Bone marrow transplantation

The bone marrow transplantation may be divided into two groups:
Autologous – when the bone marrow is transplanted form the patient himself, thus the patient is a donor and a recipient at the same time.  In this case, the bone marrow transplantation is possible because high doses of medicines destroying the cancer cells are administered (megachemiotherapy).   The bone marrow is collected before this therapy in the remission period of the disease, i.e. in the period when the cancer cells are not detected in the patient’s body no matter what detection method is applied. Colloquially we say that the disease has entered into a remission stage. 
The administered medicines destroy the residual cancer cells, but damage the remaining bone marrow permanently as well.  At this time healthy and collected in the remission period bone marrow is transplanted to the patient
Allogenic – bone marrow is collected for another person – a related or unrelated donor.
In this case, before the transplantation is made the patient takes high doses of medicines as well, sometimes the radiation of the whole body is necessary.
Such treatment destroys the patient’s bone marrow as well as his immune system and the cancer cells, thus preparing the body to receive the donor’s bone marrow.
The first allogenic transplant form an unrelated donor was carried out in Poland in 1997 and the recipient was Urszula Jaworska, the founder of the largest Bone Marrow Donors Registry, that operates at the Urszula Jaworska’s Foundation.   

Transfusion of life!
The bone marrow transplantation consists in intravenous injection of hemopoietic cells to the sick person.  The injected cells are transported with blood to the bone cavities.  The procedure takes up to several hours and looks like administering fluids through a needle.  But this administering decides on someone’s life or death.  This is because the sick person’s own bone marrow needs to be destroyed before the donor’s bone marrow is transplanted.  Thus, the sick person is left with no immune system and is defenseless in case of every small infection.  The procedure’s professional name is ablation of bone marrow and its aim is to destroy the cancer cells as well as the bone marrow of the sick person.  In order to do so, the whole body is subject to radiation and cytotoxical drugs are administered to the sick person.  Such a brutal interference into the human body causes serious, but reversible side effects (most common are intense vomiting, loss of hair and taste, movement coordination disorders, conjunctiva and skin inflammation and other unpleasant side effects).  The preparatory treatment is difficult to stand for the patient but it is also necessary, as it is a precondition for bone marrow transplantation.

Fighting for life!
After the transplantation the patient has to remain isolated and live in the sterile environment. The food consumed must be sterile as well.  The patient is kept in a room with a sterile air let into a room through the special filters keeping away bacteria, fungi and viruses.
The hospital staff has to wear sterile clothing, masks and gloves and their contact with the patient is as minimal as possible. 
Nevertheless, the infections attack the weakened organism with the double force. It is often the case, that the bacteria, fungi or viruses that normally live in the donor’s body, when transplanted, become the most feared enemy.  As a rule these include the staphylococcus and other bacteria, cythomegalic and zoster viruses, adenoviruses, yeast viruses as well fungus named aspergillus.     
This is why the patient has to take antibiotics, anti-fungi and anti-virus medicines for a long time after the transplantation.

Graft vs. host disease
New white blood cells that appear in the patient’s blood after the transplantation signal the reproduction of the regular blood cells by the grafted bone marrow that filled the bone cavities.  Usually this process begins 2-4 weeks after the bone marrow was transplanted.  The so-called graft vs. host disease (GvHD) is the most serious disease of the period.  The transplanted bone marrow “discovers” that it is inside somebody else’s body and decides to defends itself.  The bone marrow seems to “reject” the organism it was transplanted into.  Regardless of the preventive actions undertaken with respect to this disease, the GvHD afflicts significant part of patients and has various results.  Unfortunately, it happens that the disease is a cause of patient’s death.   When the disease appears the patient has to take additional immunosuppressive medicines (reducing immunity), including high doses of steroids.
Sometimes the GvHD has a chronic form and lasts for the whole life, the patient may also go through acute phases of the disease, the disease may have also progressive character.
In most of the cases, owing to the proper treatment, the GvHD may be effectively stopped, the transplanted donor’s cells become tolerant to the patient’s tissues, thus the patient may slowly turn back to his normal life.    

Translation: Maria Kukawska