What is Bone Marrow Transplantation ?
Oncologist, Jaslok Hospital, 15 years of experience
Bone Marrow Transplant
A bone marrow transplant is a procedure performed to replace the bone marrow that is damaged or diseased by healthy cells. It is an effective way to treat many diseases such as aplastic anemia, lymphoma, leukemia, thalassemia, sickle cell anemia, multiple myeloma, etc. This process involves the transplantation of blood stem cells, which once transplanted, travel to the bone marrow. These blood stem cells help in the production of new blood cells and give rise to the development of new bone marrow in the body.
In this article, let us learn about Bone Marrow transplants.
- What are Stem Cells?
- What is Bone Marrow?
- Why is Bone Marrow Transplant done?
- How do you diagnose the conditions requiring Bone Marrow Transplant?
- When is a Bone Marrow Transplant suggested?
- What are the tests done before Bone Marrow Transplant?
- What are the types of Bone Marrow Transplants?
- How is a Bone Marrow Transplant done?
- How to take care after Bone Marrow Transplant?
- What are the risks after Bone Marrow Transplant?
- What is the cost of a Bone Marrow Transplant in India?
What are Stem Cells?
The body contains a particular type of specialized cells that can make copies of themselves and transition into different types of cells required by the body for various functions. These calls are called stem cells. Many kinds of stem cells are found in different parts of the body.
Due to cancer and cancer treatment, hematopoietic stem cells which are stem cells that turn into blood cells get damaged. The types of blood cells they are supposed to form are-
- Red blood cells are essential to transport oxygen and carbon dioxide to different parts of the body. They carry oxygen from the lungs to the cells and carbon dioxide back to the lungs from the cells.
- White blood cells are an important part of the immune system. They are necessary to fight viruses, bacteria, and other disease-producing organisms.
- Platelets are the cells that have the ability to form clots and arrest bleeding.
What is Bone Marrow?
Bone marrow is the soft, spongy tissue in the body that contains hematopoietic or blood cells forming stem cells. It is present in the center of most bones. These hematopoietic stem cells are also located in the blood.
Why is Bone Marrow Transplant done?
A person’s bone marrow may get damaged if he/she is suffering from a disease for a long duration of time. The doctor suggests that the patient gets a bone marrow transplant in these conditions. Some of the diseases for which bone marrow transplants are done are-
- Lymphoma is the cancer of the disease-fighting cells of the body. ( Know more about – What is Lymphoma? )
- Pois syndrome or post-orgasmic illness syndrome wherein the patient develops flu-like symptoms after orgasms.
- Multiple myeloma is the cancer of plasma cells which are a type of white blood cells (WBCs). ( Know more about – What is Multiple Myeloma? )
- Amyloidosis is an uncommon disease that gives rise to the formation of protein in the bone marrow.
- Aplastic Anemia is the failure of the body to produce all types of blood cells which leads to a fall in the number of red blood cells (RBCs), WBCs, and platelets. ( Know more about- What is Aplastic anemia? )
- Primary immunodeficiency is a disease that damages the immune system.
- Leukemia is a type of cancer of the blood that affects WBCs increasing in their number.
- Acute lymphatic leukemia (ALL) is a cancer of the WBCs wherein the number of lymphocytes drastically increases. The ‘acute’ here means that it’s fast-growing and progresses quickly.
- Chronic lymphocytic leukemia is again a cancer of the WBCs wherein the number of lymphocytes drastically increases but unlike ALL, this type is slow-growing and progresses over a longer period of time.
How do you diagnose the conditions requiring Bone Marrow Transplant?
A Complete Blood Count (CBC) is done to check for the change in the blood count which is a potential sign for blood cancer, anemia, and many other diseases that may require a bone marrow transplant. Bone marrow cells are normally taken from the hip bone for biopsy and then examined.
When is a Bone Marrow Transplant suggested?
Bone marrow Transplant is recommended if the status of the disease:
- is in remission or not in active phase but is expected to recur
- has not responded to any treatment tried before
The patient needs to be in good health overall apart from the condition they suffer from.
What are the tests done before Bone Marrow Transplant?
Many tests and procedures have to be performed before Bone Marrow Transplant.
- The doctor needs to check the physical fitness of the patient. They also check to see if the patient has any other pre-existing medical conditions.
- A complete blood count (CBC) is an essential test done for all patients. This gives the number of cells and physical features to detect abnormalities.
- Aspiration of bone marrow along with biopsy is done.
- Laboratory tests are also done for both qualitative and quantitative analysis.
What are the types of Bone Marrow Transplants?
The types of transplants depend on the donor availability-
- Autologous bone marrow transplant –The word ‘auto’ means self. In this case, the stem cells are removed from the patient before the patient receives high-dose chemotherapy or radiation treatment. After this, the cells are stored in the freezer. Later, after the high-dose chemotherapy/ radiation, the stems cells are put back in the body for them to make normal blood cells. This process is also called rescue transplants.
- Allogeneic bone marrow transplants- The word ‘all here means other which in this case refers to another donor. In this process, stem cells are taken from a donor. The bone marrow of the donor and recipient has to match and for this purpose human leukocyte antigen, compatibility tests are done. Most times, the donor’s genes must at least partly match the genes of the patient. A brother or sister will most likely be a good match. Parents, children, or relatives of the patient may also be good matches. Donors who are not related to the patient, yet still match, may be found through national bone marrow registries.
- Umbilical cord blood transplant – Stem cells are removed from the umbilical cord of a newborn baby right he/she is born. The stem cells are frozen and preserved to be later used in case a transplant is needed. These immature cells from the umbilical cord can later differentiate into any kind of cell required by the body.
