Bone Marrow Transplant

Bone Marrow Transplant: A Major Treatment With a Clear Purpose

A bone marrow transplant replaces damaged or diseased blood-forming cells with healthy stem cells. It is considered when the bone marrow — the soft tissue inside your bones that produces blood — can no longer do its job because of cancer, marrow failure, an immune disorder or certain inherited conditions. For carefully selected patients, it offers a way to restore healthy blood production or to deepen disease control after other treatments have done their part.

Being told that you or someone you love may need a bone marrow transplant is rarely a calm moment. The words often arrive after months of uncertainty: repeated blood tests, chemotherapy, infections, fatigue, transfusions, or a diagnosis that changed daily life in an instant. Most people begin their research with the same urgent questions. Is this the right treatment? How difficult is the process? What are the risks? How long will recovery take? This page answers those questions as plainly as the medicine allows.

Two things are worth saying at the outset. First, a bone marrow transplant — also called a haematopoietic stem cell transplant — is one of the most complex treatments in modern medicine, and the decision to proceed is never routine. It requires careful diagnosis, disease staging, donor evaluation when needed, assessment of organ function, review of infection risk and a realistic discussion of benefits and possible complications. Second, transplant is not right for everyone with a marrow disease. A responsible evaluation sometimes ends with a recommendation not to transplant, or not yet.

At Acibadem, bone marrow transplant care is planned through a multidisciplinary approach that brings together haematology specialists, transplant physicians, laboratory experts, infectious disease teams, intensive care specialists, pharmacists, nurses, dietitians, rehabilitation professionals and international patient coordinators. The aim is to make a highly specialised treatment understandable, medically sound and carefully coordinated for each patient and family.

Dr. Bahadır KaynarkayaMDBoard Commentary

In a published Acıbadem series of children with high-risk acute leukemia undergoing αβ T-cell-depleted haploidentical hematopoietic stem cell transplantation, the 5-year overall survival rate was 71.1%, while the 5-year relapse-free survival rate reached 86.9%. The study represented the first reported Turkish experience of this approach in children with high-risk acute leukemia.

Commentary reviewed — August 25, 2026View profile →

What Does Bone Marrow Do?

Bone marrow is the blood factory of the body. It sits inside the cavities of your bones — mainly the pelvis, spine, ribs, breastbone and the ends of the long bones — and it contains haematopoietic stem cells: immature cells that can develop into every type of blood cell. Red blood cells carry oxygen. White blood cells fight infection. Platelets help the blood clot. Healthy marrow replaces these cells continuously throughout life, adjusting production up or down as the body needs. When the marrow is damaged by disease, genetics, immune attack or previous treatment, that production line falters, and the effects are felt across the whole body. Understanding this is the key to understanding why a transplant is sometimes proposed: the treatment does not target one organ or one tumour, it replaces the system that makes blood itself.

What happens to a person with a bone marrow problem?

When bone marrow fails or fills with abnormal cells, the consequences follow the missing cell lines. Too few red cells causes anaemia: fatigue, breathlessness on exertion, pale skin, dizziness. Too few white cells leaves the body open to frequent or unusually severe infections. Too few platelets causes easy bruising, bleeding gums, nosebleeds or prolonged bleeding from small cuts. In cancers of the marrow, abnormal cells can also crowd out normal production while spreading to lymph nodes, the spleen or other organs. Many patients become dependent on regular blood or platelet transfusions to stay stable, which is often the point at which a transplant is first discussed. Repeated transfusions bring their own problems over time, including iron overload, which is one reason specialists prefer to plan ahead rather than wait.

What are the warning signs of bone marrow cancer?

There is no fixed list of seven warning signs, whatever internet headlines suggest — but there is a recognisable pattern. The features doctors take seriously include persistent unexplained fatigue, recurrent fevers or infections, easy bruising or bleeding, bone pain, drenching night sweats, unintended weight loss, swollen lymph nodes and breathlessness out of proportion to activity. Each of these has many innocent explanations, and none of them can confirm a diagnosis on its own. Only blood tests and, usually, a bone marrow biopsy can establish what is actually happening. Some patients feel relatively well and discover an abnormality only on routine blood work — which is why a diagnosis can feel so abrupt.

How can you improve bone marrow function?

