How do you know if you need a bone marrow transplant?

A bone marrow transplant, which is also known as a stem cell transplant, is used in the treatment of various cancers. Advanced forms of leukaemia, lymphoma, myeloma, along with other blood disorders, are often treated with a bone marrow transplant. Our doctor will speak to you about your recommended treatment plan and if a bone marrow transplant is necessary for you.
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How serious is a bone marrow transplant?

A bone marrow transplant is a major medical procedure. It offers a potential curative option for some severe forms of haematological conditions such as acute leukaemia.
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Our doctor will work with you to determine if a bone marrow transplant is a suitable treatment option for your condition. Both the risks and benefits will be weighed. Our doctor will also explain to you the potential complications and the seriousness of each.
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Is it hard to find a bone marrow match?

For a patient to receive a bone marrow transplant, a matching donor must be found. Doctors use a specific blood test to analyse a potential donor’s human leukocyte antigens (HLA), specific proteins on white blood cells, before determining if they are a match.
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Unfortunately, only 30 per cent of patients who require a bone marrow transplant are able to find a fully matched donor in their immediate family members. If there are no fully-matched family members, then a donor is usually sought on the global international donor registry. The chances of finding a donor are largely related to the patient ethnicity, as HLA matching is linked to ethnicity. As such, Caucasian and Chinese patients have in general a high chance of finding a donor, whereas Malay and Indian patients often have a more limited donor pool from which to identify a donor.
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What makes you a match for bone marrow?

In order to find a donor for a stem cell transplant, DNA markers, known as Human Leukocyte Antigens (HLA), are taken into consideration. HLA markers are located on the surface of one’s white blood cells, and we inherit them from our biological parents. This means that when considering a suitable donor for a stem cell transplant, it is likely to be from a sibling. However, it is possible to find a match from an unrelated donor. This is known as a matched unrelated donor.
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Who is the best match for a stem cell transplant?

In order to find a donor for a stem cell transplant, DNA markers, known as Human Leukocyte Antigens (HLA), are taken into consideration. HLA markers are located on the surface of one’s white blood cells, and we inherit them from our biological parents. HLA typing is used to identify the best compatible donor for a patient.
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In most cases, a fully-matched family donor is often the first choice donor for an allogeneic stem cell transplant. If there are no fully-matched siblings, then alternative choices may include matched donors from the donor registry networks, haploidentical donors from the family, or even umbilical cord blood units from the cord blood registry network.
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Can leukaemia come back after a bone marrow transplant?

Unfortunately, leukaemia can come back after a bone marrow transplant, and it can be a cause of treatment failure. The chance of leukaemia coming back after a bone marrow transplant varies from 20 to 60 per cent, depending on the patient’s diagnosis and the underlying aggressiveness of the leukaemia. Our transplant team will be able to give you a more accurate estimate of the risk of relapse for your condition prior to your transplant procedure.
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What is the difference between a bone marrow transplant and a stem cell transplant?

A bone marrow transplant and a blood stem cell transplant are similar procedures that are used to treat patients with blood diseases. Both aim to replace the cells in your bone marrow with healthy ones. The difference between the two is that a bone marrow transplant utilises stem cells extracted from your bone marrow or a donor’s bone marrow. In comparison, a blood stem cell transplant makes use of stem cells extracted from your bloodstream or a donor’s bloodstream.
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Which is better: stem cell transplant or bone marrow transplant?

Our doctor will determine which method is more suited to your condition and case. However, stem cell transplants are the more common type of transplant, as opposed to bone marrow transplants. This is due to several reasons, including:

• Blood stem cells are more accessible than bone marrow, and donors prefer to donate via the bloodstream.
• More cells can be collected from the bloodstream compared to a bone marrow harvest.
• Blood counts tend to regenerate faster using blood stem cells compared with bone marrow.
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Can leukaemia be cured with a bone marrow transplant?

A bone marrow transplantation remains the only potential curative procedure for many forms of advanced acute leukaemia. However, the cure rate varies depending on the disease stage of the leukaemia. Our transplant team at CFCH will take the time to explain the treatment plan and chances of response to your therapy.
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Is there an alternative to bone marrow transplant?