How is a Bone Marrow Transplant done?
In general, each Bone Marrow Transplant, whether “Autologous” or “Allogeneic” includes collecting the replacement stem cells, the patient receiving conditioning treatment to prepare their body for the transplant, the actual transplant where new cells are received, and then the recovery period.
This is explained in detail below:
- How is Bone Marrow harvested for Bone Marrow Transplant?
If you use your own cells, you will receive injections to increase the number of stem cells. The medical team will then collect stem cells from a vein in your arm or chest. The cells are then preserved until they are used.
The donor stem cells can be extracted by the following methods:
- Bone marrow harvest – This is a minor surgery that is done under general anesthesia. The donor thus will be asleep and free from pain during the procedure. The bone marrow is extracted from the hip bones. The quantity of marrow removed depends on the weight of the person receiving it.
- Leukapheresis – In this procedure, the donor has to be given shots for several days to help stem cells move from the bone marrow into the blood. The blood is collected from the donor using an IV line. The stem cells in the white blood cells are then separated by a machine and removed to be given to the recipient. The red blood cells are then returned to the donor.
- How is your body prepared before Bone Marrow Transplant?
Before Bone Marrow Transplant is done, conditioning therapy is undertaken. Here, high doses of chemotherapy, radiotherapy, or immunotherapy are given. The purpose of conditioning therapy is to prepare the bone marrow to create space for new stem cells. The conditioning therapy can also help to reduce the severity of the disease.
Conditioning therapy has some side effects just like chemotherapy and radiotherapy. They are-
- How are the stem cells transplanted in a bone marrow transplant?
An intravenous catheter which is a long thin tube has to be implanted into a large vein in the chest or neck. This catheter is also called the central line. The transplant team uses the catheter to infuse the transplanted stem cells, blood products, and some medications via the drip into the bloodstream. The catheter remains for the entire duration of the treatment.
- What is recovery from Bone Marrow Transplant like?
After a Bone Marrow Transplant, the patient needs to be given sufficient time to recover. The recovery period is divided into stages. It starts with intensive medical monitoring after the day of the transplant. Over a period of time the patient transitions into a schedule of regular medical check-ups over the coming months and years.
The immune system can also be damaged by the intensive chemotherapy treatments given before the transplant. This is essential to prepare the body to accept the transplant. If it isn’t given, the immune system of the body will attack the transplanted stem cells. After this, the immune system requires time to go back to normal and start functioning. Because of this delay, the patient has a high chance of getting infections right after the transplant is done. Therefore, the doctor monitors the patient closely to check for signs of infection. The patient will have to undergo regular blood tests and other tests to see how your body and immune system are responding to the donor cells.
Antibiotics and other medications are given to reduce the chance of infection. If an ALLO transplant has taken place, the medications include drugs to prevent and/or manage Graft versus Host Disease (GVHD).
How to take care after Bone Marrow Transplant?
After a bone marrow transplant has been done the patient is expected to stay in the hospital for at least 28 days. This is done so that the doctor can pay attention to the condition of the patient. It takes at least 14 to 28 days for new cells to function in the patient’s body. During this period a dose of some antibiotics is given to the patient by the doctor.
In the case of an allogenic transplant, the patient requires additional attention and care. There is a higher risk of graft vs host disease (GVHD), which occurs when the immune system of the patient rejects the stem cells from the donor. The doctor advises the patient to stay in the hospital for 50 days.
The following things should be kept in mind when the patient is discharged from the hospital:
- The physician should be contacted for regular follow-up.
- Infection after the transplant occurs commonly which is why the instructions given by the doctor should be followed.
- The doctor should be informed if the patient experiences physical weakness after the bone marrow transplant.
- The patient should consume nutritious food like juice, milk, eggs, cheese, fruits, peanut butter, avocado, etc.
- Patients are advised not to exercise if they feel dizzy.
What are the risks after Bone Marrow Transplant?
Just like any other procedure, a bone marrow transplant also comes with some risks. They are-
- Graft-versus-host reaction (GVHR). In this disease, the donor cells begin to attack the recipient’s cells, which happen to be the new stem cells and therefore this causes problems related to immunity.
- In addition, there is a chance of graft rejection in which donor stem cells do not function effectively in the recipient and fail to differentiate into blood cells
- This could lead to thrombocytopenia which means a decrease in the number of platelets in the blood and anemia which is decreased a number of red blood cells (RBCs) which in turn means less amount of oxygen will be carried to the cells.
- The risk of multiple infections increases after surgery.
- The patient also experiences nausea, vomiting, fatigue, weakness, and diarrhea after the surgery.
- Liver damage, delayed growth in children, clotting in blood vessels, and even bleeding in essential organs of the body may occur. ( Know more about- What is Acute Liver Failure? )
What is the cost of a Bone Marrow Transplant in India?
The total cost of Bone Marrow Transplant in India can range from around INR 10,00,000 to INR 20,00,000.
If you are coming from abroad, in addition to the cost of a Bone Marrow Transplant, there will be an additional cost of accommodation and food, the cost of local travel, etc. After the surgery, the patient has to stay in the hospital for a few days and in the hotel after getting discharged from the hospital, for complete recovery. This might add to additional charges. So, the total cost of Bone Marrow Transplant in India can range up to INR 14,00,000 to INR 24,00,000.
We hope that we could answer your questions regarding Bone Marrow transplants through this article.
If you want more information and treatment of Bone Marrow Transplant, you can contact an Oncologist / Cancer Specialist.
We only aim to give you information through this article. We do not recommend medication, treatment in any way. Only a doctor can give you the best advice.