Bone Marrow Transplant Failure: How to Avoid Long Term Effects

Today, after reviewing the Nycirrhoe-Gynecological ethics of their care to their patients, some critics wonder if it is excessive to force a patient into a rigorous treatment procedure. To be clear, I am all for rigorous treatment in terms of obtaining the best possible outcome for a patient. But when it becomes excessively invasive, to the point where a patient’s well-being is placed in jeopardy, then something needs to be done. Whether one agrees with the process required to obtain an aplastic surgery or not, it is beyond debate that some doctors abuse their ethical guidelines.

For example, consider the case of Nycirrhoe-Gymnotherapy (Nyctomy-Gyne-Tissue Release). At issue was whether a dog undergoing treatment with Nyctomy-Gymnotherapy should have a heartworm test prior to treatment. The panel ruled that while the dog would need a heartworm test if treated with the standard therapy, the standard treatment involved a rigorous treatment procedure including deworming and trimming of the incision scars, as well as administration of heart worm pellets. The panel also explained that the dog would need to be examined for other conditions such as congenital heartworm disease and possible cardiomyopathy. The panelists noted that they felt that it was important to treat heartworms with antifungals first, before considering standard therapy.

Now, suppose that a patient chooses not to undergo the standard therapy, but instead opts to undergo a minimally invasive procedure, such as a bone marrow transplant (also known as a blood cell transplant). Suppose further that the marrow is not available at the biopsy site. Suppose further that this transplant would not provide the intended effect because the patient would then develop some life-threatening complications, such as chronic liver failure or even his death. This is the ethical dilemma of transplant. If you will recall, transplant failed in the case of a child who later died from chronic liver failure due to transplant.

In this case, we have a situation where the intended result was achieved by means of bone marrow transplantation despite the fact that the medical team had a very good plan for the procedure. What happened? According to experts, this is a rare instance. We see a lot of cases where people actually succeed in getting a transplant, yet they are put through rigorous treatment. For instance, let’s look at a man who was awaiting a bone marrow transplant and was told that he did not meet the minimum age requirement for donors. This individual did get a transplant, but unfortunately, three months later, he developed sepsis, a life-threatening condition wherein the man developed kidney failure and died on the way to the hospital morgue.

It may sound unbelievable, but the truth is that this particular man really just underwent a very rigorous plastic regimen. He needed a high blood count immediately after the bone marrow transplant because the transplant required the taking of a high dose of a new antibiotic. Although this new antibiotic was needed, the antibiotic was given at such high doses that it resulted in significant toxicity. When this case was reviewed with the expert panel, it was concluded that the blood cells were wasted and therefore, this patient did not benefit from the bone marrow transplant that he desperately desired. The other panel members also noted that the blood cells that were wasted in this case did not have the ability to form a perfect circle around the transplanted bone marrow.

Is this an example of a well-designed and rigorously implemented transplant? Unfortunately, it is not. Quite often, transplant teams make assumptions that are too aggressive. They assume that short-term effects will be minimal or will never happen. These assumptions are usually wrong.

As mentioned earlier, the transplant failed because the intended result, the formation of a perfect circle of red cells around the transplanted bone marrow transplant bone marrow did not occur. This is a classic example of a well-designed and rigorously implemented transplant. Unfortunately, the transplant team made the assumption that the short term side effect of a blood stem cells culture would be zero tolerance for all possible stem cell therapies, including marrow expansion. Unfortunately, this was not the case.

Today, most bone marrow transplants follow a more targeted approach in which a careful balance between the expected and the unknown is sought. We have also seen that some transplant teams are more willing to accept unknowns than others. A transplant team that is open to a variety of possibilities will tend to be more successful in achieving the desired long term effects. It has been my experience that teams that embrace uncertainty and embrace risk are usually much more successful than those that simply accept the knowns.