A bone marrow transplant replaces the cells in the body called the hematopoietic cells with new ones and what this does is to stop the body from making the sickle-shaped cells that cause SCD. Healthy stem cells from the bone marrow of a donor is injected into one of the veins that then go to the bone marrow to start creating healthy blood cells.
A bone marrow transplant is a long process and things start happening medically first before the actual procedure takes place:
1. There is a 1-2 week hospital stay to receive chemotherapy that aims to destroy the abnormal blood cells and weaken the immune system so it won't reject and attack the new cells.
2. Your medical team then injects the new stem cells into the body and run tests to make sure these new cells start to work. These tests will typically go on for about a month.
3. Once doctors are convinced that the transplant was successful, you are allowed to leave the hospital but it may take about 1 year or longer before your blood cells and immune system get back to normal so you will be on very close observation throughout this time.
Unfortunately my brother could not benefit from this procedure because his liver was almost 100% gone by the time he got to the hospital where the procedure was to take place. After observing him, the doctors told my mom that there was nothing they could do at that point and that he had just a few more weeks to live. He passed away shortly after that. In order to be a beneficiary of the bone marrow transplant procedure as a sickle cell patient, doctors will have to determine that you are healthy enough both physically and mentally for the process. Furthermore, one of the biggest challenges with this process is to find a matching bone marrow donor but family members are typically the first port of call. I remember my sisters and I were tested to see if we were matches and obviously my kid sister was ruled out because she also had sickle cell and I was not enough of a match to be a donor. My older sister who was, was breast-feeding at the time and was advised against undergoing such a procedure while she was still suckling my niece. My mom was found to be the next closest in match to be his donor but like I said, it was already too late by the time he got here.
I just imagine children who have no siblings to be donors either because they are an only child or none matches their bone marrow type. In this case, donors will have to be sourced publicly in a national registry of people who have volunteered to be tested. Like any other major operation, a bone marrow transplant comes with its own set of possible complications which include:
1. The body's rejection of the new cells - This is known as graft-versus-host disease or GVHD and meds can be taken to treat or prevent this but if they don't work, GVHD can damage organs or cause death.
2. Infection - This can occur because obviously the immune system is weakened from the chemo but medication can also be given to prevent this.
3. Nutritional Problems - This is also brought on by the chemo and problems like vomitting and diarrhea are known to occur
4. Damage to blood vessels in the liver
5. Infertility - This is brought on from the drugs one has to take before the procedure itself.
The truth is bone marrow transplants are 90% sucessful but in the event that they don't work, doctors will repeat the procedure to try and cure you but if that too does not work, then your own sickle stem cells will have to be re-injected into your body which means that SCD returns. If you are considering this procedure for yourself or your child, there are a few things you need to know and should ask your doctor before making a decision to do it or not and there are also some questions your doctor will ask:
1. Age of the patient
2. Extent of organ damage
3. How often pain crises occur
4. How often blood transfusions occur
5. The risks of waiting or trying other treatments first
6. Possible side effects of a transplant
7. Any risk factors that may affect how well the transplant will work
All the best to anyone dealing with this as a reality, I know what you are going through and so I'm sending prayers and positive energy your way.