Bone Marrow Transplant
A
bone marrow transplant is a procedure to replace damaged or destroyed bone
marrow with healthy bone marrow stem cells. Bone marrow is the soft, fatty
tissue inside your bones. Stem cells are immature cells in the bone marrow that
give rise to all of your blood cells.
Hematopoietic
stem cell transplantation (HSCT) is the transplantation of multipotent
hematopoietic stem cell or blood, usually derived from bone marrow, peripheral
blood stem cells, or umbilical cord blood. Stem cell transplantation is a
medical procedure in the fields of hematology and oncology, most often
performed for people with diseases of the blood, bone marrow, or certain
cancers.
Hematopoietic
stem cell transplantation remains a risky procedure with many possible
complications; it has traditionally been reserved for patients with
life-threatening diseases. While occasionally used experimentally in
nonmalignant and nonhematologic indications such as severe disabling auto-immune
disease and cardiovascular disease, the risk of fatal complications appears too
high to gain wider acceptance.
Why is a
bone marrow transplant needed?
In patients with leukemia, aplastic anemia, and some
immune deficiency diseases, the stem cells in the bone marrow malfunction,
producing an excessive number of defective or immature blood cells (in the case
of leukemia) or low blood cell counts (in the case of aplastic anemia). The
immature or defective blood cells interfere with the production of normal blood
cells, accumulate in the bloodstream and may invade other tissues.
Large doses of chemotherapy and/or radiation are
required to destroy the abnormal stem cells and abnormal blood cells. These
therapies, however, not only kill the abnormal cells but can destroy normal
cells found in the bone marrow as well. Similarly, aggressive chemotherapy used
to treat some lymphomas and other cancers can destroy healthy bone marrow. A
bone marrow transplant enables physicians to treat these diseases with
aggressive chemotherapy and/or radiation by allowing replacement of the
diseased or damaged bone marrow after the chemotherapy/radiation treatment.
Different
types of Bone Marrow Transplant
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There are three kinds of bone marrow
transplants:
Autologous
bone marrow transplant: "Auto"
means "self." Immature marrow cells (stem cells) are removed from
the patient himself before he receives high-dose chemotherapy or radiation
treatment. After these treatments are done, the stems cells are put back in
the body. This is called a "rescue" transplant.
Allogeneic bone marrow transplant: In this procedure stem cells
are taken either by bone marrow harvest or apheresis from a
genetically-matched donor, generally a brother or sister or parent. It can
also be a unrelated bone marrow transplant when the donor is not a relative
of the patient but his cells are matching genetically with the patient.
Umbilical cord blood transplant: In this type of transplant stem
cells are taken from an umbilical cord immediately after delivery of an
infant. These stem cells are than tested, typed, counted, and frozen until
they are ready to be transplanted.
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Bone
Marrow Transplant Procedure
These are
four stages involved in BMT.
Stage 1: Evaluate the patients
for BMT (WORK-UP) usually 14-30 days before
One will undergo
complete medical check-up to evaluate one’s suitability to go through the BMT
procedure. This involves the following:
- Blood Tests
- Chest X- ray and CT Scans
- Tests to assess the condition of heart
and lungs
- Bone Marrow Tests
Patients will be counselled in detail about the procedure, the
complications, the chances of success, the cost and the possible length of stay
in the hospital. Patient will be encouraged to go through the educational
material/booklet and discuss any queries or doubts that he / She might have.
Stage2: Prepare the patient for
BMT (CONDITIONING) usually 2-10 days
High dose of
chemotherapy or radiotherapy is given to destroy the diseased marrow or destroy
the cancer elsewhere and the bone marrow gets damaged as a result. This is
needed to create space for new blood stem cell and also to suppress the
patient’s own immune system (in case of allogeneic transplant), so that the
blood stem cells are not rejected.
The actual process of
transplantation
The transplant
procedure is actually fairly simple, the stem cells or bone marrow cells to be
transplanted are given through the Central Venous line (CVL). The procedure is
just like getting a blood transfusion, except the following precautions which
has to be taken care of :
- Just before the infusion of the new bone
marrow, the patient may be given medication to help avoid any allergic
reactions.
- A monitor is used to check breathing,
heart rate and blood pressure during the procedure. The nurse monitors
closely throughout the infusion of stem cells or bone marrow.
- A doctor is available in the unit and will
check the patient periodically. Medications may be given to deal with
problems that may arise, such as high blood pressure or a fast heart rate.
