Bone Marrow Transplant
The blood and bone marrow transplantation center at Apollo Hospitals, India has performed over 700 transplants with an excellent success rate. Apollo Hospitals, India is also a trusted name in BMT for international patients, as the hospital has not just a highly qualified BMT team, but also very stringent infection control norms which are critical for BMT patients. BMT treatment is available at Apollo Hospitals at Chennai, New Delhi, Hyderabad, Ahmedabad and Kolkata.
- Autologous Transplant (Stem Cells collected from one's own body)
- Hodgkin's & Non Hodgkin's Lymphoma: For relapsed / refractory cases, it is standard therapy and in most such cases, it is the only curative option.
- Myeloma: Although not curative, it is standard treatment as a part of initial therapy, as it prolongs survival substantially.
- Leukemia: Acute Myeloid Leukemia as part of consolidation therapy, to increase chance of cure in this disease.
- Allogenic Transplant (Stem Cells collected from some one else's body)
- Several other genetic disorders, especially with single gene defects
- Aplastic Anemia
- Chronic Myeloid Leukemia
- High Risk AML & Relapsed AML
- Relapsed ALL (Acute Lymphocytic Leukemia)
- As an option in several advanced or refractory haematological malignancies eg. follicular lymphoma, CLL, myeloma etc
The procedure serves mainly 3 purposes
- Replacing a missing gene e.g. in Thalassemia, Sickle cell disease and many genetic disorders. These are diseases where the person is otherwise normal, except for one missing gene, and replacing that gene is curative.
- Allows use of high doses of anticancer therapies, which may lead to loss of bone marrow. Without stem cells support, marrow will recover only after a long time, resulting in high complication rate from infections or bleeding. Infused stem cells provide early recovery of blood cells. It considerably lowers the risk of low blood counts due to marrow suppression. Thus it is one form of "Supportive Therapy" and not a treatment of cancer by itself. This is the case in Autologous (self) transplant and in majority of Allogeneic transplants.
- Some "Graft versus Disease activity", more commonly known as "Graft v Leukemia effect" in Allogeneic transplant, especially evident in chronic myeloid leukemia.
- Sources of Hematopoietic Stem Cells: Bone Marrow is the tissue that is found inside our bones. It is a spongy texture and is rich in stem cells. Bone marrow is collected from the iliac crest (hip bone) in the operating room.
- Peripheral blood stem cells (PBSC): Stem cells are collected from the circulating blood stream using a process called apheresis.
- Umbilical Cord Blood: The cord of new born babies is a rich source of stem cells.
What are Stem Cells?
Blood cells grow in the same way as other human cells. They develop in the bone marrow from a parent cell known as "stem cell". These stem cells begin to divide and mature until they are fully developed, forming all the different types of blood cells : white cells, platelets and red blood cells. Stem cells are usually found inside the bone marrow spaces of large bones, however, they can also travel from bone to bone to other by way of blood system. A very small percentage of the white blood cells circulating through our veins are stem cells.
There is no surgery involved in Transplant, for the patient or donor. It is very safe procedure for a donor. Nothing is lost permanently in the body e.g. as in kidney Transplant. Stem cells regenerate in few days. For the same reason there are over 1 crore (10 million) volunteer donors for stem cell transplant in USA. Stem Cells are infused into the patient through a live Blood Transfusion.
The Stem Cells can be collected from patient's own body or can be harvested from another person. This other person is known as donor.
Stem cells are taken from the patient either by bone marrow harvest or apheresis (peripheral blood stem cells) and then given back to the patient after conditioning treatment.
The donor has the same HLA type as the patient. Stem cells are taken either by bone marrow harvest or apheresis (peripheral blood stem cells) from a HLA matched donor, usually a brother or sister. Other donors for allogeneic bone marrow transplants include the following:
- An identical twin - A syngeneic transplant is an allogeneic transplant from an identical twin. Identical twins are considered a complete genetic match for a transplant.
- Unrelated transplants (UBMT or MUD, for matched unrelated donor) - The HLA matched stem cells are from an unrelated donor, usually found through the national registries.