Honestly: no diet, supplement or lifestyle change can restore marrow that is failing because of disease. General health measures — balanced nutrition, not smoking, avoiding unnecessary exposure to toxic chemicals — support normal blood production, and specific deficiencies of iron, vitamin B12 or folate can suppress blood counts and are correctable once a doctor identifies them as the cause. But when the marrow itself is diseased, improvement comes from treating the underlying condition, which may mean medication, immune therapy, transfusion support or, in selected cases, transplant. Be sceptical of products marketed as marrow “boosters”; none has been shown to treat marrow disease.

Is eating bone marrow good for you?

Eating bone marrow is a culinary question, not a medical treatment. Marrow from beef or lamb bones is rich in fat and contains some vitamins and collagen, and it is safe for most people in moderation. It has no effect on the function of your own bone marrow and plays no role in preventing or treating marrow disease. The two topics simply share a name.

What Is a Bone Marrow Transplant?

A bone marrow transplant is a procedure that replaces damaged or diseased blood-forming cells with healthy hematopoietic stem cells — immature cells that can develop into red blood cells, white blood cells and platelets. When marrow is affected by cancer, genetic disease, immune dysfunction or treatment-related damage, the body may no longer produce these cells normally, and the transplant provides a new supply capable of rebuilding the system.

The terminology can be confusing, so it helps to know that several names describe the same procedure. Doctors may say haematopoietic stem cell transplant or HSCT. Medical reports sometimes use the shorthand BM transplantation, and you may see BMT transplantation written in clinic paperwork or hospital summaries; both refer to exactly the process described on this page. Despite the historical name, many transplants today do not involve collecting marrow directly from the hip bone. The stem cells may come from peripheral blood, from bone marrow itself, or from umbilical cord blood, depending on the diagnosis, donor availability, transplant type and treatment plan.

The transplant itself is usually given through a vein, much like a blood transfusion. That surprises many patients: the infusion is the least dramatic part of the whole treatment. The demanding parts are the preparation that comes before it and the careful monitoring that follows, while the new cells settle into the marrow spaces and begin producing blood cells — a process known as engraftment. There are two main categories of transplant, and the difference between them shapes almost everything about the treatment.

Autologous transplant: your own stem cells

In an autologous transplant, your own stem cells are collected in advance, processed and stored, and then returned to you after high-dose treatment. This approach is often used in conditions such as multiple myeloma and certain lymphomas, where intensive therapy may help control the disease and the stored cells are given back to rescue marrow recovery. Because the cells are your own, there is no risk of the graft attacking your body, and recovery is often shorter than with a donor transplant — although the treatment remains intensive and carries real risks of its own.

Allogeneic transplant: donor stem cells

In an allogeneic transplant, the stem cells come from another person. The donor may be a matched sibling, a matched unrelated donor found through international registries, a partially matched family donor, or in selected cases another appropriate source such as cord blood. An allogeneic transplant can replace your diseased marrow with donor marrow, and it can also create an immune effect against certain cancers: the donor’s immune cells may recognise and attack remaining malignant cells. That potential benefit is balanced against significant risks, including graft-versus-host disease, infection during prolonged immune suppression, and the need for long-term immune monitoring.

Is a bone marrow transplant the same as stem cell therapy?

A bone marrow transplant is one specific, long-established form of stem cell therapy — but the broader label covers very different things, and the distinction matters. A stem cell transplant for blood disease is a standard-of-care treatment with decades of clinical experience behind it. Many other treatments marketed under the stem cell banner, particularly for joints, neurological conditions or anti-ageing, are experimental or unproven. If you have been offered “stem cell treatment” for a blood disorder, ask precisely what is being proposed: an autologous transplant, an allogeneic transplant, or something else entirely. The answer changes the risks, the evidence base and the realistic expectations.

The choice between autologous and allogeneic transplant depends on the disease, its stage, response to previous treatment, overall health, age, genetic and molecular findings, donor options and your own goals. A transplant recommendation should always be individualised — never made on diagnosis alone.

Who May Need a Bone Marrow Transplant?

Patients arrive at transplant evaluation by different routes. Some are referred immediately after a blood cancer diagnosis, because transplant is part of the standard pathway for high-risk disease. Others are referred after relapse, after a poor response to initial therapy, or after tests show that the bone marrow cannot produce healthy blood cells. Some patients have inherited disorders or immune conditions in which transplant is considered as a way to replace a malfunctioning blood or immune system altogether.

