Bone marrow is a vital element of the human body that produces blood cells. It includes stem cells capable of developing into red blood cells, white blood cells, and platelets. These cells are necessary for transporting oxygen, combating infections, and clotting blood, respectively. A bone marrow transplant (BMT) is a medical procedure that involves infusing healthy blood-forming stem cells into the human body to replace bone marrow that is not producing enough healthy blood cells. Bone marrow transplantation is also known as stem cell transplantation. If bone marrow ceases to function and produces insufficient healthy blood cells, transplantation may be required.  BMT can involve cells from own body (autologous transplant) or those from a donor (allogeneic transplant). In the field of nursing, BMT is a standard practice used to treat ailments such as leukemia, lymphoma, and other blood diseases. Nurses play an important part in this procedure, from pre-transplant preparation to post-transplant management. Nurses monitor patients for problems, treat symptoms, and offer emotional support to patients and their families.

Bone marrow transplant, Stem cells, Bone marrow, Support, Nurses.

BMT is a special therapy for patients with certain cancers or other diseases. A BMT involves taking cells that are normally found in the bone marrow (stem cells), filtering those cells, and giving them back either to the donor (patient) or to another person. The goal of BMT is to transfuse healthy bone marrow cells into a person after his or her own unhealthy bone marrow has been treated to kill the abnormal cells.

BMT has been used successfully to treat diseases such as leukemia, lymphoma, aplastic anemia, immune deficiency disorders, and some solid tumor cancers since 1968. Bone marrow is the soft, spongy tissue found inside bones. It is where most of the body’s blood cells develop and are stored. The blood cells that make other blood cells are called stem cells. The most primitive of the stem cells is called the pluripotent stem cell. This is different than other blood cells regarding the following properties:

Renewal: It can reproduce another cell identical to itself.

Differentiation: It can generate one or more subsets of more mature cells.[1]

A BMT may be used to safely allow treatment with high doses of chemotherapy or radiation by replacing or rescuing the bone marrow damaged by the treatment, replacing bone marrow that’s not working properly with new stem cells, and providing new stem cells, which can help kill cancer cells directly.[2]

Indications: The goal of BMT is to cure many diseases and types of cancer. When the doses of chemotherapy or radiation needed to cure cancer are so high that a person’s bone marrow stem cells will be permanently damaged or destroyed by the treatment, a BMT may be needed.  BMT may also be needed if the bone marrow has been destroyed by a disease.

BMT can be used to:

• Replace diseased, nonfunctioning bone marrow with healthy functioning bone marrow (for conditions such as leukemia, aplastic anemia, and sickle cell anemia).
• Regenerate a new immune system that will fight existing or residual leukemia or other cancers not killed by the chemotherapy or radiation used in the transplant.
• Replace the bone marrow and restore its normal function after high doses of chemotherapy and/or radiation are given to treat malignancy. This process is often called.
• Replace bone marrow with genetically healthy functioning bone marrow to prevent more damage from a genetic disease process (such as Hurler’s syndrome and adrenoleukodystrophy).[3]
• Multiple myeloma.
• Hodgkin lymphoma and non-Hodgkin lymphoma.
• Acute myeloid leukemia.
• Acute lymphoblastic leukemia.
• Myelodysplastic syndrome.
• Chronic myeloid leukemia and chronic lymphocytic leukemia.
• Myelofibrosis and polycythemia vera.
• Aplastic anemia.
• Sickle cell anemia.
• Severe combined immunodeficiency syndrome.
• Relapsing-remitting multiple sclerosis.
• Testicular germ cell tumors.[4]

Risks: A BMT may cause the following symptoms.[5]

• Chest pain
• Drop in blood pressure
• Fever, chills, flushing
• Headache
• Hives
• Nausea
• Pain
• Shortness of breath
• Strange taste in the mouth

Complications:

• Anemia
• Bleeding in the lungs, intestines, brain, and other areas of the body
• Cataracts
• Clotting in the small veins of the liver
• Damage to the kidneys, liver, lungs, and heart
• Delayed growth in children who receive a BMT
• Early menopause
• Graft failure, which means that the new cells do not settle into the body and start producing stem cells
• Graft-versus-host disease(GVHD), a condition in which the donor cells attack your own body
• Infections, which can be very serious
• Inflammation and soreness in the mouth, throat, esophagus, and stomach, called mucositis
• Pain
• Stomach or abdominal problems, including diarrhea, nausea, and vomiting

Types of BMT

The transplantation choice depends on factors like

• Patient’s age
• Patient’s health condition
• Patient compatibility with donors

Autologous transplant: Autologous bone marrow transplantation appears to be effective in treating lymphoma and multiple myeloma. The treatment is ideal because it employs the patient’s own marrow cells for the transplant, significantly lowering the risk of problems compared to allogeneic transplantation. Patients can look forward to a cancer-free future after the transplant since they have had high-dose chemotherapy or radiation therapy to eliminate cancer cells. Once extracted, the marrow cells are safely preserved until it is time for transplantation.

