About Bone Marrow Transplant

A bone marrow transplant (BMT) is a special procedure performed to replace either the destroyed or damaged bone marrow with a healthy bone marrow. Bone marrow is soft and fatty tissue present inside the bone, which produces the blood cells.

BMT involves taking the cells usually found in the bone marrow and then giving them back to the patient or another person. BMT aims to transfuse the healthy bone marrow cells into a person after his own unhealthy bone marrow has been treated for killing the abnormal cells.

Need for Bone Marrow Transplant

Various acute and chronic ailments may affect the functioning of the bone marrow and may require bone marrow transplants. Some of the similar conditions are listed below:

Multiple Myeloma This is a cancer which develops in a type of white blood cells.

Amyloidosis This is a rare disease which occurs when amyloid (an abnormal protein, usually produced in the bone marrow) is deposited in any tissue or organ and interferes with its normal functions. Depending upon the type of amyloidosis, a bone marrow transplant may be recommended.

Acute or chronic Leukemia It is a cancer of blood or bone marrow that may eventually need a bone marrow transplant in certain high risk subtypes.

Hodgkin’s or Non-Hodgkin’s Lymphoma These are the cancer of lymphocytes (type of white blood cell). These lymphocytes play a vital role in the immune system.

Myelofibrosis This is a rare type of blood cancer where bone marrow is replaced by fibrous scar tissue. Bone marrow transplant is a treatment which might be considered for patients suffering from this medical condition.

Germ cell tumors These are kinds of tumors where there is growth of cell form from reproductive cells. They are both cancerous or non-cancerous and mainly occur in the ovaries or the testicles.

Immune disorders These disorders lead to abnormally low activity or overactivity of the immune system. An overactivity of the immune system lead the body to attack and damage its own tissues (autoimmune diseases). Low activity of the immune system reduces the body's ability to fight invaders, making it more vulnerable to infections.

Bone marrow failure Aplastic Anemia or Myelodysplastic syndrome in which the bone marrow is unable to form blood cells.

After cancer treatments like chemotherapy or radiation Some patients after receiving chemotherapy and radiation therapy for cancer, may need a bone marrow transplant.

Type of Bone Marrow Transplant

There are 3 different types of bone marrow transplant:

Autologous bone marrow transplant This is a type of bone marrow transplant where your own cells are utilized. Before receiving a high dose of radiation or chemotherapy, your cells are removed and stored in the freezer. After receiving radiation or chemotherapy treatments, these cells are put back in your body to help in making normal blood cells. This is also called a rescue transplant.

Allogeneic bone marrow transplant This is a type of bone marrow transplant where cells are removed from another person (donor). Most times, the genes of the donor must at least partly match your genes. Before initiating the process, some special tests are done to see if a donor is a good match for you. A sibling is most likely to be a good match. However, sometimes children, parents, and other relatives are also suitable matches. In some cases, donors who are not related to you but matches you, are considered.

Umbilical cord blood transplant This transplant is a type of allogeneic transplant. In this process, cells are removed from a new born baby's umbilical cord right after birth. These cells are frozen and stored until they are needed for a transplant in the future. Umbilical cord blood cells are quite immature, so there is less of a need for perfect matching. Due to the lesser number of cells, blood counts may take much longer to recover.

Pre-Bone Marrow Transplant Evaluation

Before undergoing this procedure, you may need to undergo rigorous evaluation, which includes:

• General health exam: This consists of a physical examination and a cancer screening tests to evaluate your overall health.
• Biopsy: A bone marrow biopsy is done for evaluating its function and to assess for disease involvement.
• Blood tests: There are different blood tests that you may need to undergo to know about gene compatibility.

• Tissue typing: This is required for allogeneic patients only. It includes series of blood tests to evaluate the compatibility or closeness of tissue between the organ donor and recipient.
• Other blood tests: There are series of tests that will be done to detect certain substances in your blood and to evaluate your overall health. These might be done to screen you for any infectious diseases like HIV, to check your organ function, etc.

• Imaging tests: Various tests like CT scan, MRI or PET scan may be recommended to look for any abnormality in the organs.
• Social and psychological evaluation: These evaluations include various measures to assess your stress, financial issues, and support by friends and family.
• Skeletal survey: These are a series of x-rays done for long bones and skulls to assess the disease involvement in patients with multiple myeloma.

