Bone Marrow Transplant
Bone Marrow Transplant - What is It?
A bone marrow transplant (BMT) is a procedure that infuses healthy blood-forming stem cells into your body to treat broken or diseased bone marrow. BMT is also called a stem cell transplant (SCT). Contrary to popular belief, stem cell transplant is not a surgical procedure. It is a medical procedure with no harm to the donor. A stem cell transplant is a procedure needed to treat some types of cancers like leukemias, multiple myeloma, lymphomas, and various haematological disorders like aplastic anaemia, thalassemia etc. In the past, SCT was more commonly referred to as a bone marrow transplant because stem cells were harvested from bone marrow directly. Today, due to the techniques available to mobilise stem cells from bone marrow to blood, stem cells can be harvested from the blood, in preference over bone marrow. For this reason, the procedure now is more often referred to as a “peripheral blood stem cell transplant (PBSCT).” Stem cell donation is done like blood donation at a blood bank. SCT may either use cells from your own body (autologous SCT) or from a donor (allogeneic SCT).
Bone marrow contains stem cells; and in healthy individuals, stem cells within the marrow form different components of blood. Namely
- Red blood cells that supply the body with oxygen
- White blood cells, which help build immunity of the body and help fight off harmful infections.
- Platelets which help with blood clotting.
Who may require SCT
People with any of the following conditions may require bone marrow transplant:
- If an existing medical condition is preventing the body from making new healthy blood cells; the person in question may need to go in for a bone marrow transplant.
- The presence of blood cancers (of various kinds) including acute lymphoblastic leukaemia (ALL) or acute myeloid leukaemia (AML), which is more common in relapsed cases.
- Some forms of cancer in the lymph nodes, particularly relapsed Lymphomas.
- Genetic diseases like sickle cell anaemia, thalassemia, where the body produces faulty red blood cells.
- Bone marrow diseases such as aplastic anaemia where the bone marrow is unable to produce any blood cells at all.
- Paediatric cancers, namely Neuroblastoma, Medullablastoma, Primitive Neuroectodermal tumor (PNET)
- Rare conditions such as Primary Immunodeficiency disorders, Storage disorders, Osteoporosis
The very first allogeneic transplantation was performed by E. Donnall Thomas in 1957, and since 1957, the field has evolved greatly with the development of new technologies along with ever advancing research and breakthroughs. These new developments have have afforded higher success and reduced complications significantly when compared to the past.
Best Bone Marrow Transplant Hospital in India
Aakash Healthcare ranks among the very best hospitals for BMT/SCT in india. The hospital is wholly committed to affording unmatched care and comfort to all our patients. BMT/SCT at Aakash Healthcare is performed to replace damaged bone marrow with healthier marrow and some of the best bone marrow transplant specialists in Delhi are part of our team here at Aakash Healthcare. We are fully equipped with a state-of-the-art blood bank unit, HEPA-filter installed wards, a specialised chemotherapy preparation unit to cater to the requirements of all SCT patients. Our accompanying team of trained doctors, nurses and other paramedical staff are always ready to provide special care to cater to the specific needs of our BMT/SCT patients here.
Types of Bone Marrow Transplant
Bone marrow transplant can be categorised into three categories:
Autologous Bone Marrow Transplant
The term “auto” means self, and in this procedure, stem cells are extracted from the patient’s own body before they are administered high-dose chemotherapy or given radiation treatment. The purpose of high dose chemotherapy is to completely eradicate cancerous cells with doses of chemotherapy; which can’t be done if stem cells are not available and ready to rescue the bone marrow. It is also called a “rescue” transplant for this very reason. The stem cells are properly preserved in a freezer or can even be cryopreserved at very low temperatures with the help of certain assistant chemicals. After receiving high-dose chemotherapy, the patient’s stems cells are infused back their body to help retain the proper function of blood cell formation via stem cells. Typically it takes around 2-3 weeks for your infused stem cells to reform the blood cells in your body.
Allogeneic Bone Marrow Transplant
The term "allo" means other. Here, stem cells are removed from another person, called a “donor”. Many times, it is a prerequisite that the donor's genes match (partly/fully) with the patient’s genes. Specially designed tests (HLA testing) are performed to screen and determine if a donor is a good match for a patient. A sibling is most likely to be the ideal match and at times, parents, children, who may not be a full match but could still be good matches where half of their genes match that of the patient (Haploidentical transplant). There are various national/international bone marrow registries where people may be able to find ideal matching donors who are not related to them but are still a good match [Matched unrelated donor transplant, (MUD)].