- Umbilical Cord Blood transplant - Stem cells are taken from an umbilical cord immediately after delivery of an infant. The stem cells are tested, typed, counted and frozen until they are ready to be transplanted.
Stem cell transplant is an exciting area of medicine. It is a well established treatment for several cancers and diseases of blood for the past few decades.
There are three main steps in the transplantation process.
The first step is the collection of the bone marrow or stem cells (the harvest) from the donor. We now know that the umbilical cord blood is also a rich source of stem cells.
The second step is to completely destroy the existing bone marrow and thereby help the patient receive the new stem cells.
The third step is to infuse the bone marrow or the stem cells through the intravenous route, like a blood transfusion. There may be no signs of a new bone marrow growing for two to three weeks, and occasionally it may be a few months before the new bone marrow produces all the components of the blood adequately.
Preparing for BMT
Having a transplant can be very demanding, physically and emotionally. It may help if patients can talk about their fears and concerns.
It is important to understand why one is having the transplant and what the actual processes will be, so that the patient can make practical arrangements and also prepare himself or herself mentally. It is a good idea to discuss the entire process with the doctors and nurses involved, before the patient goes into hospital.
Here are some questions one may like to ask:
- What are the benefits of the treatment?
- What are the risks of the treatment?
- How will the transplant affect the way I live?
- Will I be able to have children after a transplant?
- How long will it be before I can start leading a normal life again?
- What are the other treatments available to me?
- Can one predict how the disease will progress?
- Who can visit me?
- Will my treatment make me feel too unwell to see people?
- Is there a television in the room?
- Is there a telephone link in the room?
- Can I bring in my own clothes?
- What do you suggest that I bring to the hospital to make my stay more comfortable?
- Where can the attenders stay?
Being fully informed and prepared will help to make the transplant process easier for the patient and the family.
Who can be a donor for an Allogeneic transplant?
Matching bone marrow is done by blood tests alone. It is not necessary to test the donor’s bone marrow at this stage.
It is usual to start by testing the brothers and sisters, as they are likely to provide the best match; parents are not usually good matches.
The donor should be in good health. He or she will be given a thorough medical checkup to make sure that there will be no risk to his or her own health from the procedure.
Collecting bone marrow
About a week or two before the bone marrow harvest is done, the patient (or the donor, for an Allogeneic transplantation) may have 1 to 2 units of blood withdrawn. This will be given back during the bone marrow harvest.
The harvest itself is carried out under general anaesthesia, so one will feel nothing. It involves the removal of some marrow from inside the bones at the back and front of the pelvis (the hip bones).
The patient or donor will have to stay in hospital overnight to recover fully from the general anaesthesia. Usually it feels sore for a few days and mild painkillers may be required. These will be administered by the nurses or doctors.
How are the stem cells collected?
Stem cell harvesting is done following a course of daily injections of a growth factor. This procedure takes about 3 hours. The patient will be made to lie down on a couch and a transfusion will be put into the vein of each arm. Blood will be collected from one arm, into a machine called a centrifuge, which spins it to separate out the stem cells. These are collected, and the remaining blood is returned through the IV in the other arm. The stem cells can even be frozen.
What is Umbilical Cord Blood Transplantation?
Many children and young adults with serious blood diseases such as leukaemia, need a bone marrow transplantation to give them a chance to live. Unfortunately a marrow donor cannot always be found. Sometimes searching for a donor takes so long that the patient dies before a compatible donor is available.
However, now a new source of blood forming stem cells has been found – Umbilical Cord Blood.
This is the blood that is left behind in the placenta and the umbilical cord after the delivery of a baby. Cord blood is rich in stem cells and can be used instead of bone marrow for transplantation.
The stem cell in the cord blood is of high quality and very potent in producing blood cells. Cord blood transplants appear to cause less serious immunological side effects. The 'matching' between donor and recipient appears to be less critical. This means that the chance of finding suitable cord blood for transplantation is much greater than that of bone marrow.