The symptoms that lead to evaluation usually reflect abnormal blood counts: severe fatigue, shortness of breath with activity, dizziness, frequent infections, fever, easy bruising, bleeding gums, nosebleeds, bone pain, swollen lymph nodes, unexplained weight loss, night sweats, or a recurring need for blood or platelet transfusions. In some cases the patient feels reasonably well and the abnormality is picked up incidentally on routine blood work.

Diagnosis begins with a detailed medical history, physical examination, a complete blood count, blood chemistry tests and a review of any prior treatment. A bone marrow aspiration and biopsy are usually essential. These tests let specialists examine the marrow cells directly under the microscope, measure the proportion and type of abnormal cells, and run advanced studies — flow cytometry, cytogenetics, molecular testing and genetic risk profiling — that shape both prognosis and treatment choice. Imaging is added for diseases such as lymphoma or myeloma, and further tests assess heart, lung, kidney, liver, dental, nutritional and infection status before any transplant can be planned.

International patients often seek a transplant consultation when they need confirmation of a diagnosis, a second opinion on timing, an evaluation of donor options, or access to a coordinated transplant programme. Some come before starting any therapy; others come after chemotherapy, targeted therapy, immunotherapy or relapse. The right timing varies significantly by disease. For some conditions, transplant is considered once remission is achieved. For others, it is planned only after disease control improves or after additional therapy has reduced the risk of proceeding.

Conditions a Bone Marrow Transplant May Treat

A bone marrow transplant is not a single treatment for one disease. It is a platform, used in carefully selected situations where replacing or rescuing the blood-forming system improves the overall strategy. The indications keep evolving as new medications, cellular therapies and genetic testing refine which patients genuinely benefit.

Conditions for which transplant may be considered include:

• Acute myeloid leukaemia and acute lymphoblastic leukaemia
• Certain myelodysplastic syndromes and myeloproliferative neoplasms
• Relapsed or high-risk lymphomas
• Multiple myeloma
• Aplastic anaemia and other forms of bone marrow failure, including inherited marrow failure syndromes
• Paroxysmal nocturnal haemoglobinuria, in selected cases
• Severe combined immunodeficiency and some other immune disorders
• Certain metabolic disorders
• Haemoglobin disorders such as thalassaemia or sickle cell disease, in appropriate candidates

The purpose differs by category. For blood cancers, the aim may be to achieve a deeper remission, reduce the risk of relapse, restore the marrow after intensive therapy, or harness donor immune cells against remaining malignant cells. For marrow failure, the goal is usually to restore the ability to produce normal blood cells and to reduce dependence on transfusions or immune-suppressive medication. For immune deficiencies and inherited disorders, transplant is used to rebuild a more functional immune or blood-forming system from the ground up.

Not every patient with these diagnoses needs a transplant. Some do better with medication, chemotherapy, targeted therapy, antibody treatment, cellular approaches such as CAR-T cell therapy, radiation, supportive care, or simply careful monitoring. A thoughtful evaluation weighs the risks of the disease against the risks of the transplant — a balance that matters most for older adults, patients with organ dysfunction, patients with active infection, and anyone whose disease is not yet under control.

How Does a Bone Marrow Transplant Work?

A bone marrow transplant works in three broad movements: preparing the body, delivering healthy stem cells, and supporting the patient while those cells engraft and rebuild blood production. In practice, the process unfolds over weeks to months and involves several distinct stages, each with its own purpose and its own demands.

Evaluation and treatment planning

Everything begins with a comprehensive review of the diagnosis, prior therapies, current disease status and overall health. For international patients, this often starts remotely, with the medical team reviewing records, pathology reports, imaging, blood test results, genetic findings and treatment summaries before travel. On arrival, testing is usually repeated or expanded, because a transplant plan must be built on current information, not on results from months earlier.

The pre-transplant work-up commonly includes blood tests, bone marrow studies, imaging where indicated, heart and lung testing, infectious disease screening, dental assessment, medication review, nutritional evaluation and an assessment of performance status. The team also considers fertility, vaccination history, prior transfusions, psychosocial support, caregiver availability, and practical questions such as accommodation near the hospital during the vulnerable early recovery period. None of this is bureaucracy; each item exists because it has, at some point, changed a patient’s plan.

