bone marrow transplant in india

Bone marrow transplant is transplant treatment which replaces damaged or unhealthy marrow with a healthy one. This transplant procedure is also called a bone marrow translate procedure. A bone marrow transplant is also called stem cell transplant also.

A bone marrow is a soft and fatty tissue inside bones. Bone marrow makes blood cells. These cells are:

  • Red blood cells carry oxygen and nutrients to the body.
  • White blood cells fight infection.
  • Platelets control bleeding.

Why patient need bone marrow transplant:

Doctors may recommend bone marrow transplant for many chronic infections, diseases and for cancers as well. The recommendation of bone marrow transplant treatment depends on the health conditions of the patient.

Bone marrow transplant benefits below diseases-

  • Hodgkin’s lymphoma
  • Non-Hodgkin’s lymphoma
  • Aplastic anemia
  • Adrenoleukodystrophy
  • Acute leukemia
  • Chronic leukemia
  • Bone marrow failure syndromes
  • Hemoglobinopathies
  • Neuroblastoma
  • Multiple myeloma
  • Immune deficiencies
  • Inborn errors of metabolism
  • Myelodysplastic syndromes
  • Plasma cell disorders

 Types of Bone Marrow Transplant:

Bone marrow transplant majorly are of two types.

 

  • Autologous Bone Marrow Transplant
  • Allogeneic Bone Marrow Transplant
  1. Autologous bone marrow transplant is a type of BMT in which a person’s own stem cells are used for the transplant. Stem cells are taken off from a person’s own body before chemotherapy or radiation treatment, because a high dose of chemotherapy or radiation can cause damage to the bone marrow cells. Then stem cells are stored in a freezer. After chemotherapy or radiation treatment stem cells are put back in the patient’s body for formation of normal blood cells.
  2. Allogeneic bone marrow transplant is a type of bone marrow transplant which involves the use of stem cells of a donor.Donor must be a close genetic match for stem cell transplant treatment. Often, relative is the more compatible choice of donor selection. Genetic matches can also be found from the donor registry. Specials tests are also performed to find out the perfect match for the donor.

Stem cells can be collected from donor by two ways:

  • Bone marrow harvest- Which is mini surgical procedure, one under general anesthesia, in which the donor will be asleep and bone marrow removed from the back of hip bones.The amount of bone marrow removed off is depends on the weight and on receiving patient
  • Leukapheresis- Firstly, some shots are given to the donor to help stem cells move to the bloodstream. Using a separation machine part of white blood cells that contains stem cells are separated and removed to be later given to the recipient. The red blood cells are returned to the donor.

Bone Marrow Transplant Process Include:-

  1. Conditioning
  2. Stem cell infusion
  3. Neutropenic phase
  4. Engraftment phase
  5. Post- engraftment phase

Conditioning

The conditioning period last for 7-10 days

The purpose are ( by delivery of chemo and / or radiation therapy).

  • To eliminate Maligancy
  • To provide immune suppression to prevent rejection of new stem cell
  • Create space for new cells

Stem cell processing and infusion

  • Infusion – 20 minutes to an hour , varies depending on the volume infused 
  • The stem cell may be processed before infusion , if indicated
  • Depletion of T-cells can be performed to decrease GVHD
  • Infused through a CVL , much like blood transfusion

Anaphylaxis , volume overload , and a (rare) transient GVHD are the major potential complication involved.

Stem cell product that have been cryopreserved contain dimethyl sulfoxide as a preservative and potentially can cause renal failure, in addition to the unpleasant smell and taste.

Neutropenic phase

During the period(2-4 weeks) , the patient essentially has no effective immune system Healing is poor and the patient is very susceptible to infection Supportive care and empiric antibiotic therapy are the mainstays of successful passage through this phase.

Engraftment phase

During this period(several weeks), the healing process begins with resolution of mucosities and lesions required in addition fever begin to subside and infection often begin to clear. The greatest challenges at this time are management of GVHD and prevention of viral infections(Especially CMV)

Post –engraftment phase

This period last for months to year hallmark of this phase includes the gradual development of tolerance weaning off of immunosuppression management of chronic GVHD and documentation of immune reconstition.

Below are some steps of bone marrow transplant treatment.

Before the Procedure

Before treatment begins, the patient will need to undergo some clinical and physical investigation to proceed with further treatment plans. Central venous catheters tubes (1 or 2) inserted into the bloodstream in the neck region or arm. These tubes provide treatment, fluids and nutrients if needed. It is also used to pull out blood.Patient can talk to a doctor or a provider for counselling if needed, it will help to prepare for treatment of bone marrow transplant.

Patient will need to plan out for the procedure and need to handle tasks which is required after transplant:

  • Arrange medical leave from office work
  • Complete an advance care directive
  • Take care some of financial statements
  • Arrange care of yourself.
  • Arrange someone for helping in household chores
  • Confirming the health insurance coverage
  • Bill payments
  • Arrange someone for care of your children.
  • Find a house or home near by hospital, if needed.

