Bone Marrow Transplant

Bone Marrow Transplant in Noida, India

Overview

A bone marrow transplant is a medical procedure in which healthy blood-forming stem cells are infused into the body to replace damaged or diseased bone marrow. This procedure is also commonly referred to as a stem cell transplant. It is often used to treat certain types of cancers such as leukemia, multiple myeloma, and lymphoma, as well as other blood-related or genetic disorders. Some blood diseases, including those caused by damage from chemotherapy or radiation, can also be treated with stem cell transplants.

Earlier, the procedure was called a bone marrow transplant because stem cells were primarily harvested from bone marrow. However, modern methods typically collect stem cells from the blood, making "stem cell transplant" a more common term today. Depending on the source of the stem cells, the transplant may be autologous (using the patient’s own cells) or allogeneic (using cells from a donor).

Understanding Bone Marrow

Bone marrow is a spongy tissue located within certain bones, such as the ribs, sternum, vertebrae, and pelvic bones. It consists of hematopoietic cells, marrow adipose tissue, and stromal cells. In adults, bone marrow contributes to about 5% of body weight.

The marrow is responsible for producing blood cells, including:

• Myeloid cells (red and white blood cells, platelets), and
• Lymphoid cells, which migrate to other organs like the thymus for maturation.

Conditions Treated by the Marrow Transplant Program

When a medical condition hinders the production of healthy blood cells, a bone marrow transplant may be necessary. Conditions that might require this procedure include:

• Blood cancers such as leukemia and lymphoma,
• Genetic or immune system disorders like sickle cell anemia and thalassemia, and
• Bone marrow-related diseases such as aplastic anemia.

The following are some of the conditions treated under the bone marrow transplant program:

Acute Myeloid Leukemia (AML)

A type of blood cancer where the bone marrow generates an excessive number of granulocytes, a type of white blood cell that typically fights infections.

Acute Lymphoblastic Leukemia (ALL)

This blood cancer is characterized by the overproduction of lymphocytes, a type of white blood cell that helps fight infections. The disease begins in the bone marrow or lymphatic organs and progresses quickly.

Amyloidosis

A rare disorder caused by the abnormal build-up of amyloid proteins in various organs throughout the body, which can disrupt their normal function.

Aplastic Anemia

A rare condition where the bone marrow fails to produce enough new blood cells, leading to fatigue, vulnerability to infections, and uncontrolled bleeding.

Chronic Myelogenous Leukemia (CML)

A slow-growing form of blood cancer that originates in the bone marrow's blood-forming cells. Over time, it spreads to the blood and other areas of the body.

Chronic Lymphocytic Leukemia (CLL)

A type of blood cancer characterized by the gradual overproduction of lymphocytes in the bone marrow and lymphatic organs.

Acute Renal Failure (ARF)

This life-threatening condition may occur as a complication following a bone marrow transplant. It is often caused by veno-occlusive disease, which can lead to hepatorenal-like syndrome within a month of the transplant and is a leading cause of early ARF.

Hodgkin’s Lymphoma (HL)

A cancer of the lymphatic system, HL originates in lymphocytes, which are white blood cells responsible for fighting infections. The disease typically begins in the lymph nodes and can spread to other areas of the body as it progresses.

Fanconi Anemia (FA)

This genetic disorder affects bone marrow function, resulting in reduced production of healthy blood cells. FA is linked to aplastic anemia and may cause physical and developmental abnormalities, skeletal issues, and unusual skin pigmentation.

Types of Bone Marrow Transplants

Bone marrow transplants are categorized into three main types:

1. Autologous Bone Marrow Transplant:
   In this procedure, the patient’s own stem cells are harvested before undergoing high-dose chemotherapy or radiation therapy. These stem cells are frozen and stored, then reintroduced into the body after treatment to restore healthy blood cell production. This type is also referred to as a "rescue transplant."
2. Allogeneic Bone Marrow Transplant:
   Here, stem cells are donated by another individual, often a sibling or family member whose genetic profile closely matches the patient’s. If a family match is unavailable, unrelated donors can be found through bone marrow registries.
3. Umbilical Cord Blood Transplant:
   Stem cells are collected from the umbilical cord of a newborn immediately after birth. These cells are then frozen and stored for future use. Since cord blood stem cells are less mature, they do not require a perfect genetic match, though recovery may take longer due to the smaller volume of stem cells.

