Bone marrow is the soft, sponge-like material found in the bones.  Its main function is to produce primitive or immature cells called stem cells (also called "progenitor cells").  These cells have the ability to divide into more stem cells or into white blood cells (WBCs), red blood cells (RBCs), and platelets, depending upon the body's needs at that moment.

White blood cells (also called "leukocytes") help the body defend itself against infection and other disease, by destroying "foreign" substances such as bacteria or viruses.  When infection is present, the body increases the production of the WBC.  When the number of WBC in the blood is low, the body has a more difficult time warding off infection.

Red blood cells (also called "erythrocytes") carry oxygen, with the aid of a protein called hemoglobin, from the lungs to cells in all parts of the body.  Oxygen helps process the nutrients from the food that we eat. RBCs also carry back carbon dioxide (considered "waste material") from the cells to the lungs.  When the number of RBC in the blood is low, a condition called anemia results.

Platelets help the blood to clot and thus, preventing bleeding.   Low number of platelets in the blood (a condition called thrombocytopenia) may cause easy bruising and bleeding.

In adults, stem cells can be found mostly in marrows of the bones of the skull, back, chest, hips and upper arms and legs.  In children, they can be found throughout most of the marrows.  Stem cells, however, can also be found circulating in the blood throughout the body and are called peripheral blood stem cells.

Q: How are bone marrow and stem cells obtained for the transplant?

Bone marrow and stem cells can be obtained or "harvested" from the patient (autologous) or from another individual (allogeneic), but are always collected before very high doses of anti-cancer drugs (chemotherapy) and/or high energy rays (radiotherapy) are administered. 

Bone marrow is usually taken from the hip bones (pelvis) using a large needle or a special syringe inserted several times into the pelvic bone through small incisions to draw out the marrow. The "harvested" marrow is then processed to remove blood and bone fragments. This process of obtaining stem cells is also called aspiration, which may require local or general anesthesia, and is usually done in the operating room.  It may require the patient to stay in the hospital for 1-2 nights, but some hospitals can perform a bone marrow harvest as an outpatient.  The site of the needle puncture will be tender for about a week with slight scars forming.   The patient or donor may feel some mild stiffness and soreness but can be lessened through exercise and pain medication.

A newer method of collecting or harvesting stem cells is called apheresis or leukapheresis.  Blood is obtained through a line (central venous catheter) inserted into a large vein and passed through a machine that removes stem cells.   The rest of the blood is returned to the patient.  The process may take 2 to 4 hours, and usually does not require staying in the hospital overnight.  There are fewer stem cells circulating in the blood when compared to those found in the marrow.   Transplant physicians are therefore looking into ways to increase the number of stem cells that can be harvested. By giving the patient "growth factors" (substances that are naturally produced by the body but can also be made in laboratories), the transplant physicians help stimulate the body to make more stem cells.  Since only a small amount of marrow or stem cells are removed, the procedure seldom poses significant problems or results in bad side effects.

Q: How are stem cells used for the transplant?

Once the stem cells are obtained, the marrow or stem cells are either preserved and frozen until needed (in an autologous transplant) or are given to the recipient almost immediately (in an allogeneic transplant).  

The patient is then given very high doses of anti-cancer drugs and/or radiation (called "conditioning") to get rid of the cancer cells throughout the body; to make space for the new marrow and; in an allogeneic transplant, to reduce the risk of the patient rejecting the cells or marrow taken from another person.  The bone marrow or stem cells that were previously collected are given to the patient through a central venous catheter to help re-grow normal blood cells and reduce the chance of severe infection, bleeding, or anemia.

Q: Is there any evidence of success for stem cell/bone marrow transplant?

As improvements are being made in the way the procedure is done, stem cell/bone marrow transplantation is becoming more commonly accepted and effectively used in treating many cancers and leukemias.  Researchers are finding better results in the use of stem cell/bone marrow transplant in patients with breast cancer, Hodgkin's disease, non-Hodgkin's lymphoma, leukemia, multiple myeloma, neuroblastoma and testicular cancer. 

In addition, the BMSCTI  transplant team is investigating the use of stem cell/bone marrow transplant in many other cancers including sarcomas, brain tumors and ovarian cancer.  The transplant team is also looking at the role of hematopoietic growth factors (also called "colony-stimulating factors" or CSFs), which are proteins that help the stem cells develop into blood cells, (a) in increasing the number of stem cells that can be harvested during apheresis, (b) in helping the stem cells develop into mature blood cells quickly, thus preventing life-threatening infections, anemia or bleeding, (c) in stimulating the growth of platelets in order to complement or replace platelet transfusion, thus cutting down the number and the costs of required transfusions, and (d) in stimulating the growth of red blood cells (RBCs), thus reducing the need for and the costs of RBC transfusions.

Criteria for Hospital Admission:

• Hypotension

• Bleeding

• Infection

• Cardiac Failure; Cardiac Arrhythmia

• Respiratory Distress

• Severe Renal Insufficiency

• Neurological Dysfunction

• Intractable Nausea, Vomiting, Diarrhea, and Fluid Depletion

• Psychiatric Emergency

• Severe mucositis not contrtolled with analgesics which can be given at home.

• Any other complication that cannot be treated in the outpatient setting or manageable in the home environment.