Stage 3: Pre-engraftment (before
the transplanted blood stem cells start working): (Usually 2-3 weeks)
After high dose
chemo-radiotherapy the blood stem cells are destroyed and normal blood cells
are not produced. The patients need to be kept in a clean room within the BMT
unit in strict isolation during this time. They also need a lot of blood and
platelet transfusion. Most patients get serious infections during this period
and need treatment with antibiotics.
Stage 4: Post-engraftment (after
the transplanted blood stem cells start working)
Early phase (first 3
months)
There are two
types of white blood cells: neutrophils and lymphocytes. Neutrophils save us
from acute infections and lymphocytes prevent repeated or chronic infections.
Once the neutrophil count is above the critical value of 500 cells per
microlitre, the patient can come out of critical isolation. This is called
engraftment or the first sign that the transplanted blood stem cells are
functioning. Soon after the neutrophil increase to normal or near-normal levels
and if there is no other complication, the patient can be discharged home.
However, regular check-up and blood tests (2-3 times a week) are required.
There is also a risk of graft-versus-host disease (GVHD) at this stage.
Late Phase (3 months-12
months)
The immunity against viruses
takes a very long time to recover. Even though some of the immunity is
restored, the patient is still at risk of infections with viruses and fungus.
This is more so if they are being treated for GVHD, which can become chronic
and lingering. If the patient is well, the frequency of check-ups and blood
tests reduce over several months.
After the Procedure
A
bone marrow transplant is usually done in a hospital or medical center that
specializes in such treatment. Most of the time, you will stay in a special
bone marrow transplant unit in the center to limit your chance of getting an
infection. All or part of an autologous or allogeneic transplant can be done on
an outpatient basis. This means you do not have to stay in the hospital or
medical center.
How
long you stay in the hospital depends on how much chemotherapy or radiation you
received, the type of transplant, and your medical center's procedures. While
you are in the hospital, you will be isolated because of the increased risk of
infection. The health care team will closely monitor your blood count and vital
signs.
While
you are in the hospital you may:
- Receive
medications to prevent or treat infections, including antibiotics,
antifungals, and antiviral drugs.
- Need
many blood transfusions
- Be
fed through a vein (IV) until you can eat by mouth and stomach side effects
and mouth sores have gone away
- Be
given medication to prevent graft-versus-host disease
Recovery
The new bone marrow normally takes
almost a year in order to function normally. During this period the patient is
to be monitored closely to identify any infections or complications that may
develop. The recovery process continues for several months or longer after
discharging from the hospital, during which time the patient cannot return to
work or many previously enjoyed activities.
New Advancements in Bone
Marrow Transplantation at Hospitals in India
Haploidentical Allogeneic BMT for patients without donors
Haploidentical Allogeneic peripheral blood stem cell
transplant offers an innovative option for patients who cannot be suitably
matched with a family member, or who do not have an unrelated donor readily
available for transplant. This technique makes it possible to use partially matched
family members as donors.
In this new procedure, peripheral blood stem
cells are collected from the donor, and depleted of T cell lymphocytes known to
cause graft-versus-host disease. The first treatment phase for the patient
includes chemotherapy, immunosuppressive drugs, and radiation. Transplant
specialists can then infuse the prepared cells from the donor into the
patient's body. This transplant method allows physicians to select a partially
matched donor from the patient's family whose white blood cells will act as
natural killer cells against the leukemic cells of the patient.
FAQ - Organ
Transplant Surgery in India
Q. Which is the Best Hospital for Organ Transplantation
in India?
India has a number of world-class
hospitals performing successful Organ
transplantations. Send us your medical report and we will choose the best
hospital after consulting medical experts.
· Q. Can I resume normal activities
after the transplant?
Yes. In fact, Organ patients feel more energized and capable of performing
daily functions. You should however strictly follow the guidelines of the
doctor.
· Q. Who are the Best Organ Transplant Surgeons in India?
There are many renowned Organ Transplant surgeons in India. Mail us your medical report
and we will find the surgeon most suitable for your medical condition.
· Q.Is Organ Transplant in India safe?
India is evolving as a hot
destination for organ transplants. Most of our surgeons doctors have
international experience and hospitals are equipped with the latest infrastructure.
The high quality and low cost treatments make India the top spot for Organ Transplant.
· Q. Can u tell me Comparison of
total Expense of Organ Transplant
in India and in Foreign Countries?
Send us your medical report and
query, and after consulting the medical experts, we will inform you about the
expenses involved and cost comparison.
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