What is Bone Marrow Transplant, or Hematopoietic Stem Cell Transplant?
Bone marrow Transplant is a medical procedure in which the stem cells from bone marrow, also known as hematopoietic stem cells, which effectively produce red blood cells, white blood cells and platelets are injected or infused into the recipient. In the present day, hematopoietic stem cells can be acquired from the peripheral blood, all this with the help of certain growth factors or from the other source which is an umbilical cord. Thus, the earlier famed ‘Hematopoietic stem cell transplantation` is now preferred and referred to as ‘Bone marrow transplantation’.
The bone marrow is a soft, fragile, and squishy part that lies within a bone. It consists of immature cells which are called stem cells, these have the ability to continuously produce different types of blood cells, like the red blood cells, white blood cells and platelets. The blood cells generated are then released from the site into the blood stream.
Bone marrow is majorly classified into two types, red marrow and yellow marrow. Red marrow exists in children, this means most of the marrow which is present in children is rich in stem cells. However, in adults, the diversion is quite evident with a large portion of the bone marrow being converted into yellow marrow, this occurs due to the infiltration of the fat cells. Only a few adults have red marrow, which exists in sites like hip bones, breast bone, ribs, shoulder blades, skull, backbone, and the ends of the arm and thigh bones.
Objective of Bone Marrow Transplant
Bone Marrow Transplant is adept for the following purpose:
- It can be useful in case replacing a missing gene. For instance, in case of Thalassemia, Sickle cell disease, and some other genetic disorders. These are diseases in which person misses a gene, which can be replaced with Bone Marrow Transplant.
- High dose of anticancer therapies may lead to loss of bone marrow. This means stem cells support is required for adept treatment, which is recovered with marrow after a prolonged period of time. This causes high complication rate from various infections and significant bleeding. Infusing the stem cells lower the low blood count risk by a significant figure due to marrow suppression.
- GVDA better known as Graft versus Disease activity, more commonly known as “Graft v Leukemia effect” is preferred in chronic myeloid leukemia.
Why Bone Marrow Transplant is done?
Stem cell transplants are used to treat people who suffer from damaged stem cells due to a disease or during the course of treatment of a disease. Leukemia is another condition that leads to stem cell damage, and affects the donor’s immune system. Stem cell transplants can be of great benefit to people who are suffering from a variety of ailments, it works well with both cancerous (malignant) and noncancerous (nonmalignant) diseases.
The way that the stem cell transplant helps effectively treat blood disorders is by the following:
- Terminating the cancer cells– In the stem cell transplant treatment, you’ll first be administered with powerful drugs (chemotherapy) and radiation therapy to terminate the cancer cells. Doctors infuse in the stem cells into the body, these healthy stem cells are all acquired from the donor. The new introduced stem cells migrated to the bone marrow over the time, help produce healthy new cells.
- Help with faster and swifter recovery from chemotherapy and radiation. The healthy cells which are infused in the stem cell transplant procedure allows and initiates faster recovery time from the chemotherapy and radiation procedures, since the cell haven’t yet been treated upon.
Types of Stem Cell Transplant
The Stem Cells can either be harvested from another person or collected from patient’s own body. Donor is the person from whom the cells are acquired.
Autologous transplant – The stem cells are acquired from the patient either from the bone marrow or apheresis, the retrieved stem cells are then given back to the patient post a proper conditioning treatment.
Allogeneic transplant – In this type of transplant Stem cells are acquired either from the bone marrow or apheresis but not from the patient, but a HLA matched donor, usually the donor is a blood relative. Other than a blood relative the donor can be an identical twin, in this case the genetic match is found and hence it is a great alternative. The HLA can be found a match from a completely unrelated donor, it is usually found that national registries serve the best for this alternate. Stem cells can also be acquired from umbilical cord immediately post the infant’s delivery. These are tested, typed, and frozen for later use.
BMT/HSCT is offered for:
Benign Hematological Disorders: Thalassemia, Sickle Cell Disease, Aplastic Anemia, Bleeding Disorders, Coagulation Disorders, etc.
Malignant Hematological Disorders: Acute and Chronic Leukemia (AML/ALL/CML/CLL), Hodgkins and Non-Hodgkins Lymphoma, Multiple Myeloma, Myelodysplasia (MDS), etc.
BMT essentially refers to the infusion of stem cells which are acquired from bone marrow or peripheral blood or cord blood into the patient. The type of BMT is distinguished with the type of bone marrow being used for the transplant.
Types of BMT
- Autologous BMT (utilizing patient’s own cells).
- Allogeneic BMT in which the stem cells of a donor are used. The donor may be anonymous, someone from the family, or anyone with whom the HLA matches.
There are essentially three phases to the BMT process:
- The Pre-BMT
- The Post-BMT
The experience of each patient will be different based on the type of treatment opted and severity of the disease.
