Bone marrow transplant, also known as hematopoietic stem cell transplant (HSCT), replaces diseased bone marrow with healthy stem cells. The first step is collecting stem cells from either peripheral blood or bone marrow. These cells are used in transplantation to treat blood-related disorders like leukemia, lymphoma, and autoimmune diseases.

Bone marrow, located within the central cavities of bones, is a soft and spongy tissue responsible for the production of blood cells. It contains microscopic compartments that house primitive cells known as stem cells. These stem cells possess the ability to differentiate into various types of blood cells, including red blood cells (which carry oxygen), white blood cells (which fight infections), and platelets (which aid in blood clotting). This unique capability of stem cells to generate different types of blood cells is crucial for maintaining a healthy blood supply and proper functioning of the body.

Red and yellow varieties of bone marrow are the most common. The majority of children's bone marrow is red and abundant in stem cells. In adolescents, however, a large portion of the bone marrow is transformed into yellow marrow due to adipose cell infiltration. Red marrow is typically restricted to a few bones in adolescents, including the hip bones, breast bone, ribs, shoulder blades, cranium, backbone, arm, and thigh ends.

Malignant
The detection of blood cancers and their treatment with chemotherapy and other modalities is required as per the case.

• Acute leukemia – Myeloid & Lymphoid Leukemia
• Chronic Leukemia – Myeloid & Lymphoid Leukemia
• Multiple Myeloma
• Myelodysplastic Syndromes
• Hodgkin’s and Non Hodgkin’s Lymphoma
• Myeloproliferative Disorders
• Neuroblastoma/Ewing’s Sarcoma, Medulloblastoma

Benign Haematology- Benign Disorders Of Blood

• Thalassemia Major & Sickle Cell Disease
• Aplastic Anaemia
• Benign WBC Disorders - LAD/Congenital Neutropenia
• Immunodeficiency Disorders
• Severe Combined Immunodeficiency Disease
• Congenital and Paediatric Syndromes
• Other states of bone marrow failure – PRCA, PNH, Fanconi's Anemia
• Adrenoleukodystrophy
• HLH - Both primary and secondary
• Hurler Syndrome
• Multiple Sclerosis/ Scleroderma

The process of bone marrow transplantation may differ depending on the type of donor and transplant procedure used. In general, there are two kinds of transplant procedures:

• Autologous Bone Marrow Transplant: In this procedure, bone marrow or stem cells are extracted from the patient's body and frozen for future use (cryopreservation).
• Allogeneic Bone Marrow Transplant: In this procedure, bone marrow or stem cells are extracted from a donor. A donor can be a relative, typically a sibling or sister, or an unrelated donor whose bone marrow matches with the patient's bone marrow and whose HLA (Histocompatible Leukocyte antigen) must be a match. In this form of transplant, the bone marrow is administered to the patient on the same day.

Types Of Allogeneic Bone Marrow Transplant:

• HLA (Immune)-Match Related Donor (Siblings) Transplant: The bone marrow or stem cells are donated by a patient's family, usually a sibling (brother or sister) whose HLA (Histocompatible Leukocyte antigen) matches perfectly.
• HLA (Immune)-Matched Unrelated Donor Transplant:The patient's relative, typically a sibling (brother or sister) whose HLA (Histocompatible Leukocyte Antigen) completely matches the patient's, provides the bone marrow or stem cells.
• Haplo Identical Donor Transplant:HLA (Histocompatible Leukocyte antigen) half-matched (haplotype) donors, such as the patient's biological parents or half-matched siblings, provide the bone marrow or stem cells. corresponds completely with the patient.
• Umbilical Cord Blood Transplant:Umbilical cord blood cells are extracted from the umbilical cord of a newborn infant immediately after birth. These stem cells are extremely immature, eliminating the need for a flawless match. Cord blood stem cells are frozen and stored until they are required for a transplant.

The harvested bone marrow or stem cells are filtered to remove fat or other particles, transported to the laboratory for processing, and then tallied, screened, and prepared for infusion. The type of transplant a patient must undergo depends on his or her specific medical requirements. A physician will evaluate the patient's medical condition and recommend an appropriate treatment plan. The purpose of a bone marrow transplant is to treat a variety of blood disorders and some forms of malignancy.

BMT Process Consists Of Three Main Phases Which Include:

• Phase 1:The Pre-BMT
• Phase 2:Stem cell transfusion- Day
• Phase 3:The Post-BMT

Here's a rundown of everything you need to know about the transplant procedure. The guide is structured into six sections, beginning with how to prepare for the trip and ending with what to expect along the route.

STEP 1: Preparation The preparation phase begins when the patient arrives at the BMT Centre, with medical assessment, guidance, informed consent, and other preceding activities.

• Multidisciplinary treatment begins with a medical evaluation. Modality
• Central Venous Catheter Insertion

STEP 2: Bone-Marrow/Stem Cells Harvest:Apheresis is a technique for extracting stem cells from bone marrow or peripheral blood. Stem cells are retrieved from the donor in an allogeneic transplant, whereas stem cells are collected from the patient in an autologous transplant.

STEP 3: Conditioning:Conditioning is the initial stage before transplantation. In this procedure, the patient receives either chemotherapy, radiation therapy, or a combination of the two. The bone marrow function is destroyed by chemotherapy and radiation therapy doses that have the highest chance of curing the disease. Depending on the timetable for administering the chemotherapeutic medicines and radiation therapy, some conditioning treatment may be given in an outpatient setting, potentially cutting the length of the inpatient stay. The pre-BMT phase consists of the following: preparation, stem cell harvest, and conditioning.

STEP 4: Transplant:In this stage, the infusion of donor bone marrow or stem cells takes place right after the conditioning regimen has been finished. This is similar to a blood transfusion. The duration beyond the transplant day is considered as the post BMT phase.

STEP 5: Awaiting Engraftment (New Cell Growth):This stage entails close monitoring, supportive therapy, and complication management while waiting for grafting indications.

• Close supervision, backing, and safety
• Control of consequences, particularly infections

STEP 6: Early Recovery and Engraftment: In roughly 2 to 3 weeks following the transplant, it is possible to anticipate signs that new bone marrow or stem cells are grafting (growing and developing). The patient will continue to receive close observation and supportive care, and preparations for their return home will begin.

STEP 7: Long-Term Recovery: This step entails releasing the patient from the facility, talking about any lingering clinical issues, and reestablishing daily routines. Regular follow-up visits are advised for patients to prevent any long-term consequences.