Finding a donor: HLA matching

If an allogeneic transplant is being considered, donor identification is a central step. Human leukocyte antigen, or HLA, typing determines compatibility between patient and donor — essentially, how closely the donor’s tissue markers match yours, which influences both the chance of successful engraftment and the risk of graft-versus-host disease. Siblings are typically tested first where appropriate. If no matched family donor exists, the team searches unrelated donor registries, considers partially matched family donors, or evaluates other stem cell sources such as cord blood. The donor’s own health and suitability are assessed thoroughly before any collection takes place; donation must be safe for the donor as well as useful for the patient.

Stem cell collection

The connection between the source of the stem cells and treatment planning is direct: where the cells come from shapes the timing, the logistics and parts of the risk profile. For an autologous transplant, your stem cells are collected before high-dose treatment. Medications are given first to move stem cells from the marrow into the bloodstream. The cells are then gathered through apheresis — your blood passes through a machine that separates out the stem cells and returns everything else to you. The collected cells are processed, tested and stored frozen until transplant day.

For an allogeneic transplant, the cells are collected from the donor. Peripheral blood collection through apheresis is the most common method, but in some situations marrow is harvested directly from the donor’s pelvic bones, in an operating room under anaesthesia. The choice of source depends on the disease, donor factors, the transplant protocol and the team’s assessment of risks and benefits for both people involved.

Conditioning treatment

Before receiving the stem cells, you undergo conditioning: a course of chemotherapy, immunotherapy, radiation therapy or a combination, chosen according to your disease and transplant type. Conditioning has up to three jobs — destroying cancer cells, suppressing your immune system so donor cells can engraft, and clearing space in the marrow for the new cells. It is, for most patients, the hardest part of the treatment.

Conditioning intensity varies deliberately. Some patients receive full-intensity regimens; others receive reduced-intensity conditioning designed to be less demanding for people who could not tolerate the full version — often selected older adults or patients with additional medical conditions. Reduced-intensity does not mean low-risk. These regimens still require careful monitoring and carry significant risks; they simply shift the balance between treatment toxicity and reliance on the donor immune effect.

How is a bone marrow transplant done on the day?

A bone marrow transplant is done as an infusion into the bloodstream, not as surgery. On transplant day, the sequence is straightforward:

1. Conditioning treatment is complete, and your central venous catheter is checked and prepared.
2. The stem cells arrive from the processing laboratory — thawed at the bedside if they were stored frozen.
3. The cells are infused through the catheter into a vein, taking anywhere from under an hour to several hours depending on the product and protocol.
4. Nurses and physicians monitor your vital signs throughout, watching for reactions such as fever, chills, blood pressure changes, nausea or breathing symptoms.
5. The infused cells travel through the bloodstream and home to the marrow spaces inside your bones, where they begin the slow work of rebuilding.

Patients often describe the day as strangely quiet. The infusion looks much like a blood transfusion, and after weeks of preparation the moment itself can feel anticlimactic. The genuinely delicate period starts afterwards.

Engraftment, monitoring and supportive care

After the infusion, the new stem cells need time to settle in and start producing blood cells. Until they do, your blood counts are very low, and the risks of infection and bleeding are at their highest. This is why transplant patients are cared for in protective environments designed to reduce infection exposure, with daily coordination of catheter care, transfusion support, antimicrobial medications, nutrition support, pain and nausea control, and fluid balance.

Modern transplant programmes track this period with specialised laboratory testing: blood counts, organ function, immune recovery, drug levels, infection markers, donor chimerism — a measure of how much of the blood is now donor-derived — and, where appropriate, minimal residual disease testing to follow the underlying condition. Imaging is used when infection, organ complications or disease assessment requires it. In allogeneic transplant, careful surveillance for graft-versus-host disease is essential, particularly in the skin, liver, gastrointestinal tract, lungs and eyes, because early recognition changes how manageable it is.

Digital medical records, multidisciplinary case review, specialised blood banking and cell processing laboratories all support this phase. But the technology matters less than how it is used. The critical skill in transplant medicine is judgement: knowing which changes matter, when to intervene, and how to adapt the plan to the patient in front of the team rather than the protocol on paper.

How long does the treatment and early recovery take?