Umbilical Cord Blood Transplant
This is also a form of allogeneic transplant. In this procedure, stem cells are detached from a newborn baby's umbilical cord right after birth. The stem cells are then frozen and stored in a highly controlled environment, till the time they are required for a transplant. There are various cord bank registrations that store a wide range different stem cells. Umbilical cord blood cells naturally aren’t fully matured and therefore, there is really no need of finding a good match. Because of the smaller range of the stem cells, the blood count takes much longer to return to full strength, about 4-6 weeks.
What is the difference between bone marrow and a bone marrow transplant?
'Bone marrow' is the spongy tissue inside your bones that forms blood cells. A Bone marrow transplant however, refers to a procedure which involves replacing blood-forming cells (known as stem cells). At first, the patient receives chemotherapy, radiation, or both to eliminate the cancerous cells and preserve the healthy cells within the bone marrow. Afterwards, the patient receives new stem cells through an IV. The new stem cells begin to generate healthy blood cells over time.
How are bone marrow transplants and stem cell transplants different?
The only real difference between a bone marrow transplant and a stem cell transplant is based on the source from where the stem cells are procured. Stem cells are produced in the bone marrow, but some of those cells also travel into the bloodstream. If the stem cells for the transplant are extracted from bone marrow, the treatment is called a "bone marrow transplant." If the stem cell is taken from the bloodstream, the treatment is called a "peripheral blood stem cell transplant."
Are there different types of bone marrow transplants?
There are two two kinds of bone marrow transplants:
- Autologous: The transplant team extracts, accumulates and stores the patient’s own healthy stem cells and the patient will receive these healthy stem cells back once the treatment is completed.
- Allogeneic: The patient receives stem cells from a donor. The donor may be a family member, friend, or even a stranger or the blood of an infant’s umbilical cord. However it is important to remember in allogenic transplants, the donor’s blood must match the patient’s blood.
How do I know if a bone marrow transplant is the best treatment option available for me?
This depends on your disease, the severity of it and your overall analysis of your health. Your doctor will be best equipped to help determine the best option for you. Discuss all treatment options with your doctor to find out what is best suited to your requirements, you can even note down your questions and concerns about bone marrow transplant before your appointment and bring them over to discuss with your doctor.
How long will I be hospitalised for after the bone marrow transplant procedure?
Generally, patients are required to stay in the hospital anywhere from 30–100 days after they have received the transplant. The recovery time varies depends on a few factors:
- The kind of transplant (Allogenic transplants take longe to recover from along with a more stringent follow up routine).
- If there are any complications that arise from or during the transplant.
Before treatment, your doctor will give you an idea of how long the stay may be, but no fixed dates or days can possibly be determined before surgery and the duration of your stay may change once the transplant has been done..
How can I find out if I am a match for a relative’s bone marrow transplant?
You will be required to undergo certain blood testing and some genetic tests to determine whether you are the right match or not. You can discuss with your family members before these tests and with the concerned doctor on how to go about testing
Complications and success rate of transplant:
These following complications of SCT are most commonly reported Autologous SCT:
- Nausea/Vomiting- It is managed with anti-emetics and other intravenous drugs.
- Mylosuppression (Drop in various components of blood) - It is managed with a combination of blood and platelet transfusion and antibiotics
- Oral ulcers: These are managed with pain killers, intravenous nutrition and local measures.
- Hair loss: It is only temporary and reversible.
Apart from the complications seen in Autologous SCT, there are certain complications unique to Allogeneic SCTs:
- Graft v/s Host Disease: Here the immune cells of the donor react abnormally against the recipient’s tissue. This can cause oral ulcers, diarrhoea and jaundice. It is managed through a combination intravenous medications and immunosuppressants. Since this complication happens in 15-40% of patients, patients are required to stay in hospital for longer and even after discharge they are advised to stay near the hospital for 3 months.
- Viral infections: Due to the immune suppressive medications used, patients are at a higher risk of certain viral infection like cytomegalovirus (CMV), Adenovirus etc.
- Success Rates: The success rate for SCT depends on the severity of disease and type of transplant used
lymphoma- 60-80% success rates are reported.
Leukaemia- 50-60% patients get cured with SCT
Thalassemia and Aplastic Anaemia - Recovery rates as high as 80% are possible.