Bone Marrow Transplant at Yapita Health

Overview

What is a bone marrow transplant?

In bone marrow transplant or stem cell transplant, healthy blood-forming stem cells replace damaged bone marrow that cannot produce enough healthy blood cells.

Why would someone need to have a bone marrow transplant?

Bone marrow plays a crucial role in immunity. With damaged bone marrow, the body’s immune system becomes weak and it increases the patient's risk of infections. Bone marrow transplant is recommended when bone marrow lacks stem cell production.

What conditions can a bone marrow transplant treat?

The indications of bone marrow transplant are:

• Immune deficiency/Severely Combined Immunodeficiency Syndrome

• Congenital neutropenia

• Aplastic anemia

• Thalassemia

• Inborn errors of metabolism

• Leukemia

• Multiple myeloma

• Lymphoma

• Hodgkin’s Lymphoma

• Non-Hodgkin’s Lymphoma

• Sickle Cell Disease

Requirements & Evaluation

Patients are explained thoroughly regarding Bone marrow transplant including the evaluation process, treatment side effects, cost of treatment, and associated complications.

Requirements and evaluation of bone marrow transplant involve a physical examination, laboratory investigations and other tests are performed including HLA typing,

Bone marrow aspirate & biopsy, EKG, Pulmonary function test, PET scan, X-rays, biopsy, Central venous line placement (catheter placement), 24-hour urine collection, and Psychosocial evaluation

Preparing for your Transplant includes:

• Finding accommodation in a hotel because patients for autologous transplants need to stay for 30 days locally and allogenic transplant patients need to stay for 100 days.

• Central Line/Catheter Placement: This is an outpatient procedure that facilitates the infusion of cells, blood products, and IV medicines.

• Consultations with members of the Transplant Team

Different Types of bone marrow transplant

1. Autologous Bone Marrow Transplant:

Auto means self. In this type of BMT, stem cells are used from your own body. Before starting cancer treatment, doctors remove stem cells from your blood or bone marrow.

2. Allogenic Bone Marrow Transplant:

Allo means “other.” Stem cells are collected from healthy donors. Brothers, sisters, Parents, children and other relatives can be a good match. Special tests are performed to determine a good match.

Allogenic BMT is of 3 types:

1. Complete Matched Sibling Donor BMT: The donor is likely to be the brother or sister of the patient.

2. Haplo-identical BMT: Parents are donors.

3. Unrelated Donor BMT: The donor is unrelated to the patient.

Process for Transplanting Bone Marrow

Before the Procedure

• Evaluation of the general health of the patient. The doctor confirms if you are a suitable candidate for BMT.

• Bone marrow examination is completed and evaluated.

• Before transplant patients are instructed to stay away from sick people. It is advisable to maintain good hygiene.

• Conditioning Process: Chemotherapy, radiotherapy or both are carried out before BMT to eliminate cancer or diseased cells.

Mini transplant or reduced-intensity therapy means chemotherapy and radiation in smaller doses while myeloablative or ablative therapy means high doses of radiation, chemotherapy, or combination. The conditioning method suppresses the immune system and destroys cancerous cells.

In autologous transplant- the patient's own stem cells are collected and stored before conditioning.

In an allogenic transplant - compatibility with the donor is matched.

• The intravenous catheter or central line is implanted into a large vein of the chest or neck. This is used to infuse the transplanted stem cells, medications, and blood products into your body.

Donor Selection Process

• A blood test is to identify the patient's tissue type.

• Donor registries are searched to find out unrelated donors if a good match cannot be found among the patient's family members.

• Donors are assessed to determine if they are a good candidate. The examinations are physical examination, imaging, and blood investigations.

• On obtaining consent from the donor, procedures like bone marrow extraction, and peripheral blood stem cell collection, are carried out.

• The process takes weeks or months.

• Donors are explained about possible side effects and duration of recovery.

Stem Cell Collection

Autologous: Patients blood is collected and put through a machine. This separates the stem cells during apheresis. The patient's body receives the leftover blood back. The stem cells are frozen and stored until BMT.

Allogenic: A medication is injected into the donor that stimulates the release of stem cells into the bloodstream followed by Apheresis for stem cell extraction from the donor's blood.

Process 

The patient receives the stem cells through an IV tube through transplantation. These stem cells start producing new blood cells. The patient is carefully monitored for weeks or months.

Some side effects are nausea, vomiting, diarrhea, fever, and infection.

After the Procedure

The patient needs to remain in the hospital for several weeks or months. Medications are given to monitor side effects and stop the transplanted cells from being rejected.

• What kind of follow-up care will I have during recovery?

Important instructions include avoiding contact with sick people, proper hygiene, and taking regular medications on time.

Risk & Benefits

Minor complications are an impaired taste sensation, nausea, vomiting, diarrhea, headache, low blood pressure, and fever. Other serious complications are GVHD, anemia, mucositis, etc.

Recovery

Recovery takes a long time. To ensure proper recovery, It is important to take regular follow-ups, timely medications, and follow all instructions given by the doctor.