Bone Marrow Depression: Treatment, Cost and Side Effects

Bone marrow is the spongy, soft tissue present inside the bones which builds up most of your body’s blood cells- white blood cells (provides immunity), red blood cells (carries oxygen) and platelets (helps in blood clotting). Depletion in the activity of the bone marrow results in the reduction of platelets, white blood cells and red blood cells. This condition leads to bone marrow depression. Usual symptoms of this condition include- fatigue, dizziness, breathlessness, pale skin and exhaustion, which are the typical symptoms of anemia, chills and fever, rash, diarrhea resulting from a weak immune system, bleeding from the nose or gums, blood in the urine, dark bowel movements etc. Bone marrow depression occurs due to heavy dose of strong drugs and anti-cancer medication such as chemotherapy or radiation therapy.

Treatment for bone marrow depression primarily involves use of certain drugs like sargramostim (Leukine), pegfilgrastim (Neulasta), filgrastim (Neupogen), erythrocytes and epoetine to stimulate the bone marrow to create new cells. Filgrastim and Pegfilgrastim are both granulocyte colony-stimulating factors (G-CSFs) while Sargramostim is a granulocyte macrophage colony-stimulating factor (GM-CSF) that helps boost the formation of white blood cells.

In order to confirm the diagnosis, the doctor will perform a bone marrow biopsy during which a needle is used to remove a sample of bone marrow from your body for further examination. Bone marrow depression can be treated with stem cell transplant or bone marrow transplant which requires you to find a suitable and matching donor. First the unhealthy bone marrow is depleted with chemotherapy or radiation therapy. Healthy stem cells are filtered from the blood of the donor, and intravenously injected in the patient’s bloodstream. These eventually reach the bone marrow cavity and helps produce new blood cells. This procedure takes time and the patient will be given certain drugs in order to prevent rejection of the donated blood cells.

Use of certain drugs like sargramostim (Leukine), pegfilgrastim (Neulasta), filgrastim (Neupogen), erythrocytes and epoetine to stimulate the bone marrow to create new cells. Filgrastim and Pegfilgrastim are both granulocyte colony-stimulating factors (G-CSFs) while Sargramostim is a granulocyte macrophage colony-stimulating factor (GM-CSF) that helps boost the formation of white blood cells.

If you see symptoms of bone marrow depression such as fatigue, dizziness, breathlessness, pale skin and exhaustion, chills and fever, rash, diarrhea, bleeding from the nose or gums, blood in the urine, dark bowel movements etc, then you should consult a doctor and get yourself diagnosed. Usually people who’ve gone through cancer treatments like chemotherapy and radiation therapy, are likely to have their blood cell count reduced, resulting in bone marrow depression.

If you do not experience any symptoms of bone marrow depression, then you are not eligible for the treatment.

There are a few side effects resulting from the treatment of bone marrow depression, such as vomiting and nausea, fatigue, mouth sores, anemia or diarrhea. Viral or bacterial infections are also very common after you’ve had a bone marrow transplant. One of the most serious side effects is Graft-versus-host disease (GVHD) seen among the transplant recipient. GVHD occurs when the transplanted marrow does not quite adapt to your immune system and attacks them.

You will need to follow certain guidelines after the treatment of bone marrow depression. These primarily include- following the prescribed medication to stimulate bone marrow, avoiding lifting heavy weight or participating in strenuous sports activity, abstaining from alcohol, etc. You should always keep your hands clean and washed, use an alcohol-free mouthwash. Do not eat undercooked food or pre-cut vegetables and fruits as they may contain bacteria. Make sure you consume lots of fluids and high-protein food.

Recovering from bone marrow depression may take several months. The patient will have to spend the initial few weeks after a transplant surgery at the hospital. And even after their discharge they will need to follow the post treatment guidelines to recover from the condition.

The cost of treatment for bone marrow depression in India ranges between Rs.20 lakh to Rs.35 lakh at any private hospital. However, the cost may be relatively less if the patient seeks medical attention at any government-aid hospital.

Whether the results of the treatment for bone marrow depression are permanent or not, is not known. However, on several occasions the chances of finding a matching donor for the patient accounts to only 25%. Moreover, it may so happen that the patient’s body does not accept the donor cells, resulting in the failure of bone marrow transplant. Even if the transplant works, the patient will have to make lifestyle changes in order to see long-term results.

The alternative treatment for bone marrow depression may include certain antivirals or antibiotics and immune-suppressants such as cyclosporine and anti-thymocyte globulin which suppress the activity of your immune cells and help the bone marrow produce new blood cells.