Bone Marrow Transplant
About Bone Marrow
A bone marrow transplant or stem cell transplant is a procedure to replace damaged or destroyed bone marrow with healthy bone marrow stem cells. Bone marrow is the soft, fatty tissue inside your bones. Stem cells are immature cells in the bone marrow that give rise to all of your blood cells.
There are three kinds of bone marrow transplants:
Autologous bone marrow transplant: The term auto means self. Stem cells are removed from you before you receive high-dose chemotherapy or radiation treatment. The stem cells are stored in a freezer (cryopreservation). After high-dose chemotherapy or radiation treatments, your stems cells are put back in your body to make (regenerate) normal blood cells. This is called a rescue transplant.
Allogeneic bone marrow transplant: The term allo means other. Stem cells are removed from another person, called a donor. Most times, the donor's genes must at least partly match your genes. Special blood tests are done to see if a donor is a good match for you. A brother or sister is most likely to be a good match. Sometimes parents, children, and other relatives are good matches. Donors who are not related to you may be found through national bone marrow registries.
Umbilical cord blood transplant: This is a type of allogeneic transplant. Stem cells are removed from a newborn baby's umbilical cord right after birth. The stem cells are frozen and stored until they are needed for a transplant. Umbilical cord blood cells are very immature so there is less of a need for matching. But blood counts take longer to recover.
Donor stem cells can be collected in two ways:
Bone marrow harvest. This minor surgery is done under general anesthesia. This means the donor will be asleep and pain-free during the procedure. The bone marrow is removed from the back of both hip bones. The amount of marrow removed depends on the weight of the person who is receiving it.
Leukapheresis. First, the donor is given 5 days of shots to help stem cells move from the bone marrow into the blood. During leukapheresis, blood is removed from the donor through an IV line in a vein. The part of white blood cells that contains stem cells is then separated in a machine and removed to be later given to the recipient. The red blood cells are returned to the donor.
Treatment for Sickle Cell Disease
Summary: Homozygous SS (Sickle cell disease) is a form of hemoglobinopathy where the sickle cell percentage in blood is high. In case of hypoxia, these sickle cell aggregate and cause various vaso occlusive manifestations.
- Maintain hydration
- Tab Hydroxyurea
- Tab Folvite
- In selected cases repeated red cell transfusions
- Vaccination against capsulated organisms
- Rest of the management depends on organ specific complications
The definitive treatment for this disease is Bone Marrow Transplant. BMT can be done preferable form a matched sibling or a matched related donor. If none of them is a suitable match we can look for an unrelated donor also who is a suitable HLA match with the patient. Even if this is not possible then we can even consider a haploidentical BMT form either of the parents. The results depend on the physical state of the recipient and the HLA matching with the donor. With 6/6 or 10/10 matched donor and physically well child the results are close to 80-90% DFS.
Why the Procedure is Performed
A bone marrow transplant replaces bone marrow that either is not working properly or has been destroyed (ablated) by chemotherapy or radiation. Your doctor may recommend a bone marrow transplant if you have:
Bone marrow transplant can be done for the below mentioned indications:
- Sickle cell anemia
- Other transfusion dependent anemia
- Aplastic anemia (acquired)
- Inherited bone marrow failure syndromes ex Fanconi anemia, diamond blackfan anemia etc
- High risk ALL
- High risk AML
- Juvenile Myelomonocytic leukemia
- Immunological disorders s.a. SCID
- Inborn errors of metabolism
- High grade lymphomas
- Relapsed or high grade pediatric solid tumors
Any of the patients fulfilling above mentioned illnesses can be considered for bone marrow transplant. Bone marrow transplant can be autologous (self) or allogenic (different donor). As the name implies autologous BMT is used in patients with high risk solid tumors as a rescue after giving high dose chemotherapy.
On the other hand allogenic BMT can be considered for all the above mentioned indications baring high risk solid tumors. For allogenic BMT we need a HLA (Human leucocyte antigen) matched donor. We can screen family members to look for a suitable donor. If donor is not available in the family then we can look for donor in various bone marrow donor registries. In few cases where both these options are not available and the patient needs a transplant we can do a haplo-identical or half matched transplant from either of the parents.
Before deciding about transplant, we need a brief summary of the patient and HLA report. If HLA has not been done then it is requested to contact me before getting it done because a high resolution typing will be preferred.
Once a donor is identified then we can admit the patient for BMT. Total duration of stay in hospital is approximately 5-6 weeks. Success rate depends on the indication, type of donor and type of transplant.
Bone Marrow FAQ
When is a bone marrow transplant done?
A bone marrow transplant is done as a definite solution for serious blood related diseases like blood cancers, thalassemia, aplastic anaemia, sickle cell disorders, auto-immune disorders, immune deficiencies etc.
What is a bone marrow transplant?
Bone marrow is the tissue found inside your bones. It is the ‘factory’ for stem cells, which make your blood cells. Sometimes, the stem cells disappear or turn abnormal which affect your entire system. Here we remove the defective stem cells and replace them with healthy ‘donor cells’.
Where do the donor cells come from?.
They are collected from matching donors. Transplants are classified based on who these donors are.
What are the 4 different types of transplants?
- Autologous transplants are those where you donate your own healthy stem cells.
- Allogeneic transplants use cells from family members or strangers whose cells match yours.
- Umbilical cord blood. The biggest hurdle in transplants is finding matching donors.
- That is why the latest Haplo-identical transplant done for the first time at our centres is so important.
How is the Haplo-identical transplant different?
Here the transplant can be done using donor cells that are just a 50% match. This means you can find a donor within your immediate family - your parents, children or siblings. It saves valuable time and money and treatment can be started immediately.
How are Bone Marrow Transplants done at our Centres?
It is a procedure which requires advanced treatment facilities and experts at every stage. Your diseased bone marrow is destroyed with chemo or radiotherapy. We then collect, strengthen and store donor cells at - 170˚C until the transplant is done.
Once it is done, your immunity is very low. So we keep you isolated in 100% infection free HEPA filtered wards where you are monitored 24 hours, by experts. You are given transfusions of safe blood alongwith a customized combination of medicines to prevent infection and rejection of the transplant. Frequent blood tests at our 24 hour laboratory are done to see if the cells have started working.