With advancement in technology, indications & supportive therapy, bone marrow or stem cell transplants continue to progress in the treatment of human diseases. Bone marrow transplant procedure is designed to infuse healthy blood stem cells in the body in order to replace damaged or diseased bone marrow. It may be necessary for people to undergo bone marrow transplant when bone marrow in their body stops functioning properly & is unable to produce sufficient amounts of healthy blood cells.
There are two main types of bone marrow transplants; Autologous transplant which uses cells from the patient’s own body & Allogeneic transplant which involves receiving cells from a matching donor.
• Autologous Stem Cell Transplant
This type of bone marrow transplant utilizes healthy blood stem cell from the patient’s own body. Using stem cells from the patient’s own body during Autologous Bone Marrow Transplant offers some advantages in comparison to cells received from a donor. The patient will now have no worry about incompatibility while undergoing autologous stem cell transplant. This, in fact, is an excellent option for people whose body is producing enough amounts of healthy bone marrow cells. During the procedure, most often before undergoing cancer treatments, healthy stem cells are collected from the patient, frozen & stored for use at a later point in time. This type of bone marrow transplant is typically used for patients who are undergoing high dosages of chemotherapy & radiation therapy as part of their treatment plan & which are most likely to damage their bone marrow in the process.
Autologous Bone Marrow Transplant is most often used in the treatment of the following diseases.
o Plasma Cell Disorders
o Hodgkin’s Lymphoma
o Non-Hodgkin’s Lymphoma
• Allogeneic Stem Cell Transplant
This bone marrow transplant procedure utilizes healthy blood stem cells obtained from a matching donor in order to replace diseased or damaged bone marrow of the patient. Allogeneic bone marrow transplant donor can be an acquaintance, a family member or some other unassociated person as well. Stem cells which are acquired for allogeneic stem cell transplant can be the following.
o Collected from bone marrow within hipbone of the donor
o Collected from blood of the donor
o Collected from donated umbilical cord blood
Patients undergoing allogeneic bone marrow transplant usually receive high doses of chemotherapy or radiation therapy for destroying diseased or damaged cells in their blood or bone marrow prior to the transplantation procedure.
Allogeneic stem cell transplantation is normally a treatment option for patients with a wide spectrum of cancerous & noncancerous diseases including the following.
o Acute Leukemia
o Chronic Leukemia
o Aplastic Anemia
o Bone Marrow Failure Syndromes
o Hodgkin’s Lymphoma
o Non-Hodgkin’s Lymphoma
o Inborn Errors of Metabolism
o Immune Deficiencies
o Myelodysplastic Syndromes
o Multiple Myeloma
o POEMS Syndrome
o Plasma Cell Disorders
o Primary Amyloidosis
Stem cell transplant is normally used to safely allow treatments involving high doses of chemotherapy or radiation therapy which are typically employed for rescuing or replacing damaged bone marrow in people. Bone marrow transplant is an ideal solution for replacing diseased or damaged marrow with new stem cells which can directly help in destroying cancerous cells in some cases.
There are many risks & complications associated with bone marrow transplantation & some of which are potentially fatal. These risks, however, depend upon several factors including the type of transplant procedure, type of disease or condition along with the age & health of the patient receiving the transplant. While some patients experience minimal problems associated with bone marrow transplant, there are others who might develop complications which require extra treatments including hospitalization.
Complications which generally arise following bone marrow transplant include the following.
• GVHD – Graft-Versus-Host Disease with allogeneic transplants only
• Organ damage
• Failure of stem cell graft
• New Cancers
Doctors or the bone marrow transplant team will discuss the risk of complications of this treatment with the patient prior to undertaking treatment. Together they will weigh out the risks & benefits in order to decide whether bone marrow transplant is an ideal healthcare solution for the patient.
