Bone Marrow Transplant

Bone Marrow Transplant, also known as Hematopoietic Stem Cell Transplant is an essential treatment for several diseases such as Leukemia, Anemia, Blood cancers, Thalassemia etc. It involves the replacement of damaged bone marrow with stem cells that form healthy bone marrow.
 
Bone marrow transplant is a permanent and effective way to treat several diseases such as- 
  • Aplastic Anemia
  • Lymphoma
  • Leukemia
  • Thalassemia
  • Sickle Cell Anemia
  • Multiple Myeloma
Know More About Surgery

The symptoms that indicate the necessity of a bone marrow transplant are-

  • Chest pain
  • Low Blood Pressure
  • Fever and chills
  • Headaches and Weakness
  • Nausea 
  • Shortness of breath

A complete blood count is necessary if these symptoms are observed. Blood and Laboratory Tests have to be carried out along with Bone Marrow aspiration and a Biopsy to assess cellularity qualitatively and quantitatively. A change in the number of blood cells indicates the possibility of blood cancers, anemia and several other diseases that may require a Bone Marrow Transplantation. The cells of the bone marrow are usually taken from the hip bone for a biopsy and are thoroughly examined under the microscope. Several imaging tests such as MRI scan and CT scan are also essential for diagnosis as they produce detailed pictures of the bones.  

There are several types of Bone Marrow Transplantations on the basis of the availability of the donor such as – 

  • Autologous bone marrow transplant in which the stem cells used are of the patient himself. These stem cells would have been taken before chemotherapy or radiation therapy.
  • Allogeneic bone marrow transplant in which the stem cells used are of another person, preferably a close relative. Several tests are carried out to check the compatibility of the stem cells.
  • Umbilical cord blood transplant in which the stem cells have been taken from the umbilical cord immediately after birth. These immature cells can differentiate into whichever cells required.
The bone marrow in case of a donor has to be matched using Human Leukocyte Antigen compatibility tests. The stem cells can be collected by apheresis or bone marrow harvesting. In Apheresis, the donor is connected to a cell separation machine in which the stem cells are removed from the blood. For this, it is essential that one week prior to apheresis; suitable medication for the stem cells to come out of the bone marrow to the peripheral blood system is given. In case of Bone Marrow Harvesting, stem cells are collected usually from the hip bone using a needle. 

The main risk involved in a Bone Marrow Transplant is Graft-versus-Host disease in which the donor cells start to attack those of the recipient and hence causes problems in relation to immunity. In addition to this, there is a chance of Graft rejection in which the donor stem cells do not function effectively in the recipient and fail to differentiate into blood cells. This would lead to thrombocytopenia and anaemia. The patient may also be prone to several infections after surgery and may experience nausea, vomiting, fatigue, weakness and diarrhoea. There are possibilities of damages to the liver, delayed growth in children, clotting in blood vessels and even bleeding in the essential organs of the body.

After a bone marrow transplant, the patient is monitored by the doctor for signs of graft rejection. A medication for GVHD is given to prevent it from occurring. Antifungals, antivirals and antibiotics are also given in order to prevent all sorts of infections. Regular blood tests are conducted in order to check if blood counts are back to normal and to check the functioning of the donor’s stem cells in the recipient. The patient may require blood transfusions in case of too much blood loss or slow recovery.     

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Bone Marrow Transplant

Bone Marrow Transplant, also known as Hematopoietic Stem Cell Transplant is an essential treatment for several diseases such as Leukemia, Anemia, Blood cancers, Thalassemia etc. It involves the replacement of damaged bone marrow with stem cells that form healthy bone marrow.
 
Bone marrow transplant is a permanent and effective way to treat several diseases such as- 
  • Aplastic Anemia
  • Lymphoma
  • Leukemia
  • Thalassemia
  • Sickle Cell Anemia
  • Multiple Myeloma

Symptoms

The symptoms that indicate the necessity of a bone marrow transplant are-

  • Chest pain
  • Low Blood Pressure
  • Fever and chills
  • Headaches and Weakness
  • Nausea 
  • Shortness of breath

Diagnosis

A complete blood count is necessary if these symptoms are observed. Blood and Laboratory Tests have to be carried out along with Bone Marrow aspiration and a Biopsy to assess cellularity qualitatively and quantitatively. A change in the number of blood cells indicates the possibility of blood cancers, anemia and several other diseases that may require a Bone Marrow Transplantation. The cells of the bone marrow are usually taken from the hip bone for a biopsy and are thoroughly examined under the microscope. Several imaging tests such as MRI scan and CT scan are also essential for diagnosis as they produce detailed pictures of the bones.  

Treatment

There are several types of Bone Marrow Transplantations on the basis of the availability of the donor such as – 

  • Autologous bone marrow transplant in which the stem cells used are of the patient himself. These stem cells would have been taken before chemotherapy or radiation therapy.
  • Allogeneic bone marrow transplant in which the stem cells used are of another person, preferably a close relative. Several tests are carried out to check the compatibility of the stem cells.
  • Umbilical cord blood transplant in which the stem cells have been taken from the umbilical cord immediately after birth. These immature cells can differentiate into whichever cells required.
The bone marrow in case of a donor has to be matched using Human Leukocyte Antigen compatibility tests. The stem cells can be collected by apheresis or bone marrow harvesting. In Apheresis, the donor is connected to a cell separation machine in which the stem cells are removed from the blood. For this, it is essential that one week prior to apheresis; suitable medication for the stem cells to come out of the bone marrow to the peripheral blood system is given. In case of Bone Marrow Harvesting, stem cells are collected usually from the hip bone using a needle. 