The length of hospitalisation and early follow-up varies with the transplant type, the conditioning regimen, any complications and the speed of engraftment. Many patients remain in or near the hospital for several weeks through the most vulnerable phase. Autologous transplant recovery is often shorter than allogeneic recovery, although individual experiences vary widely. Allogeneic transplant usually requires longer monitoring because of immune suppression, donor-cell dynamics and the risk of graft-versus-host disease.

After discharge, frequent outpatient visits continue: blood tests, medication adjustments, transfusions when needed, infection surveillance, nutrition support and symptom review. International patients should plan to stay close to the transplant centre until the team judges that travel is medically appropriate. Long-term follow-up continues for months to years, often coordinated with physicians in the patient’s home country.

Recovery Timeline After a Bone Marrow Transplant

Recovery is highly individual, but most patients move through several recognisable phases before returning to broader daily activities. The table below describes a typical course, not a promise — your own timeline will depend on your disease, transplant type and how your body responds.

Time Period	What Patients Can Expect
Day 1	Stem cells are infused through a vein. The care team monitors for infusion reactions and begins close daily tracking of blood counts, symptoms, fluid balance and infection risk.
First Week	Blood counts are often very low. Fatigue, nausea, mouth sores, appetite changes, diarrhoea, fever or the need for transfusions may occur. Protective precautions and supportive medications are important.
First Month	Engraftment may occur during this period, though timing varies. Frequent monitoring, infection prevention, nutrition support and medication adjustments continue. Some patients are discharged but remain near the hospital.
First Three to Six Months	Energy gradually improves for many patients, but immune recovery remains incomplete. Allogeneic transplant patients require close observation for graft-versus-host disease and medication side effects.
Longer Term	Follow-up may include disease surveillance, revaccination planning, management of late effects, fertility and endocrine assessment when relevant, and coordination with the patient’s local medical team.

Benefits of a Bone Marrow Transplant

The potential benefits depend on your diagnosis, the transplant type, your disease status at the time of treatment, donor compatibility and your overall health. What a transplant can realistically offer falls into a few broad categories.

Benefit	What It Means for You
Restoration of blood-forming function	Healthy stem cells can help the body produce red blood cells, white blood cells and platelets again, reducing complications related to marrow failure.
Deeper disease control in selected cancers	For certain leukaemias, lymphomas and myeloma, transplant may be used after other treatment to improve the depth or durability of response.
Donor immune effect in allogeneic transplant	Donor immune cells may help recognise and attack remaining cancer cells in some blood cancers, although this effect must be balanced against immune-related risks.
Reduced dependence on transfusions or intensive supportive care	For selected marrow failure conditions, successful engraftment may lessen the need for repeated blood or platelet transfusions and related hospital visits.
A structured pathway for complex disease management	Transplant evaluation brings together diagnostic review, risk assessment, donor planning, supportive care and long-term monitoring in one coordinated treatment plan.

Risks and Factors That Influence Outcomes

Outcomes after a bone marrow transplant are shaped by many interconnected factors: the underlying disease, its stage, response to previous treatment, genetic and molecular risk features, age, organ function, infection status, performance level, donor match, transplant type, conditioning intensity, and any complications that arise afterwards. No responsible transplant programme can predict an individual result with certainty. What careful selection and preparation can do is improve the likelihood of a favourable course — and that distinction is worth holding onto when comparing programmes.

For blood cancers, being in remission or having a low disease burden at the time of transplant is generally associated with a better course. For marrow failure and inherited conditions, timing the transplant before serious infections or organ injury develop can be important. In allogeneic transplant, donor compatibility and immune management play central roles. Graft-versus-host disease deserves particular honesty: it can be mild and manageable, but it can also become serious or chronic, affecting quality of life for a long time. Preventive medications, early recognition and specialised follow-up are essential, which is one reason allogeneic patients remain under surveillance for so long.

Your own participation genuinely matters. Taking medications as prescribed by the treating team, caring for the central catheter, reporting fever or new symptoms promptly, maintaining nutrition, staying physically active within safe limits, avoiding infection exposures and attending follow-up visits all contribute to recovery. Caregiver support is especially important during the early months, when patients may need help with medications, transport, meals, symptom monitoring and communication with the medical team. Programmes ask about caregiver availability during evaluation because experience shows it changes how safely recovery goes.

