Today more than 50,000 bone marrow transplants are carried out annually worldwide, and they are increasing each year. In India alone, last year, over two thousand bone marrow transplants were performed for various blood and immunological disorders. However as per statistics, each year, approximately 17,500 people, age 0-74 years, might benefit from potentially lifesaving bone marrow and umbilical cord blood transplant.
What is bone marrow?
Bone marrow is the seat of production of all blood cells in the body. It is present mainly in the flat bones of the body like the breast bone (sternum), or the hip bones, ribs and spine.
What are stem cells?
They are the precursor cells which can differentiate into any mature cell in the body based on the surrounding environment. Blood-forming stem cells (immature cells) are also called bone marrow cells or hematopoietic (blood-forming) stem cells. These stem cells can form any type of blood cell, including:
infection-fighting white blood cells
red blood cells, which will carry oxygen throughout the body
Platelets, which are essential in the blood clotting process and help control bleeding.
How is bone marrow transplant done?
Before the BMT, the patient will receive either high dose chemotherapy or a combination of radiation and chemotherapy. This treatment is called the conditioning or preoperative regimen. It destroys cancerous cells as well as the normal stem cells in the patient's bone marrow. It prepares and helps the body to accept the new stem cells. Even though its named transplant, no surgery is required.
Next, the stem cells are added to the patient's bloodstream through a central venous catheter. This tube goes through the vein and makes it easier for the care team to give medications and blood products. The actual bone marrow transplant is done in the patient's room. It is just like having a blood transfusion. After the procedure, the newly injected stem cells have the ability to travel to the bone marrow all over the body. There these cells will grow to become new mature white blood cells, platelets and red blood cells including.
To get back to the level of a healthy number of mature cells, it usually takes several weeks. During this time, the patient will need extra protection from infections and bleeding.
If you are looking for a bone marrow transplant in India then consult Cancer Therapy India, the best hospital for bone marrow transplant in India having board-certified surgeons who are well trained and possess several years of experience in the same field.
In the initial few days of an Autologous BMT, the patient will be given booster injections to mobilize stem cells in the blood. Following 4-5 days of booster injections, the patient will undergo a process similar to blood donation called stem cell apheresis. Suppose the dose of stem cells collected is of a sufficient quantity, in that case, the next step will be to give chemotherapy which can last for anywhere between 1-6 days depending on the type of preparative regimen. Following this, the patient will need to be in the BMT unit approximately for the next two weeks, until the recovery of blood counts. Stay in the BMT unit is to monitor the clinical condition of the patient and to ensure that patient is protected from infections.
In this, the type of stem cells used will be the donor stem cells. The patient will initially have to undergo the preparative regimen, which may consist of only chemotherapy or chemotherapy and radiation. Following this, the patient will receive the donor stem cells, which is just like receiving a blood transfusion. Subsequently, the patient will have to stay in the BMT unit for another 2-3 weeks till recovery of blood counts. On average, a patient undergoing Allogenic BMT will have to stay in the hospital for anywhere between 2-3 weeks. During this period, the patient is continuously encouraged to maintain some level of physical activity depending on the functional capacity. The help of the Physiotherapy team is taken to enable this. The patient is supported on a diet which varies depending on the phase of the transplant and dieticians advice. This food will have to be prepared under strict aseptic precautions and transported from the kitchen to the unit in sealed containers to maintain hygiene. Patients are also encouraged to indulge in various forms of activities like reading, writing, meditation exercises, hobbies like craft-making or playing music to ensure that the mind is relaxed and ready to deal with any stress or anxiety. The patient is usually discharged when the blood counts have sufficiently recovered (a phenomenon called – engraftment) and if there are no signs of graft versus host disease.
Since the patients will be subjected to a high dose of chemotherapy, patients become more susceptible to variations in blood levels with an increased risk of infection and bleeding. There might be inflammation of the gastrointestinal tract leading to pain while swallowing and loose stools. Stomach aches and vomiting are a common feature due to gastric irritation from all the medications. Depending on the type of BMT done, a condition called Graft Versus Host Disease (GVHD) may arise. Some of the rarer side effects include Veno-occlusive disease (VOD), cardiac and renal dysfunction.
In patients undergoing an Allogenic BMT or a Haplo-identical BMT, where the stem cells are from a donor and not-self, there is a chance that the donor immune cells might not recognize the host cells and attack them as foreign cells. This attack can happen either within the first 100 days of the BMT – called Acute GVHD or later up to a couple of years (Chronic GVHD). To reduce the incidence of GVHD, any patient who undergoes an allogeneic BMT or haploidentical BMT will also receive medications to suppress the immunity.
The patient who has undergone an Autologous BMT usually resume full functional activities by 6-8 weeks. The patients who have had an Allogenic BMT, typically need to be monitored regularly for up to 6 months. This monitoring may include hospital visits weekly to check for any signs of GVHD and adjust the dose of immune-suppression medications.
For everyone who undergoes a BMT, it will be a life-changing experience, and with time, patients will adapt to a new normal. Within a few months of completing a BMT, patients will regain most of their functional capacity and will be able to re-integrate back into their regular social life. Some of the long term changes include hormonal imbalances, depending on the age, risk of developing infertility and rarely, reduction in heart or lung capacity.
Patients who are suffering from a variety of cancerous and non-cancerous blood disorders can be offered the option of a bone marrow transplant. The blood cancers in which a BMT has a curative role include:
Acute Myeloid Leukaemia with High risk and relapsed disease.
Acute Lymphoblastic Leukaemia with High risk and relapsed disease.
Multiple Myeloma
Relapsed Hodgkins Lymphoma
Relapsed Non – Hodgkins Lymphoma – High grade
High-risk Chronic Myeloid Leukaemia.
The non-cancerous blood disorders where BMT plays a curative role include:
Thalassemia Major
Sickle cell anaemia
Paroxysmal Nocturnal Hemoglobinuria
Primary Immunodeficiency disorders
Aplastic Anaemia.
In particular solid cancers which generally occur in the younger age group like Neuroblastoma and Ewings Sarcoma, BMT has a role in treatment.
