Autologous bone marrow transplantation

Autologous bone marrow transplantation involves the use of the patient's own marrow to restore haematopoietic function. The reinfused haemopoietic stem cells may be from the:

• bone marrow
• peripheral blood - collected following chemotherapy and/ or the use of growth factors such as granulocyte colony stimulating factor

The main advantages of autologous transplantation is that it may be used in older patients - up to 60-70 years of age - and there is no risk of graft versus host disease. It is also useful when a closely matched allogeneic donor cannot be found and in the treatment of widespread myeloma in young fit patients.

The harvested bone marrow is stored in liquid nitrogen. The patient then undergoes intensive chemo and/or radiotherapy before the marrow is re-infused.

The marrow may be treated in vitro with monoclonal antibodies to remove malignant cells prior to re-infusion.

The main complications are:

• pneumonitis during the first three to four weeks after transplantation - this is associated with increasing haemorrhage but no identifiable cause
• hepatic veno-occlusive disease