Bone marrow transplantation in the branches of National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation.

In order to identify possible contraindications and timely prevention of complications, patients are recommended to perform the following examinations within a month before autologous hematopoietic stem cell transplantation (auto-HSCT):

• complete blood count (including white blood cell differential) and biochemical blood test (uric acid, electrolytes, creatinine, calcium, phosphates, urea, liver tests, C-reactive protein, lactate dehydrogenase and glucose);
• coagulation test;
• blood group and Rh factor;
• creatinine clearance (24-hour urine collection);
• PET / CT of the whole body and / or CT of the chest, abdomen, retroperitoneal space and small pelvis;
• esophagogastroduodenoscopy;
• in case of suspicion of possible involvement of the bone marrow – bone marrow biopsy (with morphological, cytogenetic studies, determination of minimal residual disease, immunophenotyping);
• estimation of external respiration function;
• dental pantomography, dental examination;
• X-ray examination of the paranasal sinuses (search for foci of infection);
• examination by a gynecologist / urologist, neurologist, otorhinolaryngologist, cardiologist;
• echocardiography, ECG;
• testing for viral hepatitis, HIV, syphilis, determination of the titer of cytomegalovirus, Epstein-Barr virus, herpes viruses, toxoplasma.

Modern chemotherapy strategies allow us to achieve long-term complete remission (recovery) in a significant number of patients with various types of lymphomas. However, in some patients, the use of standard doses of chemotherapy drugs does not allow achieving complete destruction of the tumor or the antitumor effect is short-term, i.e. some time after the end of treatment, a relapse of the disease may develop. In such cases, second line induction chemotherapy (3-4 courses) is carried out and then, at the peak of the effect of this treatment, it becomes necessary to carry out high-dose consolidation, followed by autologous hematopoietic stem cell transplantation (auto-HSCT).

According to modern clinical guidelines for the diagnosis and treatment of multiple myeloma, high-dose chemotherapy with auto-HSCT should be used as a consolidation in primary patients (without serious concomitant pathology, younger than 65 years old) after first line induction chemotherapy.

High-dose chemotherapy means the use of maximum tolerated doses of chemotherapeutic agents that are many times higher than the standard ones. This type of treatment is considered effective due to significant relationship between the dose of certain cytostatics and their antitumor efficacy. This method makes it possible to overcome the resistance of tumor cells, destroy all surviving tumor cells, and thereby achieve a stable remission of the disease. However, this inevitably leads to suppression of normal hematopoiesis in the bone marrow, which leads to a long and deep decrease in peripheral blood counts (leukocytes, platelets, erythrocytes) with a high risk of developing severe complications.

Autotransplantation of hematopoietic cells, harvested before high-dose chemotherapy, can significantly shorten the period of inhibition of hematopoiesis, as a result of which the frequency and severity of infectious and hemorrhagic (when there is an increased risk of bleeding) complications developing in the post-transplantation period are significantly reduced. Hematopoietic stem cells fill the “empty” areas of the bone marrow, multiply and differentiate into mature blood cells and, thus, in a relatively short time (7-14 days) hematopoiesis, damaged after high-dose chemotherapy, is completely restored.

For transplantation, the patient’s own hematopoietic cells are collected using a special method. First, the stage of stimulating their release into the bloodstream is carried out, while their concentration in the blood is checked daily, and upon reaching the desired level, sessions of collecting these cells are carried out using a special apparatus. Then the cells are processed, frozen and stored until the moment of transplantation.

The end of the transplantation is only the first stage. And even if everything went well, it is too early to talk about success. Patients spend the next several weeks in sterile boxes – it takes time for the bone marrow cells to settle and the immune system to recover. For patients, everything is disinfected: from underwear to food. And all this time, a team of doctors monitors the slightest changes in their condition. The patient’s stay in the hospital is 1 month on average.