A bone marrow transplant replaces diseased or failing marrow with healthy stem cells capable of producing new red cells, platelets and immune cells. The cells may be collected from the patient, which is called an autologous transplant, or from a tissue-matched donor — a sibling, another relative or a registry donor — which is called an allogeneic transplant. They are given into a vein like a blood transfusion after conditioning treatment has emptied the marrow, then travel to the bone cavities, settle there and begin producing blood over the following weeks. Transplantation is used for defined groups of diseases: certain leukaemias, lymphomas and multiple myeloma, aplastic anaemia, selected cases of thalassaemia major and sickle cell disease, and some inherited immune deficiencies and metabolic disorders in children. Not every patient with these diseases is a candidate. The decision is made by a multidisciplinary team based on the disease type, stage and response to previous treatment, and on age, heart, kidney, liver and lung function and the presence of active infection, and it is determined by examination and testing rather than by reading. This is a major decision that must be made with full information, and you will not find survival percentages or promises of outcome here, because the figures differ fundamentally by disease, stage and transplant type and cannot be generalised to an individual. What matters is understanding that the pathway is long: intensive conditioning, then weeks with almost no immunity, then months of medication and close monitoring. Fever in an immunosuppressed patient is an emergency: do not wait, and do not take a fever medicine and go to sleep. Contact your team or attend the emergency department immediately, because a minor infection can become bloodstream sepsis within hours. The limits are equally important. Transplantation does not eliminate the chance of relapse, is not suitable for every cancer, and does not end at discharge. In allogeneic transplants there is a genuine risk of graft-versus-host disease, in which donor cells attack your tissues, requiring immunosuppressive drugs for months or years with the infection risk that follows. Fertility, hormone glands and growth in children may be affected, which is why fertility preservation options are discussed before treatment starts rather than afterwards, and why revaccination, long-term follow-up and surveillance for late effects are part of the plan.
Procedure steps
- 1
Eligibility assessment and tissue matching
The disease, its stage and its response to treatment are reviewed, and tests are done of heart, lung, kidney and liver function, screening for latent infections, and dental, psychological and social-support assessment. Tissue typing compares you with potential donors, and fertility preservation is discussed before treatment begins.
- 2
Collecting the stem cells
Cells are most often collected from the bloodstream after a medicine mobilises them out of the marrow, using a machine that separates the stem cells and returns the rest of the blood, or they are harvested from the pelvic bone in an operating theatre under general anaesthesia. The cells are then tested, counted and stored until the day of infusion.
- 3
Conditioning treatment
An intensive course of chemotherapy is given, sometimes with radiotherapy in specific situations, to clear diseased cells from the marrow and suppress immunity so the new cells are not rejected. A central venous catheter is placed, and expected effects such as nausea, mouth ulceration, hair loss and fatigue are anticipated and treated pre-emptively.
- 4
Cell infusion and the low-immunity period
The cells are infused through the catheter in a session resembling a blood transfusion, after which white cell and platelet counts fall very low until the cells engraft and start producing blood. Blood products are transfused when needed, infection prophylaxis is given, and temperature, weight and fluid balance are monitored daily.
- 5
Long-term follow-up after engraftment
After discharge, frequent visits continue for blood counts, immunosuppressant drug levels and monitoring for graft-versus-host disease and late infections, and medicines are then tapered only on medical instruction. The vaccination schedule is repeated, and hormone glands, bones, fertility, the heart and any late effects are monitored for years.
Before the procedure
Bring your complete medical file: diagnostic reports, marrow samples, genetic results, previous lines of treatment and imaging, because these underpin the transplant decision. Tell the team about every medicine, supplement and herbal product you use, and take nothing new without approval. Report every past or current infection and any dental or gum problems, and complete dental treatment beforehand, since any focus of infection becomes dangerous once immunity falls. Discuss fertility preservation before conditioning starts, not afterwards. Organise the practical side: extended leave from work, a consistent caregiver, accommodation near the centre and a fast way to reach the team. Clean the house and set aside a well-ventilated room, remove indoor plants, plan safely prepared food, and keep emergency numbers somewhere visible.
After the procedure
Take every medicine on time, particularly immunosuppressants and infection prophylaxis, never stop or adjust a dose yourself even if you feel better, and ask before starting any new drug, supplement or herbal remedy. Measure and record your temperature daily, wash your hands often, avoid crowds, unwell visitors and children recently given live vaccines, and stay away from dust, building work, gardening and animals or their waste. Drink clean water, avoid raw and unpasteurised foods and loose nuts, and care for your mouth with a soft brush. Use sun protection, as skin becomes more sensitive. Contact your team or go to the emergency department immediately for any fever or chills, cough or breathlessness, persistent diarrhoea or vomiting, a new rash or yellowing, bleeding or bruising, pain or redness around the catheter, or confusion, because fever in an immunosuppressed patient cannot wait until morning.
Expected duration
The infusion itself usually takes 30 minutes to two hours, but the whole pathway is far longer: weeks of pre-transplant assessment, several days of conditioning, a hospital stay that typically runs three to six weeks until engraftment, then intensive follow-up for six to twelve months and long-term surveillance afterwards.
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