Internal Medicine

A bone marrow transplant is a treatment performed to replace the unhealthy bone marrow of the patient with the healthy bone marrow cells. Bone marrow or peripheral blood stem cell harvesting is the first step towards bone marrow transplant treatments and stem cell therapies performed to treat patients suffering from various blood-related disorders such as leukaemia, lymphoma, and specific autoimmune disorders.

Bone marrow is a soft and spongy substance that is present between the inner cavities of bones, from where the blood is produced. There are several tiny spaces in the bone marrow that hold the primitive cells which are capable of growing into a different type of blood cells. These cells are called stem cells, which are capable of producing various kinds of blood cells, i.e. red blood cells, white blood cells, and platelets.

In general, there are two types of bone marrow, red and yellow. Most of the bone marrow in kids is red marrow and rich in stem cells. However, in adolescents, owing to fat cell infiltration, a big part of the bone marrow is transformed into yellow marrow. In adolescents, red marrow is generally confined to a few bones, such as hip bones, breast bone, ribs, shoulder blades, skull, 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, Medulloblastome

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
• Adrenoleucodystrophy
• HLH - Both primary and secondary
• Hurler Syndrome
• Multiple Scleors/ Scleroderma

The Bone marrow transplant process may vary depending upon the types of donor and transplant procedures. Generally, there are two types of transplant processes:

• Autologous Bone Marrow Transplant: In this process, the bone marrow or stem cells are harvested from the patient’s own body and frozen (cryopreserved) for future use. 
• Allogeneic Bone Marrow Transplant: In this process, the bone marrow or stem cells are harvested from a donor’s body. A donor can be a relative usually a brother or sister or an unrelated donor whose bone marrow matches with the patient’s bone marrow and must be an HLA (Histocompatible Leukocyte antigen) match. In this type of transplant, the bone marrow is given to the patient on the very same day.

Types Of Allogeneic Bone Marrow Transplant:

• HLA (Immune)-Match Related Donor (Siblings) Transplant: The bone marrow or stem cells come from the relative of the patient, who is usually a sibling (brother or sister) who's HLA (Histocompatible Leukocyte antigen) matches completely with the patient.
• HLA (Immune)-Matched Unrelated Donor Transplant:The bone marrow or stem cells come from the unrelated donor whose HLA (Histocompatible Leukocyte antigen) matches completely with the patient.
• Haplo Identical Donor Transplant: The bone marrow or stem cells comes from HLA (Histocompatible Leukocyte antigen) half-matched (haplotype) donors such as biological parents of the patient or half-matched siblings.
• Umbilical Cord Blood Transplant:Umbilical cord blood cells are collected from a newborn baby's umbilical cord right after birth. These stem cells are very immature so the need for perfect matching is eliminated. The stem cells collected from the cord are frozen and stored until they are used for a transplant.

After the harvest, the bone marrow or stem cells are filtered to remove fat or other particles and then taken to the laboratory for processing, after which they are counted, screened, and ready to infuse.
The type of transplant patient has to undergo depends upon the unique medical needs of the patient. A doctor will evaluate the patient’s medical condition and will suggest the treatment plan accordingly. The goal of a bone marrow transplant process is to treat a variety of blood disorders and certain types of cancer.

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 is all you need to know about your transplant journey. The guide is divided into six steps beginning from how to prepare for the journey and include what to expect along the way.

STEP 1: Preparation The preparation stage starts when the patient arrives at the BMT Centre with medical assessment, guidance, informed consent and other preliminary activities start.

• Beginning of medical Evaluation
• Multidisciplinary treatment Modality
• Central Venous Catheter Insertion

STEP 2: Bone-Marrow/Stem Cells Harvest:The stem cells are collected either from the bone marrow or peripheral blood by apheresis. In an allogeneic transplant, stem cells are collected from the donor and in case of an autologous transplant from the patient itself.

STEP 3: Conditioning:The first step towards transplantation starts with the conditioning stage. In this process, either chemotherapy or radiation therapy or a combination of both is given to the patient. Chemotherapy and radiation therapy are given in doses that demolish the bone marrow function and result in the greatest possibility of destroying the disease. Some conditioning treatment may be administered in the outpatient environment depending on the chemotherapy agents and radiation therapy administration schedule, thus possibly shortening the inpatient stay. The preparation, stem cell harvest and conditioning all together comprises of the pre-BMT phase.

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: Waiting For Engraftment (New Cell Growth):This stage involves close monitoring, supporting therapy, and complications management while awaiting indications of grafting.

• Close monitoring, support and protection
• Management of complications especially infections

STEP 6: Engraftment And Early Recovery: Signs that fresh bone marrow or stem cells are grafting (growing and developing) can be anticipated in about 2 to 3 weeks after the transplantation. Close monitoring, supporting care will persist and preparation for the patient's return to home will start.

STEP 7: Long-Term Recovery: This stage involves the discharge of the patient from the centre, discussing any continuing clinical problems, and restoring patterns of life. Patients are advised to take regular follow-ups to avoid any long-term complications.