Certain diseases such as leukemia, blood disorders, and immune disorders were once considered incurable. However, with the development of the bone marrow transplant (BMT), people with these diseases have a reasonable chance of being cured or at least controlling disease. The idea of using bone marrow to treat certain diseases began in the late nineteenth century. In 1951, it was observed that mice who received lethal doses of radiation could survive if injected with cells from the spleen. Another study showed the same response when the irradiated mice were given an infusion of bone marrow from a twin animal.
In 1957, Dr. E. Donnell Thomas of Cooperstown, New York reported the success of a human BMT and engraftment. However, the medical profession did not have enough knowledge regarding tissue typing and the patient rejected the transplant. It was not until the 1960s and 1970s that the notion of BMT began to resurface. With antibiotics, transfusions and isolation techniques, improvements in transplantation outcomes were seen. In 1973, the first unrelated donor BMT occurred at Memorial Sloan Kettering Cancer Center.
Over the last twenty years, major changes have occurred regarding BMT. Hematopoetic stems cells, which are immature blood cells, are now obtained from peripheral blood rather than bone marrow. Hematopoetic stem cells give rise to all mature blood cells such as: white blood cells (WBC), red blood cells (RBC) and platelets.
It was estimated that 14,985 people have received peripheral blood stem cell transplants (PBSCT). These stem cells can either be from the person who owns the stems cells (autologous) or from a donor (allogeneic). Autologous stem cell transplants are used for patients who are receiving high doses of chemotherapy that will destroy the person hematopoetic system. The stem cell transplant is used as a rescue after chemotherapy. An allogeneic transplant is used to take over for the dysfunctional marrow due to leukemia or other hematological disorders. Chemotherapy is given prior to the allogeneic transplant to treat the disorder.
PBSCT has several advantages over BMT, which has lead to its increased use and success. There is a short duration of risk for bleeding and infection since the stem cells begin to mature into the necessary cells (RBC, WBC and platelets) quicker. Hospitalization duration is also shorter and medical costs are lower due to shorter period of blood cell recovery. Last a surgical procedure to harvest bone marrow does not need to be completed. The stems cells are obtained through a process similar to donating blood.
Since not all patients are candidates for autologous transplants, a registry has been set up to recruit potential donors. For more information on becoming a donor, log onto www.marrow.org. For more information on transplants, leukemia or other blood disorders, go to: www.cancer.gov, www.cancer.org or www.leukemia.org.
Tara Baney, RN, MS, AOCN is an oncology nurse specialist at Mount Nittany Medical Center.