From the Guidelines
Bone marrow transplantation has been shown to be effective in improving health-related quality of life (HRQoL) and reducing the risk of red blood cell transfusions and their possible complications, with a significant increase in hemoglobin (Hb) levels and a reduction in the relative risk of receiving red blood cell transfusions by 36% [I] 1.
Health Benefits of Bone Marrow
The health benefits of bone marrow are numerous, including:
- Improving HRQoL by increasing Hb levels and reducing the need for red blood cell transfusions 1
- Reducing the risk of iron overload, transmission of infection, and immune suppression related to transfusions 1
- Increasing Hb levels with an overall weighted mean difference of 1.63 g/dl compared to controls 1
- Reducing the relative risk of receiving red blood cell transfusions by 36% 1
Bone Marrow Transplantation
Bone marrow transplantation has been shown to be effective in improving HRQoL and reducing the risk of red blood cell transfusions, with a significant increase in Hb levels and a reduction in the relative risk of receiving red blood cell transfusions 1.
- After autologous transplantation, there is a reduced response to erythropoietin (EPO), although endogenous EPO is produced by the kidney in appropriately increased amounts 1
- After allogeneic transplantation, there is a faster response to EPO of the bone marrow, although inflammatory cytokines and immunosuppressive therapy may cause a reduction in endogenous EPO production and a diminished response to EPO 1
Treatment Recommendations
Treatment with erythropoiesis-stimulating agents (ESAs) should be considered to increase Hb levels and improve HRQoL, with a target Hb level of < 12 g/dl 1.
- The dose of ESAs should be adjusted based on the response to treatment, with a decrease in dose by 25%–50% if the Hb increase is at least 1 g/dl above baseline after 4 weeks of treatment 1
- Treatment with ESAs should be discontinued if the Hb increase is < 1 g/dl above baseline after 8–9 weeks of therapy, or if the Hb exceeds 13 g/dl 1
From the Research
Health Benefits of Bone Marrow
- Bone marrow produces approximately 500 billion new blood cells daily to maintain steady-state levels in the peripheral circulation 2
- Bone marrow transplantation may be preferred for younger patients with acquired aplastic anemia who have matched, related donors, with excellent long-term survival for patients who respond to either form of therapy 3
- Erythropoietin, essential for bone marrow erythropoiesis, also modulates bone marrow stromal cell differentiation, with endogenous erythropoietin required for normal differentiation of bone marrow stromal cells to osteoblasts and bone marrow adipocytes 4
- Bone marrow cells from patients with folate and/or vitamin B12 deficiency may be more susceptible to azidothymidine (AZT)-induced hematologic toxicity, with AZT inhibition of DNA synthesis in bone marrow cells relatively consistent in a variety of hematologic disorders 5
Bone Marrow and Nutritional Deficiencies
- Nutritional deficiencies, such as lack of vitamin B12, folic acid, or iron, can affect the bone marrow and blood, with concomitant conditions of vitamin B12 and/or folate deficiency along with iron deficiency not infrequent 6
- Specific diagnostic tests are available to determine definitive diagnoses, and specific therapy is readily available to restore and maintain a normal nutrient status 6
Bone Marrow and Disease Treatment
- Bone marrow transplantation is an accepted treatment for patients with aplastic anemia, with survival rates and long-term complications compared to immunosuppressive therapy 3
- Erythropoietin treatment can increase hematocrit, reduce bone and bone marrow adipocytes, and reduce bone morphogenic protein signaling in the bone marrow 4