The Bone Marrow Transplant process

Autologous transplant

Allogeneic transplant

Complications of a bone marrow transplant

As with every surgery, the risk of complications is there and bone marrow transplant is no exception. However, it is not always necessary that a patient develops these complications, but it is good to be aware of it. Below are some of the common complications linked with bone marrow transplant:

Graft versus host disease

If you have undergone an allogeneic transplant, then you are at higher risk of developing GVHD, which is more likely to occur if the cells have been taken from an unrelated donor. However, it may occur otherwise as well. The symptoms of GVHD may occur within the initial month or even after a longer duration of time. These may include:

• Dry eyes
• Skin rashes
• Breathlessness and cough
• Nausea and vomiting
• Change in appetite
• Bloating or diarrhea
• Jaundice
• Joint pains

The other complications may include:

• Damage to organ
• Infection
• Cancer
• Bleeding
• Problem in eyes such as cataract
• Problems in liver or kidney
• Infertility
• Cramps or numbness in arms or legs
• Breathing problems

Post-Bone Marrow Transplant Procedure

The cells injected into the body enter your bone marrow and start multiplying. After that, if everything goes well, new blood cells production will begin. This whole process is called engraftment, and it may take two to three weeks.

The progress will be monitored through regular blood tests, and you may require an infusion of blood cells until your own bone marrow becomes functional. During this phase, you should be cautious enough to look out for any side effects like nausea, vomiting, infection, and contact your doctor in case of any such occurrences.

In case of no side effects or symptoms, you may be discharged from the hospital after a few days once your blood counts recover. However, you may be required to frequently visit the hospital for regular follow-ups. It is recommended that the patient and their family arrange for a stay near the hospital, as it may take about three months for the body to get accustomed to the cells and develop immunity.

Your health care team will design a program to monitor your long-term side effects, which may occur even months after the transplant process.

Life after Bone Marrow Transplant

A bone marrow transplant can significantly improve the quality of life of the patients. However, there are certain practices and measures that you need to follow to live a normal life.

• Regular follow-ups: You may have to have frequent follow up with your doctor for the initial few months after the transplant. They will keep a check on the body's response to transplant and any complications which may arise.
• Immunosuppressants: As our body tends to reject the foreign body or object. You may have to take immunosuppressant medicines to avoid the possibility of rejection in case of allogeneic bone marrow transplant.
• Hygiene and lifestyle: Practising good hygiene and staying active is an excellent contributory factor for recovery. Live a healthy lifestyle by engaging in any form of physically activity, eating a balanced diet, avoiding smoking, etc.

Success rate and life expectancy of a bone marrow transplant

With progress in medicine, the life expectancy of patients undergoing bone marrow transplants is also improving. The success rates depend on many factors like underlying disease, source of cells and patient's general health condition. In comparison to the last decade, the life expectancy of patients has improved.

• Success rate
• Autologous transplant greater than 90%.
• Life expectancy
• Increased lifespan with matched sibling donor of 1 year: 70-80%
• Increased lifespan with matched unrelated donor of 1 year: 50-60%

Choosing the ideal Bone Marrow Transplant center

It is essential to learn about different transplant hospitals and centers before finalizing the one. Here are few things to keep in mind while choosing a transplant hospital/center:

• Consult more than one doctor and talk to patients who have undergone bone marrow transplants in the hospital and know about their experience.
• Reputation of hospital/center, and it’s mortality rate for transplant patients.
• If the hospital/center is covered under your insurance policy.
• Total experience the hospital/center hold in dealing with transplant cases.

Cost analysis of Bone Marrow Transplant

Living with a disease that badly affects your life is an extremely painful experience both for the patient and his family. Getting a bone marrow transplant can certainly improve the quality of life of the patient. The aprroximate cost of bone marrow transplants in India varies between 12-15 lakh for an allogeneic transplant and 8-10 lakh for an autologous transplant approximately. It is essential to check with the insurance company whether the transplant cost is covered in your plan. Various factors that will affect the cost are:

• Hospital infrastructure and location
• Length of stay in hospital
• Expertise of doctors, their team, and use of advanced technology
• Any health complications
• Recovery and rehabilitation
• Post-transplant medications

A patient who travels away from home to hospitals for transplant also needs to keep the cost of stay near the hospital in the new city. The cost of staying also adds up over the course of a few months specially in an allogeneic transplant.