Syngeneic Bone Marrow Transplantation

This procedure involves receiving bone marrow from an identical twin who is healthy. The genetic similarity between twins minimizes the risk of complications, making it a unique and highly compatible option.

Pre-Transplant Eligibility and Testing

Before initiating treatment, the transplant team—including a nurse coordinator and advisor—must submit the necessary documentation and evaluate the patient’s eligibility. Approval from the transplant team ensures the procedure is tailored to the patient’s specific diagnosis and health condition.

Required Tests and Evaluations:

• Blood tests
• Kidney function assessment through a 24-hour urine collection
• Electrocardiogram (EKG) to evaluate heart rhythm
• Chest X-ray
• CT scans of the chest, sinus, abdomen, or pelvis (if necessary)
• Bone marrow diagnostic testing (if required)
• Echocardiogram to assess heart performance
• Pulmonary function test to measure lung capacity
• Psychological evaluation (if recommended)

The transplant coordinator oversees the treatment plan and works closely with the patient throughout the process.

Bone Marrow Transplant in India

India has become a leading destination for bone marrow transplants, offering high-quality care at competitive costs. Among the top hospitals, Yatharth Hospitals stands out for its expertise in this field. The hospital is renowned for its skilled bone marrow transplant specialists and commitment to patient comfort and care.

Estimated Costs of Bone Marrow Transplants in India depends on the type of transplant and the patient’s individual requirements.

Initial Steps and Support

Initially treatment can be an overwhelming experience. Patients are encouraged to maintain open communication with their transplant coordinator, who will be the main point of contact during the process. Additionally, families should designate a caregiver to assist the patient with daily activities and medication management during recovery.

The Bone Marrow Transplant Process

A bone marrow transplant is often compared to a blood transfusion. The basic principle is to replace damaged or diseased bone marrow cells with healthy ones.

Steps of the Procedure:

Stem Cell Collection:
Healthy stem cells can be obtained from three sources:

• Blood: The preferred and most common method. Blood is drawn from one arm, passed through a machine to filter stem cells, and returned to the body. This process takes 2-3 hours and may need to be repeated to collect sufficient cells. Donors undergo a similar procedure, but their cells are typically used immediately.
• Bone Marrow: A needle is used to extract bone marrow from the hipbone under anesthesia. The procedure takes 1-2 hours, and recovery involves minor soreness.
• Umbilical Cord Blood: Collected from the placenta and umbilical cord after birth, these cells are stored for future use.

Conditioning:
Before receiving new stem cells, patients undergo chemotherapy (and sometimes radiation) to:

• Create space in the bone marrow for new cells.
• Suppress the immune system to reduce rejection risks.
• Destroy any remaining cancer cells.

Conditioning can last up to a week, with radiation therapy varying based on individual needs.

Transplant:
The new stem cells are infused into the patient through a central line—a thin tube inserted into a chest vein. The process takes a few hours and is painless. The stem cells naturally migrate to the bone marrow and begin generating new blood cells.

Recovery can take weeks, during which patients may experience side effects, especially if frozen cells with preservatives are used. These side effects, typically mild, may including fever and chills, chest pain, nausea, headache, or a garlic taste in the mouth.

Complications

Autologous Bone Marrow Transplant

Before undergoing an autologous bone marrow transplant, patients typically receive chemotherapy, sometimes accompanied by radiation therapy. Many of the side effects associated with this type of transplant stem from these pre-treatment regimens. The most critical complication is an increased risk of infections due to a temporary reduction in white blood cell levels.

