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A bone marrow transplant may be used to treat patients with certain forms of cancer, such as leukemia, lymphoma, or breast cancer. The goal of such a transplant in women with breast cancer is to allow them to undergo high-dose chemotherapy -- which aggressively attacks the cancer cells, but also damages normal blood cells - and then replace the damaged cells with healthy ones.

What Is Bone Marrow?

Bone marrow is the spongy tissue found inside bone. The bone marrow in the breastbone, skull, hips, ribs, and spine contains stem cells that produce the body's blood cells. The three kinds of blood cells that the body needs to function -- oxygen-carrying red blood cells, infection-fighting white blood cells, and clot-forming platelets -- are all made in the bone marrow.

Who Is A Candidate For A Bone Marrow Transplant?

The decision to prescribe a bone marrow transplant is always made on an individual basis. Your doctor will consider your age, general physical condition, diagnosis, and stage of disease. Your doctor will also make sure you understand the potential benefits and risks of the transplant procedure.

Where Does The Transplanted Bone Marrow Come From?

Bone marrow given during a transplant either comes from you or from a donor whose bone marrow "matches" yours.

The matching process is called human leukocyte antigen testing (HLA testing). A series of blood tests evaluate the compatibility or closeness of tissue between the donor and recipient. These test results are used to help the tissue-typing lab match a bone marrow transplant donor to you.

What Happens Before The Transplant?

A number of tests are performed before the bone marrow transplant procedure to make sure you are physically able to undergo a transplant. These tests also help the transplant team identify and treat any potential problems before the transplant.

Your heart, lungs and kidney function will be tested. Your doctor may also order blood tests, a CAT scan, and a bone marrow biopsy. A complete dental examination is required before the procedure to minimize your risk of infection, and other precautions will be taken as necessary to minimize the risk of infection.

The tests required before the bone marrow transplant are usually done on an outpatient basis. Your transplant coordinator will help arrange these tests for you.

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Central Venous Catheter Placement

Before the bone marrow transplant can be performed, a central venous catheter is inserted through a vein in your chest during a simple surgical procedure. A central venous catheter is a slender, hollow, flexible tube that allows fluids, nutrition solutions, antibiotics, chemotherapy, or blood products to be delivered directly into your bloodstream without repeatedly having to insert a needle into your vein. The catheter can also be used to collect blood samples.

Stimulating Your White Blood Cells

"Colony-stimulating factors," which are hormone-like drugs, are given before your bone marrow transplant to help your white blood cells recover from chemotherapy so that they can help fight the risk of infection. They also increase the number of stem cells in your blood.

Bone Marrow Harvesting

Bone marrow is withdrawn through a needle inserted into a bone in the hip. This procedure is performed in the operating room and the patient is given general anesthesia (pain-relieving medication that puts you to sleep). If your own bone marrow cannot be used for transplantation and if a donor is not found, stem cells may be harvested from your circulating blood.

Chemotherapy And/Or Radiation Therapy

Very high doses of chemotherapy and/or radiation therapy are given to destroy the abnormal stem cells and blood cells. The high-dose therapy essentially "wipes out" your normal bone marrow. As a result, your blood counts (number of red blood cells, white blood cells, and platelets) quickly fall to low levels.

During this phase of treatment, you will be given intravenous (IV) fluids to flush out your kidneys and minimize the damage from chemotherapy. You will also be given medications to control nausea, since chemotherapy often causes nausea and vomiting.

Because you will be in a fragile state of health and won't have enough white blood cells to protect you from infection, you will be isolated in your hospital room until after the new bone marrow begins to grow. Your healthcare providers will give you specific guidelines about the isolation procedure.

What Happens During The Transplant?

The day you receive your bone marrow transplant, the harvested bone marrow is infused into a vein through an intravenous tube. The bone marrow looks like dark, thick blood. It migrates to the large bone cavities (breast bone, skull, hips, ribs and spine), and begins producing normal blood cells after several weeks.

Will My Insurance Provider Cover My Bone Marrow Transplant?

Insurance reimbursement for bone marrow transplantation is not automatic. Many insurance companies require precertification letters of medical necessity.

As soon as you know that a bone marrow transplant is a possibility, contact your insurance carrier. Don't assume your insurance will cover any or all costs associated with your transplant. It is essential to know your rights as a patient, understand your insurance policy, enlist the support of your employer, and have your physician work closely with you and your insurer to cover your bone marrow transplant.

Reviewed by the doctors at The Cleveland Clinic Taussig Cancer Center.

Edited by Charlotte E. Grayson, MD, WebMD, February 2004.

Portions of this page copyright © The Cleveland Clinic 2000-2004

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Reviewed on 1/31/2005
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