading to healthier, more fulfilling lives after recovery.