Infections

Chemotherapy compromises the immune system, reducing the body’s ability to fight off bacteria, viruses, and other pathogens. The highest risk of infection occurs within the first few weeks following the transplant. Although neutrophils (a type of white blood cell) usually recover after about two weeks, the immune system may never fully return to its pre-transplant state.

Immediate Side Effects

The following side effects are most severe during the first one to two weeks after receiving high-dose chemotherapy:

• Nausea and vomiting
• Mouth sores
• Fatigue
• Low platelet count
• Anemia caused by reduced red blood cell levels
• Diarrhea

Long-Term Side Effects

Some complications may emerge months or even years after the transplant, including:

• Infertility
• Cataracts (clouding of the eye's lens, causing blurred vision)
• Early menopause (in women)
• Thyroid dysfunction
• Lung or bone damage
• Increased risk of developing secondary cancers

---

Allogeneic Bone Marrow Transplant

Complications associated with allogeneic transplants include those resulting from the use of donor stem cells. The two major risks are infections and Graft-Versus-Host Disease (GVHD).

Infections

As with autologous transplants, infections are a major concern during the early post-transplant period. However, in allogenic transplants, the risk of infection can persist throughout a patient’s life. Pre-transplant treatments like chemotherapy, radiation, or immunosuppressive drugs further weaken the immune system, increasing susceptibility to infections.

Graft-Versus-Host Disease (GVHD)

GVHD occurs when the donor’s stem cells attack the recipient’s body, causing inflammation. Even with a perfect donor match, doctors usually prescribe preventive medications. If GVHD develops, additional treatments can help control the condition. In rare cases, GVHD can become life-threatening.
There are two types of GVHD:

• Acute GVHD: Occurs within the first 100 days post-transplant.
• Chronic GVHD: May develop later and can last for months or years.

Immediate Side Effects

These side effects resemble those seen in autologous transplants and are more common after high-dose chemotherapy. Reduced-intensity conditioning regimens may lessen their severity. Common side effects include:

• Nausea and vomiting
• Mouth sores
• Low platelet count
• Anemia caused by reduced red blood cell levels
• Diarrhea

Long-Term Side Effects

Like autologous transplants, allogenic transplants may result in complications that develop over time, such as:

• Infertility
• Cataracts
• Early menopause (in women)
• Thyroid disorders
• Damage to the lungs or bones
• Increased risk of secondary cancers

Pediatric Bone Marrow Transplant

Bone marrow transplants in children carry unique risks, some of which may be life-threatening. The likelihood of complications depends on several factors, such as:

• The type of transplant (autologous or allogenic)
• The child’s specific disease
• Pre-transplant medications
• Age of the child
• Compatibility of donor and recipient tissues

Possible Complications

• Infections: Severe bone marrow suppression often leads to a reduced production of blood cells, increasing the risk of infections. Preventive and therapeutic medications are usually administered.
• Thrombocytopenia and Anemia: Low platelet and red blood cell levels may become critical, requiring frequent blood transfusions.
• Pain: Oral sores and gastrointestinal (GI) irritation caused by chemotherapy or radiation are common. Pain medications and proper oral care can help manage this discomfort.
• Gastrointestinal Issues: Nausea, vomiting, and diarrhea may occur due to pre-treatment regimens or GI irritation.
• Fluid Overload: When the kidneys cannot handle the large volumes of intravenous fluids administered during treatment, fluid overload may result. Regular monitoring of the child’s weight, blood tests, and urine output helps prevent complications. Medications may be used to improve kidney function and eliminate excess fluid.
• Respiratory Problems: Serious breathing difficulties can arise from infections, airway inflammation, fluid overload, GVHD, or bleeding. Supplemental oxygen may be required temporarily.
• Organ Damage: Short-term or long-term damage to the liver or heart can result from infections, GVHD, pre-transplant treatments, or fluid overload. Regular monitoring of blood and vital signs helps detect and manage these issues early.