After the procedure of bone marrow transplant treatment:

Bone marrow transplant procedure is done in patients or in hospitals or medical centers which are specialized in BMT. To avoid any kind of infection,patient will be in the hospital for the treatment. Stay in hospital will depends on if the patient suddenly faces any health complications related to bone marrow transplant, transplant type.

When patient is in hospital:

  • The doctor’s team will regularly monitor patient’s blood count and vital signs.
  • You will take precautionary medications to prevent GVHD, to treat or prevent infections; which includes antibiotics, antifungals, and antiviral medicines.
  • Blood transfusion will be needed depending upon the severity of the disease.
  • All food nutritions will be fed through IV.

Before discharge make sure of all instructions and care which should get follow after discharge.

Graft-versus-host disease: A potential risk when stem cells come from donors

If you receive a transplant that uses stem cells from a donor (allogeneic transplant), you may be at risk of developing graft-versus-host disease (GVHD). This condition occurs when the donor stem cells that make up your new immune system see your body’s tissues and organs as something foreign and attack them.

GVHD may happen at any time after your transplant. Many people who have an allogeneic transplant get GVHD at some point. The risk of GVHD is a bit greater if the stem cells come from an unrelated donor, but it can happen to anyone who gets a bone marrow transplant from a donor.

There are two kinds of GVHD: acute and chronic. Acute GVHD usually happens earlier, during the first months after your transplant. It typically affects your skin, digestive tract or liver. Chronic GVHD typically develops later and can affect many organs.

GVHD signs and symptoms include:

  • Rash
  • Shortness of breath
  • Joint or muscle pain
  • Vision changes, such as dry eyes
  • Persistent cough
  • Dry mouth
  • Skin changes, including scarring under the skin or skin stiffness
  • Mouth sores
  • Diarrhea
  • Yellow tint to your skin or the whites of your eyes (jaundice)
  • Nausea
  • Vomiting

What you can expect

During your bone marrow transplant treatment:- On the day of your transplant, stem cells are infused into the body through your central line. The infusion is painless. You’ll be awake during the procedure. After the transplant new stem cells enter the body, they travel through blood to your bone marrow. Cells multiply and begin to make new and healthy blood cells. This process is called engraftment. It takes some weeks before the number of blood cells in your body starts to return to normal. It will be longer periods for some patients.

After the transplant procedure, some tests are done to monitor the condition. Doctors may recommend some medications to manage complications, such as nausea and diarrhea.

After bone marrow transplant, you will need to remain under close medical care.Any infections or complications, you may need to stay in the hospital for several days.Depending upon the type of transplant and the risk of complications, you’ll need to remain near the hospital for several weeks to months to allow close monitoring.

You may also need periodic transfusions of red blood cells and platelets until your bone marrow begins producing enough of those cells on its own.

Medications After Bone Marrow Transplant

If your bone marrow transplant is using stem cells from a donor (allogeneic transplant), your doctors may prescribe medications to help prevent graft-versus-host disease and reduce your immune system’s reaction (immunosuppressive medications).

After your transplant, it takes time for your immune system to recover. During this time, you may be given medications to prevent infections.

Lifestyle and diet factors:

After bone marrow transplant treatment or BMT, some diet factors need to change. You will need to add a healthy diet and nutritions to meet needs.Dietitian can also give you food suggestions to control side effects of chemotherapy and radiation, such as nausea.
Some of recommendations of food may include:

  • Avoid or restrict alcohol intake
  • Limits your salt intake.
  • Eat a variety of protein rich food including vegetables, fruits,meets,fish,healthy fast, olive oil.
  • Avoid grapefruit due to their effect on a group of immunosuppressive medications
  • Avoid smoking

Results of bone marrow transplant treatment

Bone marrow transplant treatment or BMT cures some diseases and puts others into remission..
Goals of bone marrow transplant treatment depends on individual situations. It improves quality of life.

Some people complete bone marrow transplantation Some people complete bone marrow transplantation with few side effects and complications. Others experience numerous challenging problems, both short and long term. The severity of side effects and the success of the transplant vary from person to person and sometimes can be difficult to predict before the transplant

It can be discouraging if significant challenges arise during the transplant process. However, it is sometimes helpful to remember that there are many survivors who also experienced some very difficult days during the transplant process but ultimately had successful transplants and have returned to normal activities with a good quality of life.

Videos about Bone Marrow Transplant

Bone Marrow Transplant is a procedure to replace damaged & unhealthy stem cells with healthy cells.

Slide about Bone Marrow Transplant

Types of Bone Marrow Transplant:

There are two major types of bone marrow transplants. The choice of transplant will depend upon the type of disease a patient is suffering from –

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Top Hospitals for Bone marrow Transplantation:

Top Doctors for Bone marrow Transplantation:

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