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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.

  • Costs

    Rs 8-15 Lakh

  • Stay at Hospital

    3 - 4 weeks

  • Back to work

    Autologous Transplant
    6 - 12 Months

  • Back to work

    Allogenic Transplant
    6 - 12 Months

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:

The Bone Marrow Transplant process

Autologous transplant

Step 1
Collection of cells This step may take several days. At first, you will get injections of a medication that will increase your cells. Then your doctor and his team will collect the cells through a vein in your arm or chest. These cells will then be stored until needed.

Step 2
Pre-transplant treatment This step usually takes 5-10 days. You will get a higher dose of chemotherapy. Sometimes, patients also receive radiation therapy.

Step 3
Getting the cells back This step is the transplant day. The process takes about 30 minutes for each dose of cells. This is known as an infusion. Your doctor team puts the cells back into your bloodstream via a catheter. You may have more than one infusion.

Step 4
Recovery Your doctor will closely monitor the recovery and growth of your cells and may prescribe you antibiotics to reduce infection. They will also take care of any side effects.

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Allogeneic transplant

Step 1
Identification of donor The first step to initiate this transplant is to find a matched donor. This will be done through a blood test. Then, the team of doctors will work with you to do human leukocyte antigen (HLA) testing on potential donors in your family, and if required, to search a volunteer registry of unrelated donors.

Step 2
Collection of cells from the donor The team of doctors will collect cells either from donor’s bone marrow or blood. When the cells are coming from bone marrow, your donor has a procedure known as bone marrow harvest in a hospital's operating room. When the cells are coming from the bloodstream, the donor will get daily injections (shots) of medication for increasing the white cells in the blood for a few days, before the collection process. After this is done, the cells are collected.

Step 3
Pre-transplant treatment This step usually takes 5-7 days. You may receive chemotherapy, with or without radiation therapy for preparing your body to receive the cells from the donor.

Step 4
Receiving the donor cells This step is your transplant day, and your doctor and his team put or infuses the donor’s cells into your bloodstream through the catheter. Generally, this procedure takes less than an hour.

Step 5
Recovering During your initial recovery phase, you will get antibiotics to reduce the risk of infection and other drugs, including medicines to prevent and/or manage graft versus host disease (GVHD). Your doctor’s team will also treat any side effects.

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:

The other complications may include:

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.

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