The first successful transplantation of bone marrow took place in 1968 on a child suffering from immune deficiency syndrome. Since then, BMT has become standard therapy for hematologic malignancies, breast cancer, anemia and immune deficiency disorders.

This means that if BMT is not the standard therapy for a certain illness, it will be deemed investigational and therefore will not be covered by insurance. A recent survey of transplant centers showed, for example, that autologous transplants are frequently not reimbursed by insurance companies.

Bone Marrow
BMT essentially eradicates the patient's own marrow and replaces it with the marrow of a healthy donor. Patients first receive high-dose radiation or chemotherapy to completely wipe out the malignancy present in their marrow and blood. The donor's healthy marrow is then infused. This marrow makes its way into the bones, attaches to the tissue and begins cell division, and produces a new population of blood cells.

The dosages of radiation or chemotherapy must be high enough to completely eradicate the patient's own marrow, or surviving cells will recognize the donor tissue as foreign and reject it. Marrow is drawn from the hip bone of the donor and infused into the patient in the form of a blood transfusion. The donor must receive a general anesthetic before undergoing the surgical procedure to remove the marrow.

There are two types of bone marrow transplantation-allogeneic and autologous.

Allogeneic transplantation means that the marrow comes from a relative, preferably a sibling or unrelated donor who matches all six of the HLA antigens, or tissue types, of the patient. Nearly 70 percent of allogeneic transplants come not from a family member, but from an unrelated donor. If family members are not compatible donors, the National Marrow Donor Program can assist patients in their search for an unrelated, HLA-matching donor. There are now more than 1 million potential donors registered with the NMDP. The process usually takes four to six weeks for most patients.

However, for patients with a mixed or multi-racial background the search for a donor can be lengthy and difficult. A side effect known as graft-versus-host disease (GVHD) can occur following allogeneic transplantation. This means that the new tissue, or graft, does not recognize the cells of the patient, or host, and launches an attack against the body's tissue. Drugs that suppress the immune response to new tissue are usually used to prevent or treat GVHD.