Risks

The main risk involved in a Bone Marrow Transplant is Graft-versus-Host disease in which the donor cells start to attack those of the recipient and hence causes problems in relation to immunity. In addition to this, there is a chance of Graft rejection in which the donor stem cells do not function effectively in the recipient and fail to differentiate into blood cells. This would lead to thrombocytopenia and anaemia. The patient may also be prone to several infections after surgery and may experience nausea, vomiting, fatigue, weakness and diarrhoea. There are possibilities of damages to the liver, delayed growth in children, clotting in blood vessels and even bleeding in the essential organs of the body.

After Procedure

After a bone marrow transplant, the patient is monitored by the doctor for signs of graft rejection. A medication for GVHD is given to prevent it from occurring. Antifungals, antivirals and antibiotics are also given in order to prevent all sorts of infections. Regular blood tests are conducted in order to check if blood counts are back to normal and to check the functioning of the donor’s stem cells in the recipient. The patient may require blood transfusions in case of too much blood loss or slow recovery.     

FAQ Section

1) What Is a Bone Marrow Transplant?

A bone marrow transplant is a surgical procedure which is performed to replace the bone marrow when it is damaged or destroyed by disease, infections, or chemotherapy. This procedure involves transplantation of blood stem cells, which travel to the bone marrow where they help in the production of new blood cells and fosters the growth of new bone marrow. Bone marrow is the spongy, fatty tissue present inside bones. It is also known for supplying nutrients to the bone.
Bone marrow produces the following types of cells:

  • Erythrocytes (RBC) which carry oxygen throughout the body
  • Leucocytes (WBC), which fight infections and kills foreign cells.
  • Thrombocytes (platelets), responsible for blood clotting.

Bone marrow transplant helps in replacing the damaged stem cells with healthy cells. This helps your body to avoid infections or bleeding disorders.

2) From where do surgeons get the healthy stem cells for the transplant?

Healthy stem cells can be taken from a donor, or they can come from a patient's own body. In such cases, stem cells can be harvested or grown, and those healthy cells are then stored and used in transplantation.

3) How long can you live after a bone marrow transplant?

Although life expectancy is not fully restored, patients who have survived for at least 5 years after transplantation without the reappearance of the original disease have a high probability of surviving for an additional fifteen years.

4) What is the success rate of a bone marrow transplant?

The predicted rate of survival was 62 percent, but the current rate of survival is about 30% to 60%, which may seem low, but these patients all would have died of their diseases within a matter of a few months without getting a transplant.

5) Is it dangerous to donate bone marrow?

Donating bone marrow is not that dangerous. In fact, the most serious risk associated with donating bone marrow involves the use of anesthesia during surgery which can have a lot of side-effects on the donor. A donor might feel tired or weak and have trouble walking for a few days.

6) How long does it take to find a bone marrow match?

Finding a match for your transplant can take anywhere from several weeks to many months. The time from the start of the formal search for a bone marrow match to the day of transplant is about 3 months.

7) What are the side effects of a bone marrow transplant?

  • Low levels of red blood cells, which can cause anemia
  • Diarrhea
  • Mouth Sores
  • Fatigue
  • Low levels of platelets, which can decrease how well blood can clot

8) Why you may need a bone marrow transplant?

Bone marrow transplants are performed when a person’s marrow is damaged to such an extent that it could not function properly. There can be any number of causes for marrow disease, such as chronic infections, disease, or cancer treatments.
Some reasons for bone marrow transplant are:

  • Aplastic anemia, a disorder in which bone marrow stops making new blood cells.
  • Cancers that affect the marrow.
  • Damaged bone marrow
  • Sickle cell anaemia, which is an inherited blood disorder that causes thalassemia, an inherited blood disorder where the body makes an abnormal form of haemoglobin.

9) What Are the Complications in a Bone Marrow Transplant?

A bone marrow transplant is a serious medical procedure, it may cause:

  • A drop in arterial blood pressure
  • Events of headaches
  • Nausea or fatigue
  • Pain
  • Pyrexia
  • Breath Shortness

10) What are the types of Bone Marrow Transplants?

There are two major types of transplants:

  • Autologous Transplants:

In Autologous transplants, patients own stem cells are used. It can only be used from healthy bone marrow.

  • The Allogeneic Transplant:

Allogeneic transplants are done with the help of a donor. Allogeneic transplants are necessary if bone marrow cells are completely damaged. But, they have a higher risk of certain complications. The success of this kind of transplant depends upon how closely the donor cells matches patients own cells, which is the reason why a close genetic allogeneic transplant is preferred more.

11) What happens in bone marrow donation surgery?

  • Hospital Stay: You will arrive at the hospital on the day of the donation itself.
  • Anaesthesia: Anaesthesia will be given to block the pain during marrow donation. If general anaesthesia is given, you will be unconscious during donation. If you receive regional anaesthesia (either spinal or epidural), medication will block sensation in the affected area, but you will not be unconscious and will be aware of your surroundings.
  • Donation: During the marrow donation, you will be lying on the bed posteriorly. Generally, the doctors use special, hollow needles to withdraw liquid marrow from both sides of the back of the pelvic bone. The incisions made are less than one-fourth inch and do not require any stitch.
  • Recovery: Hospital staff will watch you closely, until the anaesthesia wears off, and continue to monitor your condition afterward.

12) What is the cost of bone marrow transplant surgery in India?

A bone marrow transplant can cost between Rs20 lakh and Rs35 lakh. In a government-run setup, the cost may get reduced by up to 40%.