Transplant Treatment Process
The bone marrow stem cell treatment procedure is widely divided into seven types:
Preparation: This is the phase which initiates as the patient reaches out for the treatment. The patient reaches the stem cell center and starts by explaining the condition. After doctor’s thorough medical evaluation, orientation, informed consent, and other preliminary activities. The procedure is finally initiated. A learned professional doctor will prepare you with the must know information and help you with the procedure insight.
Stem Cells Harvest: Collection or accumulation of the stem cells is a necessary step which is done either from the bone marrow or from the peripheral blood by apheresis. The acquiring process can be done from the donor which is a form of Allogenic transplant or from the patient itself, this is called Autologus transplant.
Conditioning: This phase is generally the one which is inclusive of high-dose chemotherapy, radiation therapy, or both of them initiated as per doctor’s advice after thorough analysis of your particular condiiton. Chemotherapy and radiation therapy are both administerd in doses which obliterate the bone marrow functioning and results in the effectivley destroying the impening disease. Depending upon the chemotherapy and radiation therapy schedule and outcomes, some conditioning therapy may or may not be administered in the outpatient setting. The Preparation, Harvesting and Conditioning together comprises of the Pre-Bone Marrow Transplant Phase.
Transplant: This is the actual transplant phase is which the infusion of the donor’s bone marrow or stem cells takes place. Post the completion of conditioning regimen, the patient will receive the infusion of stem cells from bone marrow. The duration which extends beyond the transplant is considered and called as the Post Bone Marrow Transplant phase.
Engraftment: This phase essentially is inclusive of monitoring, supportive treatment, and management of all the impending complications while waiting for the signs of generation and growth of new cell growth.
Early Recovery: After the transplant it usually takes about 10 to 28 days for the signs to appear that affirm the new bone marrow or stem cells are engrafting which is inclusive of growth and development. Close monitoring will continue with supportive care during this time. Preparation is made for the patient to return.
Long-Term Recovery: This phase involves ditching the treatment center, or dealing with any ongoing clinical issues, and adopting and establishing life patterns. Patients however are expected to undergo follow ups to steer clear from any long term complication of BMT.
Key features incorporated in Stem Cell Therapy Centres
- High-quality state-of-the-art infrastructure with latest technical advancements
- Fastest growing stem cell transplant program in India.
- The provision to adeptly perform haploidentical and matched donor transplant.
- Use of cryopreservation with use of liquid nitrogen (N2).
- CD34 Detection Lab facility.
- Indian Stem cell transplant registry and the Asia Pacific Blood and Marrow Transplantation group.
- HLA testing present in-house.
- Transplant suit room with spacious accommodation well equipped with HEPA filter and positive pressure
- Intensive care unit with isolation beds for Infant and adults.
- Outpatients are offered Day care facility.
- Endoscopy / Bronchoscopy / Dialysis unit available.
- Chemotherapy / Immunotherapy / Blood Transfusion.
- Transplants for- infants, child, adult and elderly.
- Chemotherapy / Immunotherapy/Blood Transfusion.
- Endoscopy/Bronchoscopy/Dialysis unit available.
Department of Transfusion Medicine
- 24/7 service of blood components which is inclusive of platelet apheresis.
- Blood components NAT tested.
- Peripheral stem cell harvesting and bone marrow processing both have transplant units dedicated for the treatment.
- Gamma Irradiator.
- Acute leukemia – Myeloid & Lymphoid Leukemia
- Chronic Leukemia – Myeloid & Lymphoid Leukemia
- Multiple Myeloma
- Myelodysplastic Syndromes
- Hodgkin`s and Non Hodgkin`s Lymphoma
- Myeloproliferative Disorders
- Anemias – Thalassemia, Aplastic Anemia, Sickle Cell Disease and all other anemias
- Bleeding Disorders and Coagulation Disorders
- Immunodeficiency Disorders
- Benign WBC Disorders
- Thalassemia Major & Sickle Cell Disease
- Aplastic Anemia
- Acute and Chronic Leukemia
- Lymphoma – NHL And HD
- Severe Combined Immunodeficiency Disease
- Other states of bone marrow failure – MDS, PNH, PRCA, Fanconi`s Anemia
- High – risk Neuroblastoma, Ewing Sarcoma & Medulloblastoma
- Hurler Syndrome
- HLH – Both primary and secondary
- Auto Immune Disorder – Multiple Sclerosis, Systemic Sclerosis
Bone Marrow / Stem Cell Transplantation
- Any Cytopenia or Cytosis
- Deranged coagulation profile
- Thrombosis at unusual sites or Inherited Thrombophilia
- Hemolytic Jaundice
- Any Cytopenia or Cytosis
- Deranged coagulation profile
- Thrombosis at unusual sites or Inherited Thrombophilia
- Hemolytic Jaundice
What to expect
During the stem cell transplant
Stem cell transplant procedure is inclusive of infusing the donor stem cells through the central line into the patient’s body post the conclusion of some days of chemotherapy, radiation therapy or both. The infusion generally lasts somewhere from one to five hours, also, a thing to keep in mind here is that you will be awake during the procedure.