A bone marrow or blood stem cell transplantation remains the main curative option for patients with advanced blood disorders.
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However, not all blood cancers need a transplantation. Some patients with good risk leukaemia, for example, may only require chemotherapy. Likewise, there are newer forms of cellular therapy, such as CAR-T cell therapy, that may be more effective for patients with advanced and aggressive acute lymphoblastic leukaemia or lymphoma.
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Our medical team at CFCH will go through your medical records and help to explain and guide you on the best and most appropriate treatment plan for you.
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What disqualifies you from being a bone marrow donor?

There are several reasons someone may not be able to be a bone marrow donor. This includes being diagnosed with autoimmune diseases (e.g. fibromyalgia and multiple sclerosis), being diagnosed with HIV (AIDS), or being overweight or underweight.
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Doctors will review potential donors and their suitability to become bone marrow donors on a case-by-case basis.
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What is the cut off age for a bone marrow transplant?

Generally, patients above 60 years of age are considered with greater care and assessment before transplantation. However, there is no specific upper age limit for bone marrow transplantation.
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Your suitability for transplantation will mainly depend on your overall physical status, as well as your underlying disease status. Our transplant team at CFCH will take all factors into account and have an open and frank discussion about the risks and benefits of bone marrow transplantation on a case-to-case basis.
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What is the average cost of a bone marrow transplant?

The cost of a bone marrow transplantation depends on several factors, which include the type of transplant (autologous vs allogeneic), type of donor (related, vs unrelated, vs haploidentical) as well as the disease status of the patient and whether any potential complexities are expected for the procedure.
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At CFCH, our team will work to establish the most appropriate treatment strategies for your condition. If a bone marrow transplantation is required, a detailed transparent breakdown of the costs will be provided upfront to you.
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If you are concerned about the costs required for your bone marrow transplant, feel free to get in touch with us. We will be happy to help you understand the various fees involved.
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How long does it take to know if a bone marrow transplant is successful?

In order for doctors to determine if your bone marrow transplant is successful, your blood count levels need to return to normal along with your immune system. This can take between 6 to 12 months. Our transplant team will continue to monitor you during this period for any issues that may surface.
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How long does it take for a bone marrow transplant to engraft?

Engraftment refers to transplanted stem cells settling into the bone marrow to begin creating new blood cells.
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It typically takes between 10-14 days after the transplant for engraftment to occur.
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What is the success rate of a stem cell transplant?

Bone marrow and blood stem cell transplants are an effective form of treatment for many forms of advanced blood cancers. However, the specific success rates depend on the type of cancer, the stage of the underlying blood cancer, as well as the type of treatment required. Our team of doctors will work to provide you with a personalised treatment plan with estimated chances of response after reviewing your case.
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What percentage of bone marrow transplants are successful?

Bone marrow and blood stem cell transplants are an effective form of treatment for many forms of advanced blood cancers.
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However, the specific success rates depend on the type of cancer, the stage of the underlying blood cancer, as well as the type of treatment required. Our team of doctors will work to provide you with a personalised treatment plan with estimated chances of response after reviewing your case.
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How successful is a second bone marrow transplant?

Second bone marrow transplants are usually performed if the first transplant has failed. This could be due to graft failure or relapse of the underlying blood cancer.
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If the cause is graft failure, a second bone marrow transplantation has a higher chance of success.
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However, in patients who have relapsed after their first transplant, the success rate of the second transplant is lower and would be affected by the fitness of the patient, the aggressiveness of the underlying blood cancer, and the availability and suitability of the second transplant donor.
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What is the recovery period for a bone marrow transplant?

The first stage of recovery after a bone marrow transplant typically takes 4 to 6 weeks. This is the period in which our transplant team will monitor you to see if engraftment has occurred.
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Typically, patients remain in the hospital until their blood counts stabilise and the patient is fit and independent without any infective complications.
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Full recovery after a bone marrow transplant can take between 6 months to a year. 

What are the possible complications of a stem cell transplant?

There are a number of complications that can occur after a stem cell transplant. These include both short term and long term complications.
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Patients may experience short term complications such as mouth and throat pain, vomiting or nausea, infection, or graft-versus-host-disease (GVHD). Longer-term complications include disease relapse, GVHD, cardiac and hormonal changes, as well as secondary cancers.
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Our transplant team will work closely with you through the different phases of your transplant to monitor, prevent and manage any such complications.
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What happens if a bone marrow transplant fails?