Allogeneic transplant: Using stem cells from a donor, allogeneic BMT is a technique used to treat specific blood diseases and tumors. To prevent issues like GVHD, meticulous matching between the donor and the receiver is necessary.

Umbilical cord blood transplant: This transplant is a good option when a compatible donor is unavailable. Stem cells can be easily harvested from babies’ umbilical cord blood, which contains a high concentration of hematopoietic stem cells. Cord blood is meticulously stored in cord blood banks so that it can be utilized for future life-saving transplants.

Haploidentical transplant: It allows stem cells from a donor who is only partially matched. Furthermore, techniques have been developed to lower the risk of GVHD and graft rejection. Leukemia, lymphoma, and genetic disorders might be curable.

Mini transplant (Non-myeloablative transplantation): This novel strategy uses lower doses of chemotherapy or radiation therapy, which is a significant improvement over the typical high-dose conditioning regimen. Reduced intensity conditioning strives to produce an environment that promotes effective engraftment of donor stem cells while minimizing the negative effects and toxicity associated with high-dose conditioning. Reduced intensity conditioning is a good choice for people who are unable to withstand high-dose exercise, such as the elderly or those with serious medical concerns.[6]

Pre-Transplant Nursing Care
Pre-BMT nursing care is crucial for ensuring the patient is well-prepared physically and emotionally for the procedure. Here are some key aspects of pre-transplant nursing care:

• Patient education: Educate the patient and their family about the transplant process, potential risks, and post-transplant care. This helps in reducing anxiety and ensuring they are well-informed.[7]
• Medical assessment: Conduct thorough medical assessments, including blood tests, imaging studies, and organ function tests to ensure the patient is fit for the transplant.[8]
• Infection prevention: Implement strict infection control measures, as patients are highly susceptible to infections due to their compromised immune systems.[8]
• Nutritional support: Assess and optimize the patient’s nutritional status to promote healing and recovery. This may involve dietary modifications and supplements.[9]
• Psychological support: Provide psychological support to help the patient cope with the stress and emotional challenges associated with the transplant.[10]
• Medication management: Ensure the patient understands their medication regimen, including any pre-transplant medications they need to take.
• Coordination of care: Coordinate with the multidisciplinary team, including doctors, dietitians, and social workers, to provide comprehensive care.[11]

These steps help in preparing the patient for a successful BMT and improving their overall outcomes.

Post-Transplant Nursing Care
Monitoring and assessment:

• Vital signs: Regular monitoring of blood pressure, heart rate, temperature, and respiratory rate to detect early signs of complications.
• Blood tests: Frequent blood tests to monitor blood cell counts and detect any signs of infection or (GVHD).

Infection prevention:

• Hygiene: Strict hygiene protocols to prevent infections, including hand washing and using protective gear.
• Isolation: Patients may need to be in isolation to protect them from infections due to their weakened immune system.

Medication administration:

• Immunosuppressants: Administering medications to prevent GVHD and other complications.
• Antibiotics and antivirals: To prevent or treat infections.

Nutrition and hydration:

• Dietary support: Providing a balanced diet that meets the patient’s nutritional needs and supports recovery.
• Hydration: Ensuring adequate fluid intake to maintain hydration and support kidney function.

Psychosocial support:

• Emotional support: Offering counseling and support to help patients cope with the emotional and psychological challenges of recovery.
• Family education: Educating family members about the care and support needed for the patient at home.

Follow-up care:

• Regular check-ups: Scheduling regular follow-up appointments to monitor the patient’s progress and address any complications.
• Rehabilitation: Providing physical therapy and rehabilitation services to help patients regain strength and function.

These guidelines help ensure that patients receive comprehensive care tailored to their specific needs during the critical post-transplant period.

In the intricate and life-saving process of BMT, nurses are essential. From pre-transplant evaluation to post-transplant care, they are involved at every stage of the transplant process. Nurses supervise pre-transplant therapies, educate patients about the operation, and help them get ready for the transplant. They oversee controlling symptoms, giving emotional support, and giving chemotherapy or radiation therapy throughout the transplant. Nurses keep an eye out for issues including infections, GVHD, and treatment adverse effects following the transplant. In addition, they ensure that patients follow their prescription schedules, coordinate care with other medical specialists, and offer patients and their families continuing education and support. Nurse’s knowledge and kind assistance are crucial for the successful outcome of BMT.

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Nandeesh Kumar P R
Department of Nursing
Cauvery College of Nursing, Karnataka, India
Email: nandeeshk@hotmail.com

The author contributed to the conceptualization, investigation, and data curation by acquiring and critically reviewing the selected articles and was involved in the writing – original draft preparation and Writing – review & editing to refine the manuscript.

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https://doi.org/10.63096/medtigo30622464

Nandeesh KPR. Role of the Nurse in Bone Marrow Transplantation. medtigo J Med. 2024;2(4):e30622464. doi:10.63096/medtigo30622464 Crossref