A good result is not defined by engraftment alone. It includes disease control, the avoidance or effective management of complications, functional recovery, emotional resilience and a follow-up plan that can continue safely after the patient goes home. For international patients, that means planning not only the hospital treatment but also the transition back to local care.

Why Acting Early Matters

Timing is one of the most consequential decisions in transplant medicine. Acting early does not mean rushing into a transplant. It means obtaining expert evaluation before the disease progresses, before organ function worsens, and before donor search or stem cell collection becomes urgent. For many conditions, the best transplant window opens when the disease is controlled and the patient is still strong enough to tolerate treatment — and that window does not stay open indefinitely.

Delay can narrow the options in several ways. Blood cancers may relapse or become more resistant to therapy. Bone marrow failure can lead to repeated infections, bleeding, iron overload from transfusions, or a declining performance status. Active infection, poor nutrition, uncontrolled disease, kidney or liver impairment or severe weakness can make a transplant more difficult or temporarily unsafe. In allogeneic transplant, identifying and preparing a donor takes time; waiting until the situation is critical can leave too little of it.

Early consultation also allows you and your family to understand the alternatives properly. A transplant team may recommend proceeding, postponing, collecting stem cells now for possible later use, pursuing additional therapy first, or choosing a non-transplant approach altogether. The value of early assessment is that it preserves options — and helps you avoid making a high-stakes decision under emergency conditions.

How Acibadem Approaches Bone Marrow Transplant Care

Patients travelling for a transplant need more than a hospital appointment. They need a medically rigorous programme, clear communication, reliable coordination and a team that understands the practical and emotional weight of undergoing high-risk treatment far from home. Acibadem’s approach is built around those needs while keeping the clinical discipline that transplant medicine demands.

Care is planned by experienced physicians working in multidisciplinary teams. Haematology and transplant specialists review the diagnosis, treatment history, donor options, disease risk and patient fitness before recommending a pathway. Where cancer care is involved, multidisciplinary boards help align chemotherapy, targeted therapy, radiation, transplant timing, infectious disease management and supportive care. This shared decision-making matters because a transplant is rarely an isolated event; it is one step in a longer treatment sequence, and the steps have to fit together.

Diagnostic and monitoring capabilities support every stage: detailed bone marrow evaluation, flow cytometry, cytogenetic and molecular testing, imaging when needed, HLA typing, donor assessment, blood bank support, cell processing, infection surveillance, organ function testing, and post-transplant monitoring of engraftment and disease status. The point of these tools is not to accumulate data but to guide safer timing, more precise risk assessment and earlier intervention when something changes.

Treatment planning is individual by necessity. A young patient with high-risk leukaemia, an older adult with myelodysplastic syndrome, a child with inherited marrow failure and a patient with relapsed lymphoma need very different strategies. Conditioning intensity, donor source, graft-versus-host disease prevention, antimicrobial prophylaxis, transfusion support, nutrition, rehabilitation and follow-up scheduling are all adapted to the diagnosis and the person carrying it.

For patients arriving from abroad, coordination runs before arrival, through treatment and after discharge: medical record collection, appointment planning, interpretation in more than 20 languages, admission coordination, communication with clinical departments, travel-related guidance and support for accompanying family members. Clear communication carries particular weight during transplant, when medication changes, laboratory results, precautions and symptom reporting must be understood accurately on both sides.

Continuity is the final piece. Before a patient returns home, the team prepares medical summaries, medication plans, follow-up recommendations and guidance for the local physician. In many cases, long-term monitoring is coordinated with the patient’s doctors at home, with the transplant centre remaining available for review when questions arise. That continuity is what bridges the distance between specialised transplant care and everyday medical support after the journey ends.

Making the Decision

A bone marrow transplant is a serious undertaking, but it is also a carefully structured medical pathway with a clear purpose: to restore blood-forming function, improve disease control, or replace a malfunctioning immune or marrow system in patients who are appropriate candidates. The decision deserves a full understanding of the potential benefits, the real risks, the alternatives and the recovery commitment — including the months of follow-up that come after the hospital stay.

For many patients and families, a specialist second opinion is the most useful early step: an independent review of the diagnosis, an honest assessment of whether transplant is appropriate, which type might be considered, what timing makes sense and what preparation would be required. Good transplant medicine begins with accurate information, careful clinical judgement, and a conversation that respects both the complexity of the disease and the concerns of the person living with it.