A bone marrow transplant can fail if the body does not accept the new donor cells. This is known as graft failure and is suspected in patients whose counts do not increase after three to four weeks following a bone marrow transplant.
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Graft failure can result in severe bleeding and infection and is more likely to occur in patients who receive a lower number of stem cells or when the patient and donor are not well matched.
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Should a patient’s graft fail, they can receive a second dose of stem cells from the original donor. Sometimes a second transplant from a different donor is required.
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How long are you in the hospital for a bone marrow transplant?

You will be expected to remain in the hospital for between 3 to 4 weeks following a bone marrow transplant, depending on the type of transplant you received.
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Do you lose weight during a stem cell transplant?

Several short-term and long-term complications of a stem cell transplant can result in weight loss. Short term complications such as throat and mouth pain, along with vomiting or nausea, can make it difficult for patients to eat. Additionally, long term complications following a stem cell transplant like graft-versus-host-disease (GVHD) may also result in weight loss.
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Our transplant team will monitor your oral intake as well as weight through the transplant journey. A dietician is an important member of our transplant team who will regularly review and advise if additional nutritional support is required.
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Do you need chemotherapy before a stem cell transplant?

Patients will usually receive chemotherapy (typically over 7-8 days) prior to their stem cell transplant (infusion). This phase is called the conditioning phase.
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Conditioning therapy, which consists of chemotherapy and/or radiation therapy, is often done for two reasons. Conditioning therapy helps make space in the bone marrow for the transplanted stem cells and suppress the patient’s immune system in order to reduce the chance of graft rejection.
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How long can you live with multiple myeloma after a stem cell transplant?

Patients with multiple myeloma typically receive an autologous stem cell transplantation as consolidation after they have completed their initial induction phase of chemotherapy.
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The response to an autologous stem cell transplantation depends on the disease risk stage of the underlying myeloma, as well as whether a complete remission is attained before transplantation.
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Outcomes are improving significantly for patients with myeloma. However, the autologous stem cell transplantation is not curative in most cases and rather serves to extend the duration of remission for treated patients.
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Can stem cell transplant patients have visitors?

Following a stem cell transplant, patients are allowed to have contact with people in their immediate family at home. However, patients should take extra care to avoid contact with someone who shows symptoms of being sick or having a cold. Take precautions to wear a mask if you need to be in the same vicinity as someone who is ill. Visitors are also allowed, but they should visit in small groups and avoid visiting if they are sick, have recently received a vaccine with a live virus, or have recently been exposed to chickenpox, herpes, and shingles.
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*At present, due to restrictions imposed because of the COVID pandemic, do note that it may not be possible for the patient to have hospital visitors while in-patient for the transplantation. Do contact our team directly for clarification as the situation remains fluid.
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How long does fatigue last after a stem cell transplant?

Fatigue after a stem cell transplant is a side effect experienced by many patients. During the second and third weeks following your stem cell transplant, you are likely to feel the most tired as your blood cell counts will be at their lowest. You should begin to gain more energy as time passes. However, the fatigue can last for up to a couple of years post-transplantation.
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When can you go back to work after a stem cell transplant?

While the time taken for a patient to return to work after a stem cell transplant varies, the earliest is between 2 to 4 months following their transplant. While the idea of being away from work for such a long period before returning may be worrying, you may want to start slow, such as going in a few times a week.
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It is normal to find it challenging to match the pace of work you were comfortable at before your stem cell transplant. Our transplant team is available to help you make the transition easier and help you manage the side effects experienced during your recovery, if any.
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Can you live a normal life after a stem cell transplant?

Yes, it is possible to live a full and normal life following a stem cell transplant. While it will take time for you to regain your regular level of activity, many patients start to feel stronger between 2 months to a year after their stem cell transplant. However, patients should note that this is still the recovery period, and fatigue is to be expected.
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What are the long-term side effects of a bone marrow transplant?

Long-term side effects following a bone marrow transplant vary depending on several factors. For example, the type of transplant, pre-transplant chemotherapy, the patient’s age and health, and whether graft-versus-host-disease (GVHD) is present may all affect the potential side effects experienced by a patient.
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Some possible long-term side effects include organ damage, reduced fertility, relapse, second cancer, cataracts, and hormonal changes.
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Disclaimer:
The information on the Centre For Clinical Haematology website is intended for educational use.  It should not be considered or used as a substitute for medical advice, diagnosis or treatment from a qualified health professional.
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