- Breast Cancer: Bone Marrow Transplantation Center
- Breast Cancer Slideshow
- Take the Breast Cancer Quiz
- Breast Cancer Screening
- Find a local Oncologist in your town
- What is bone marrow?
- Who is a candidate for a bone marrow transplant?
- Where does the transplanted bone marrow come from?
- What happens before the transplant?
- Central Venous catheter placement
- Stimulating your white blood cells
- Bone marrow harvesting
- Chemotherapy and/or radiation therapy
- What happens during the transplant?
- Will my insurance provider cover my bone marrow transplant?
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.
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
Health Solutions From Our Sponsors
Top Bone Marrow Transplantation for Breast Cancer Related Articles
Breast Cancer (Facts, Stages)
Breast cancer is an invasive tumor that develops in the mammary gland. Breast cancer is detected via mammograms, breast self-examination (BSE), biopsy, and specialized testing on breast cancer tissue. Treatment of breast cancer may involve surgery, radiation, hormone therapy, chemotherapy, and targeted therapy. Breast cancer risk may be lowered by managing controllable risk factors.
Breast Cancer and Coping With StressBeing diagnosed with breast cancer is stressful. Learning relaxation techniques, exercising, eating well, getting adequate sleep, receiving psychotherapy, and maintaining a positive attitude can help you cope. Creating documents, such as an advance directive, living will, and durable power of attorney will outline your wishes in the event that you are no longer able to make decisions regarding your care.
Breast Cancer and LymphedemaLymphedema is a common chronic, debilitating condition in which excess fluid called lymph collects in tissues and causes swelling in them. It is common after a mastectomy, lumpectomy or breast cancer surgery and radiation therapy.
Breast Cancer Clinical TrialsBreast cancer clinical trials are research programs designed to evaluate new medical treatments, drugs, or devices for the treatment of breast cancer. Clinical trials are designed to test the safety and efficacy of new treatments as well as assess potential side effects. Clinical trials also compare new treatment to existing treatments to determine if it's any better. There are many important questions to ask your doctor before taking part in a breast cancer clinical trial.
Breast Cancer During PregnancyBreast cancer occurs in about 1 in every 1,000 pregnant women. Treatment of breast cancer during pregnancy involves surgery, but it is very difficult to protect the baby from the dangerous effects of radiation and chemotherapy. It can be an agonizing to decide whether or not to undergo breast cancer treatment while one is pregnant.
Breast Cancer in Young WomenAbout 5% of cases of breast cancer occur in women under the age of 40 years old. Some risk factors for breast cancer in young women include a personal history of breast cancer or breast disease, family history of breast cancer, prior radiation therapy, and the presence of BRCA1/BRCA2 gene mutations. Breast self-exams, clinical breast exams, and screening mammograms may help detect breast cancer. Treatment may include surgery, chemotherapy, radiation, and hormone therapy.
eribulin mesylate, HalavenEribulin mesylate (Halaven) is a chemotherapy agent used to treat metastatic breast cancer by interfering with the growth of crucial intracelluar structures. Side effects, drug interactions, and use during pregnancy should be reviewed prior to taking any medication.
Genetic Testing Families With Breast CancerBreast cancer can be a killer and the decision to get tested to see if a patient is prone to the disease should be discussed with a doctor -- particularly if the woman has a history of breast cancer in her family. Genetic testing can only tell so much about breast cancer risk, however.
Tykerb (lapantinib) is indicated in combination with capecitabine for the treatment of patients with advanced or metastatic breast cancer and other specific conditions. Tykerb (lapantinib) is also used in concert with letrozole for the treatment of postmenopausal women with hormone receptor-positive metastatic breast cancer with other conditions present.
Male Breast CancerMale breast cancer accounts for 1% of all breast cancers, and most cases are found in men between the ages of 60 and 70. A man's risk of developing breast cancer is one in 1,000. Signs and symptoms include a firm mass located below the nipple and skin changes around the nipple, including puckering, redness or scaling, retraction and ulceration of the nipple. Treatment depends upon staging and the health of the patient.
Stem CellsStem cells are referred to as undifferentiated cells because they have not yet committed to a developmental path to form specific organ tissue. There are a variety of stem cell types, including:
- adult peripheral blood,
- umbilical cord, and
- induced pluripotent stem cells.
- heart disease,
- Parkinson's disease,
- spinal cord injury,
- diabetes mellitus,
- amyotrophic lateral sclerosis,
- arthritis, and
Treatment of Breast Cancer by Stages
Treatment of breast cancer depends upon the stage of the cancer at the time of diagnosis. Some of the various treatments include:
- hormone therapy,
- radiation therapy,
- HER2-targeted therapy,
- neoadjuvant therapy, and
- adjuvant therapy.