Bone Marrow Transplant

BMT is a medical procedure done to replace damaged or destroyed bone marrow with healthy bone marrow stem cells. Bone Marrow is the soft fatty tissue inside the bones. Stem cells are the immature cells that reside in the marrow giving rise to blood cells.

What is bone marrow transplant?
Bone marrow is a semisolid substance within our bones, where blood cells such as white blood cells, red blood cells and platelets are manufactured from hematopoietic stem cells (HSC). In a bone marrow transplant (BMT) it is actually the HSC which are transplanted to replace damaged or diseased cells in the marrow with the cells of an apparently normal person. This is called an allogeneic hematopoietic stem cell transplant (HSCT). A bone marrow transplant (BMT), also called a stem cell transplant, is a procedure in which diseased or damaged bone marrow cells are replaced with healthy ones. This procedure is performed after a patient has high-dose chemotherapy or radiation. Conditions successfully treated with BMT include cancers, such as leukaemia, lymphoma, multiple myeloma and solid tumours, as well as aplastic anaemia.

What are the treatment methods?
Types of Bone Marrow Transplant
There are two major types of bone marrow transplants. The type used will depend on the reason you need a transplant.
Autologous Transplants
Autologous transplants involve the use of a person’s own stem cells. They typically involve harvesting your cells before beginning a damaging therapy to cells like chemotherapy or radiation. After the treatment is done, your own cells are returned to your body.
This type of transplant isn’t always available. It can only be used if you have a healthy bone marrow. However, it reduces the risk of some serious complications, including GVHD.
Allogeneic Transplants
Allogeneic transplants involve the use of cells from a donor. The donor must be a close genetic match. Often, a compatible relative is the best choice, but genetic matches can also be found from a donor registry.
Allogeneic transplants are necessary if you have a condition that has damaged your bone marrow cells. However, they have a higher risk of certain complications, such as GVHD. You’ll also probably need to be put on medications to suppress your immune system so that your body doesn’t attack the new cells. This can leave you susceptible to illness.
The success of an allogeneic transplant depends on how closely the donor cells match your own.

When is Bone Marrow Transplantation Done?
A bone marrow transplantation can be used to:

  • Replace diseased, non-functioning bone marrow with healthy functioning bone marrow (for conditions such as leukaemia, aplastic anaemia, and sickle cell anaemia).
  • Regenerate a new immune system that will fight existing or residual leukaemia or other cancers not killed by the chemotherapy or radiation used in the transplant.
  • Replace the bone marrow and restore its normal function after high doses of chemotherapy and/or radiation are given to treat a malignancy. This process is often called rescue (for diseases, such as lymphoma and neuroblastoma).
  • Replace bone marrow with genetically healthy functioning bone marrow to prevent further damage from a genetic disease process (such as Hurler's syndrome and adrenoleukodystrophy).


What if the patient has no total matched sibling?
If the patient has no total matched sibling, then the cost for the procedure would increase and would go up to around 46,000 USD. If the patient has a totally matched sibling, then the cost of would be around 30,000 USD.
The breakdown would be:

  • Procedures cost package would be- 21,000 USD
  • Transfusion medicine services cost- 4,600 USD
  • Donor workup cost- 1200 USD
  • Recipient workup cost- 1200 USD


What is the cost of the procedure?
The procedure costs around 29000-38000 USD which has an 85% success rate.

How much time is required?
The time required in the procedure might take long. Different procedure take different set of time and hence the hospital stay varies, if it is for BMT donor it would be an overnight whereas a PBSC donor would have to be there for several donations which would last a couple of hours each.


What are the complications of Bone Marrow Transplantation ?
Complications depend on the underlying diseases, age, general conditions of the patient and the chemotherapy or radiotherapy given before BMT. It also depends on the extent of the match of the donor stem cells, type of BMT (Auto or Allo). Complications include
Infections

  • Anemia, bleeding
  • Soreness of the mouth, throat, food pipe and stomach
  • Damage to organs like kidneys, liver, lungs and heart.
  • Graft failure
  • Graft vs. host disease


Detection and Diagnosis
Bone marrow transplants are performed when a person’s marrow isn’t healthy enough to function properly. This could be due to chronic infections, disease, or cancer treatments. Some reasons for a bone marrow transplant include:

  • aplastic anaemia, which is a disorder in which the marrow stops making new blood cells
  • cancers that affect the marrow, such as leukaemia, lymphoma, and multiple myeloma
  • damaged bone marrow due to chemotherapy
  • congenital neutropenia, which is an inherited disorder that causes recurring infections
  • sickle cell anaemia, which is an inherited blood disorder that causes misshapen red blood cells
  • thalassemia, which is an inherited blood disorder where the body makes an abnormal form of haemoglobin, an integral part of red blood cells


Tests required in the procedure are

  • Blood tests-tissue,
  • Typing,
  • Infectious,
  • Disease screening,
  • Chest x-ray,
  • CT scan,
  • PET scan,
  • MRI,
  • Bone marrow biopsy.


Precautions
AFTER THE PROCEDURE

  • Eating plenty of fruits and vegetables each day
  • Eating lean meats, poultry and fish
  • Eating whole-grain breads, cereals and other products
  • Having enough fiber in your daily diet
  • Drinking low-fat milk or eating other low-fat dairy products, to help maintain enough calcium
  • Maintaining a low-salt and low-fat diet
  • Following food safety guidelines
  • Avoiding alcohol
  • Staying hydrated by drinking adequate water and other fluids each day
  • Avoiding grapefruit and grapefruit juice due to their effect on a group of immunosuppressive medications (calcineurin inhibitors)