Bone marrow is the substance in the center of your bones that produces red blood cells. A person with sickle cell disease has bone marrow that produces red blood cells with defective hemoglobin S. But if that bone marrow is replaced with healthy bone marrow, a person's body may start to produce normal hemoglobin. Bone marrow transplants require bone marrow from another person (donor) and carry a high degree of risk. They are used only in cases of severe sickle cell disease for children who have minimal organ damage due to the disease. Experts consider the procedure experimental.
Before the transplant, bone marrow stem cells are taken from someone who has closely matching bone marrow, usually a healthy brother or sister. The child who has sickle cell disease is then treated with drugs that destroy his or her bone marrow cells. After that, the donated bone marrow stem cells are injected into a vein.
After the process is complete, the donor's bone marrow begins to replace the recipient's bone marrow. These new cells restore the immune system and make normal red blood cells.
After bone marrow transplant, recovery takes 1 to 2 months in the hospital. The child's natural defense system needs this time to start working again.
During recovery, doctors watch closely for signs that the immune system is rejecting the new bone marrow and for signs of infection. If a problem occurs, recovery can take longer or the transplant may fail.
Bone marrow transplants offer a potential cure for a child's sickle cell disease. They are usually considered only for children younger than 16 who have:
The risks of bone marrow transplant become greater as a person gets older and/or develops damage to major organs. For these reasons, a bone marrow transplant is not a treatment option for most adults who have sickle cell disease. But research on bone marrow transplants in adults is ongoing.
If successful, a bone marrow transplant can cure sickle cell disease. This treatment has been successful in about 85% of children who had transplants.1 But the risk of dying after a transplant is about 5% to 10%.2
- National Heart, Lung, and Blood Institute, National Institutes of Health (2002). The Management of Sickle Cell Disease (NIH Publication No. 02-2117). Available online: http://www.nhlbi.nih.gov/health/prof/blood/sickle/.
- Wang WC (2009). Sickle cell anemia and other sickling syndromes. In JP Greer et al., eds., Wintrobe's Clinical Hematology, 12th ed., pp. 1038–1082. Philadelphia: Lippincott Williams and Wilkins.
- Steinberg MH (2008). Sickle cell disease and associated hemoglobinopathies. In L Goldman, D Ausiello, eds., Cecil Medicine, 23rd ed., pp. 1217–1226. Philadelphia: Saunders Elsevier.
Last Revised: October 7, 2010
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