Bone marrow - nonneoplastic
Systemic disorders
Bone marrow transplantation

Author: Nat Pernick, M.D. (see Authors page)

Revised: 27 June 2017, last major update December 2006

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Bone marrow nonneoplastic transplantation

Cite this page: Bone marrow transplantation. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/bonemarrowbmt.html. Accessed August 19th, 2017.
Definition / general
  • Indications:
    • Aplastic anemia, osteopetrosis or other primary / congenital bone marrow disease
    • Post high dose chemotherapy for malignancy
    • Posttransplant if blood counts do not recover as expected
  • Autologous transplantation:
    • Graft is patient's own marrow, often after monoclonal antibodies to tumor or cell sorting regimen
  • Allogeneic transplantation:
    • Graft is from another individual after recipient myeloablative preparatory regimen of high dose chemotherapy, total body radiation or monoclonal antibodies
  • Nonmyeloablative allogeneic stem cell transplantation:
    • In elderly or those with relatively indolent disease
    • Myeloablative steps are reduced or eliminated as curative potential is largely due to graft versus tumor effect
    • Similar outcome as traditional approach in patients > age 50 years (Blood 2005;105:1810)
    • Examination of bone marrow morphology recommended posttransplant in additional to traditional molecular studies (Arch Pathol Lab Med 2006;130:1479)
  • Peripheral blood transplant:
    • Uses CD34+ stem cells
  • Preparation:
    • Chemotherapy, total body irradiation to:
      • Immunosuppress patient to prevent rejection
      • Eradicate tumor cells (antitumor antibodies also used for this purpose)
Complications
  • Infection, graft rejection, graft versus host disease, recurrence of malignancy
  • Infection:
    • Due to immunosuppression
    • Less common due to antibiotics, growth factors
  • Graft rejection:
    • Rare with matched siblings
    • Common with unrelated donors
    • Characterized by decreasing marrow cellularity and progressive cytopenia
    • Decrease in a myeloid cell line may predict impending rejection or be due to drugs or viruses
    • Erythroid hypoplasia may be due to parvovirus B19 infection in immunocompromised patients
    • Dyserythropoiesis and dysgranulopoiesis may reflect toxic effect of immunosuppressive drugs or antibiotics
    • Maturation arrest of granulocytes may occur due to various drugs
    • Granulocyte growth factors cause hyperplasia of immature forms and leukemoid peripheral blood reaction with Döhle bodies, abnormally segmented neutrophils and atypical granulation
  • Graft versus host disease:
    • Associated with increased lymphocytes, plasma cells and eosinophils
Microscopic (histologic) description
  • Successful engraftment:
    • 0 - 1 week:
      • Usually not biopsied
      • Marked hypocellularity, hemorrhage, proteinaceous debris, scattered fat cells and macrophages
    • 1 - 2 weeks:
      • Adipose tissue present
    • 2 - 3 weeks:
      • Scattered islands of hematopoietic cells
      • Often erythroid precursors initially, then promyelocytes and myelocytes
    • 5 - 10 weeks:
      • Increasing erythroid precursors, granulocytes and megakaryocytes
      • Megakaryocyte reconstitution may lag behind other cell lines
Microscopic (histologic) images

Images hosted on PathOut server:

Promyelocytes and myelocytes in upper field

Foci of erythropoiesis



Images hosted on other servers:

Pre and posttransplant bone marrow