Hotline to focus on marrow problems

Blood stem cell or bone marrow transplant may cure a variety of cancers, including leukemia, lymphoma, multiple myeloma and certain solid tumors such as sarcomas. It can also fix bone marrow problems, including aplastic anemia, or diseases such as sickle cell anemia.

The high-dose chemotherapy needed to kill some cancers would itself be deadly without a bone marrow transplant, which rescues the patient by replacing essential-to-life bone marrow function.

Transplanted using an infusion (like a blood transfusion), the stem cells in the marrow find their own way "home" to grow new, healthier bone marrow, according to Dr. Finn Bo Petersen, medical director of the Intermountain Blood and Marrow Transplant Program at LDS Hospital.

Petersen and Dr. Julie Asch, associate medical director of the program, will be featured on Saturday's Deseret Morning News/Intermountain Healthcare Hotline. From 10 a.m. to noon, they'll answer questions about transplants, blood and marrow-related diseases and risks.

A bone marrow transplant can also be used to cure genetic errors, such as when a person is missing an important enzyme and it prevents the immune system from functioning well, Asch says. Someone else's marrow can solve that problem.

The most dangerous time is the waiting period between transplant and engraftment, when the cells begin to take over the job of manufacturing bone marrow.

During that time, says Petersen, side effects and complications from the chemotherapy (and sometimes radiation) used to kill the patient's bone marrow are likely. So are problems from the loss of marrow function. The patient must be watched closely, a number of medications given to counter nausea, infection, dehydration, inability to eat and others. That waiting period typically lasts two to five weeks.

Stem cell sources depend on the disease, the patient's age and physical condition. For some diseases, a patient's own bone marrow is used, called an autograft. Before the marrow is killed, stem cells are harvested and frozen to be reinfused later. It takes 10-12 days to get a normal blood count again, and the hospital stay is typically about three weeks. That's the least complicated bone marrow transplant.

Other diseases or factors require a marrow donation from someone else, called an allograft. It's easiest to get a good donor match from a full sibling, who has a one in four chance of matching. Allografts usually take three to five weeks after transplant before the bone marrow starts to produce. And because the immune cells are made to protect the donor from infection, they may react against the recipient. The transplant team tries to dull that reaction so it's not an overreaction.