How is Bone Marrow Transplantation Performed? What Are the Requirements?
Bone marrow transplantation, also known as hematopoietic stem cell transplantation, is currently a method used in clinical practice to treat various malignant hematological diseases, especially as a common treatment for severe aplastic anemia. Through bone marrow transplantation, the patient's normal hematopoiesis and immune system can be restored, thereby achieving the purpose of treating the disease and allowing the patient to recover their hematopoietic function. However, there is still limited understanding of this treatment method, as bone marrow transplantation is a relatively complex surgical procedure.
1. Selection of Recipient and Donor: The recipient must have appropriate physical and financial conditions. For allogeneic transplantation, the donor must match the human leukocyte antigen (HLA).
2. Collection and Preservation of Hematopoietic Stem Cells: For allogeneic transplantation, it is necessary to find a donor with a compatible HLA type to collect stem cells. For autologous transplantation, the patient's own stem cells from the remission period should be collected before pre-treatment and appropriately preserved outside the body.
3. Pre-transplantation Preprocessing: Prior to transplantation, the patient undergoes various examinations and undergoes pre-treatment (high-dose chemotherapy and/or radiotherapy) in a fully environmentally protected setting. The goal is to eliminate malignant cells or abnormal cell populations in the bone marrow, while preparing the environment for the implantation of normal stem cells.
4. Infusion of Hematopoietic Stem Cells: The stem cell suspension of the donor (allogeneic or autologous) is infused intravenously.
5. Prevention and Treatment of Post-transplantation Complications: After bone marrow transplantation, it is necessary to prevent and treat complications such as graft-versus-host disease (GVHD, allogeneic), infection, bleeding, and interstitial pneumonia, as well as provide supportive treatment.
1. Finding a suitable match is crucial, as the probability of finding a complete HLA match is extremely low. Even among siblings, the chance is only 1/4. Therefore, although international practices often involve establishing bone marrow banks to search for matched donors among non-relatives, the likelihood of finding a match is still between one in a thousand to one in tens of thousands. In fact, most patients are unable to find a suitable match, leading to delays in treatment.
2. The cost of the surgery is astonishing. Even if a patient is fortunate enough to find a suitable match, they still need to prepare for the surgical expenses. Generally, the cost of a fully matched transplantation between relatives is around 150,000 yuan, while the cost for a fully matched transplantation from the China Marrow Donor Program (CMDP) is between 250,000 and 300,000 yuan. For a semi-matched transplantation between relatives, the cost can range from 300,000 to 400,000 yuan.
3. Chemotherapy and radiotherapy are also challenges that patients must face if they meet the above conditions. These treatments can have severe side effects, including infections from pathogenic microorganisms and rejection reactions by the body. Any of these issues can pose a significant threat to the patient's life, and only 60-70% of patients are able to successfully overcome these challenges.