The transplanted stem cells then pave their way into your bone marrow, the site where they initiate creating new and improved blood cells. This may take a few weeks for the new blood cells to be produced, and also for the blood count to begin to get better and recover.
Bone marrow or the blood stem cells that have been frozen and thawed consist of a preservative which essentially protects the stem cells from any external issue. Just prior to the transplant, you may receive the right medication to greatly minimize the side effects and the ill effects of the preservative.
You’ll be administered with IV fluids (hydration) post and prior your transplant to help the body get rid of the preservative. Side effects of the preservative may be inclusive of:
- Red urine
The one thing to note here is that not everyone will experiences the side effects from the preservative. For some people these side effects may be minimal or not present at all.
After your stem cell transplant
After days or weeks of your stem cell transplant, you’ll have to undergo blood tests and other related tests to monitor your specific condition. You may need a medicine to manage the complications well, such as nausea and diarrhea.
Post the stem cell transplant, you’ll be asked to remain under close observation and medical care. If you experience infections or complications then you must remain in the hospital for a few days. Depending on the transplant type and the risk of complications, you’ll be kept under close observation for months to weeks. You may be advised for specific and regular transfusions of red blood cells and platelets until the bone marrow starts generating enough of these cells on its own. You may be a risk of infections or other complications post your transplant.
The stem cell transplant can effectively cure some or most of the diseases and put most into remission. The end goal of the stem cell transplant depends on an individual situation but generally is inclusive of controlling or curing the blood disorder. This will help extend the life of patient, and significantly improve the quality of life. Some people conclude the stem cell transplantation with a few impending side effects and chances of complications. Experiencing numerous challenging problems which maybe both short and long term. The severity of the side effects and the chances of success of the transplant differ from person to person and also is affected by various factors which makes it difficult to be predicted post the transplant. It can be discerning if significant challenges take place during the process. However, it can also be sometimes helpful to recall and not forget that there are many survivors who have shown and experienced the positive effects of it. During the transplant process they might have not benefited but ultimately found success from the transplant procedure and have returned to normal activities with a good quality of life.
How ViezecMedicalHealthCare helps?
We are a leading health consultant in Delhi with an abounding experience and expertise in delivering high-quality healthcare at a modest price. Improvising the quality of human life with the help of stem cell transplant procedure is the end goal of ViezecMedicalHealthCare. The fairly new tissue engineering has been evolved over the years and we wish to provide the best procedure with amenities and high quality treatment. Consult us to help you provide the best treatment and greatly help change the fate of diseased.
Who can be a donor for an Allogeneic transplant?
The one with whom the bone marrow matches, it is concluded with the help of blood tests alone. It is not important or imperative for the donor’s bone marrow to be tested at this stage. It is usually initiated with testing the cells of sisters and brothers, as they are likely to be a perfect best match; parents are generally not a perfect or even a good match. The donor must be in good health. He or she will be administered under a full medical checkup to ensure that exists no risk to his or her own health from the procedure.
Collecting bone marrow
About a week or two prior to the bone marrow harvest, the patient may have 1 to 2 units of blood withdrawn from his body for the test. This will be gained back during the bone marrow harvest.
The harvest is administered under general anaesthesia, so the patient will feel nothing. It involves the removal of some marrow from inside the bones at the back and front of the pelvis (the hip bones).
The patient or donor will be required to3 hospital overnight to recover fully from the general anaesthesia. Usually it feels sore for a few days and mild painkillers may be required. These will be administered by the nurses or doctors.
How are the stem cells collected?
Stem cells are harvested following a course of daily injections of a growth factor. This procedure takes about 3 hours. The patient will be made to lie down on a couch and a transfusion will be put into the vein of each arm. Blood will be collected from one arm, into a machine called a centrifuge, which spins it to separate out the stem cells. These are collected, and the remaining blood is returned through the IV in the other arm. The stem cells can even be frozen.
What is Umbilical Cord Blood Transplantation?
Most children and young adults suffering from one or the blood disease for instance leukaemia, which needs a bone marrow transplantation to provide them a chance to lead a happy and disease free life. Sometimes searching for a donor can get complex. In some cases the patient may die before even finding a donor.
However, the latest trend that has been giving life with new formed stem cells.
This is formed with the help of blood that is left behind in the placenta and the umbilical cord post the delivery of a baby. Cord blood is rich and highly infused with stem cells and can be used instead of bone marrow for transplantation.
The blood is rich in stem cells of high quality and very potent in producing blood cells. Cord blood transplants appear to cause less serious immunological side effects. When the right match is found between the donor and recipient the process appears to be less critical and more efficient. This means that the chance of finding a suitable cord blood for transplantation is much greater than that of bone marrow.