BONE MARROW TRANSPLANTATION

Among the ever lengthening list of organ transplants which are being performed all over the world, one of the least understood by the public is that of the bone marrow, which has been performed for the last 30 years, and in which the British Hospital was the first to undertake it in Argentina just over 20 years ago.

The Bone Marrow resides in the bones, where primitive cells called Stem cells differentiate into 3 different lines, which eventually spill out into the blood as red blood cells, white blood cells and platelets. These last are the smallest of the lot, and they play a vital role in sticking to any damaged area of the inner lining of arteries and veins, thereby participating in clot formation to seal off the wound and staunch bleeding. The Red Blood Cells lose their nucleus just before emerging into the blood stream, and are specially shaped (like 2 small saucers stuck back to back) to be able to transport oxygen from the lungs to all the tissues.  The White Blood Cells with several subsets, participate in reducing inflammation, blocking off infection, and making antibodies to combat infection.

In many instances, the Bone Marrow is affected by tumours of the white cells themselves, by cancer spread from other organs, by infections, by the effect of drugs or toxic substances, in which case it can stop functioning or it can be replaced by other tissues. Once that happens, if it cannot be corrected, the person affected can be put in a life threatening situation. To this end, Bone Marrow Transplantation (BMT) was researched and developed.

If you have an organ transplanted, and no special treatment is installed, your body will reject the transplanted organ. That is why drugs were developed to fight the rejection process, and they have to be taken for life. To have a BMT, in most instances one has to receive a lethal dose of chemotherapy and radiotherapy first, to eliminate every single Bone Marrow cell, and the bone marrow aspirated from the marrow of the donor is then infused intravenously in to the patient, and it takes from 7 to 10 days for it to graft onto the inner bone structure.  Curiously, the graft might reject the tissues of the body it is put into (!!!), and produce a very serious illness called “Graft vs. Host Disease”. To avoid this, the donor must be selected very carefully, so as to be as close a match as possible to the sick person who must receive it, ideally a twin brother or sister, or a very close relative, and anti-rejection therapy started right after the transplant is performed.  The lesser the match, the higher chance to have this dreaded complication. That is why the candidates for a transplant go onto a national and an international registry, with all the details of his or her antigen screening status, so as that when a donor appears, it will be offered to the person highest on the list with the closest match.

The British Hospital did the first BMT in 1986, and since then has performed over 370 transplants. It has a special area in the Hospital with 4 rooms fitted out for this procedure, with special circulation of air and all other precautions to avoid infections, which is another of the serious complications that can occur.  The team of Haematology specialists is led by Dr. Eduardo Bullorsky, and their experience has been published worldwide.  Last year, to celebrate the first 20 years, an academic meeting was held at the British Hospital, where one of the top European specialists was present, plus local leaders. The event was capped by the presence of many survivors, including their children, making for a very emotional moment.

Dr. Eduardo Bullorsky

Translation:  Dr. J. Emery