Every bone marrow transplant patient will have to undergo a series of tests & procedures which are meant to assess the overall health & condition in order to ensure that they are physically fit for undergoing the procedure. This evaluation process may take several days or more of time prior to actual treatment. Additionally, the surgeon or the radiologist may implant an intravenous catheter into the patient’s large vein in chest or neck region. Often known as the central line, this usually remains in place for the entire duration of bone marrow transplant treatment. The transplantation team will eventually use this central line for infusing medications, blood products & stem cells into the patient’s body.
The patient will undergo a procedure known as apheresis for the collection of blood stem cells in case of an autologous bone marrow transplant. For this purpose, they will receive a daily dose of injections of growth factor for increasing production of stem cells & subsequently moving them into the blood circulation from where they are to be collected. Blood is drawn from a vein & circulated through a machine separating blood into different parts, including stem cells, during apheresis. While stem cells are collected & frozen for transplant in future, blood is pumped back to the patient’s body from the stem cell collection machine.
Stem cell collection procedure from a donor during allogeneic bone marrow transplant will involve the gathering of stem cells from a matching donor. Often called bone marrow harvest or stem cell harvest, stem cells for transplant usually come from the donor’s blood or bone marrow. However, it is the bone marrow transplant team which will decide which option is more suitable based upon the patient’s situation.
There is another type of allogeneic bone marrow transplant which is known as cord blood transplant utilizes stem cells that are obtained from blood of umbilical cords. Many mothers nowadays choose to donate umbilical cords following the birth of babies. Blood from these umbilical cords is them frozen in cord blood banks until the time they are required for bone marrow transplants.
The bone marrow transplant patient will undergo the conditioning procedure following stem cell collection process. Most often they will undergo chemotherapy or radiation therapy or both in order to destroy cancerous cells as a treatment for malignancy. Suppressing the immune system is another aspect of conditioning patients alongside preparing their bone marrow for receiving new stem cells. Type of conditioning which the bone marrow transplant patient will undergo depends upon a number of factors including the disease, general health & the type of transplantation procedure which is planned.
Side effects of the conditioning procedure for bone marrow transplantation may include nausea, vomiting, diarrhea, infection, mouth sores or ulcers, bleeding, fatigue, anemia, cataracts, infertility issues & organ complications involving liver, heart or lung failure along with hair loss. However, patients can take medications or rely on other measures in order to reduce these side effects.
• Reduced-Intensity Conditioning
Based upon the age & health history of the patient, doctors may in some cases recommend lower doses or an even different variety of chemotherapy drugs or radiation procedures as conditioning treatments. This is known as reduced-intensity conditioning which while destroying some cancerous cells also suppresses the immune system at the same time. Donor stem cells are then infused into the patient’s body in order to replace the diseased or damaged cells in bone marrow over time. This way, immune factors in donor cells are able to fight cancer cells.
Bone marrow transplantation procedure is undertaken only after completion of the conditioning procedure. Stem cells are infused into the patient’s body through the central line on the day of bone marrow transplant & which is known as the ‘day zero’. Since the stem cell transplantation procedure is absolutely painless, the patient will be awake during the operation. Transplanted stem cells will start creating newer blood cells as they make their way into the patient’s bone marrow. However, it may take about a few weeks of time for blood counts to recover as the production of new blood cells take some time. Since the frozen & then thawed bone marrow or blood stem cells contain a preservative for protection, patients may, therefore, receive medications just before the transplantation procedure in order to reduce side effects. Patients are also likely to be given IV fluids before & after the transplant in order to overcome dehydration & to help rid the body of preservative. Some of the most common side effects of preservatives added to stem cells include a headache, nausea, shortness of breath & a strange taste in the mouth. However, not all stem cell transplant patients experience these side effects of preservatives while for some other patients these may be minimal.
Transplanted stem cells travel through the patient’s body & into the bone marrow. They will now in time multiple & start making new & healthy blood cells. This process is known as engraftment & which usually takes many weeks before the quantity of blood cell in the patient’s body return to normal levels. However, depending upon the patient to patient, in some cases, this may take longer. The bone marrow transplant patient will have to undergo blood tests & other examinations in the days & weeks following the procedure in order to monitor the condition. These patients may also require medications so as to manage complications like diarrhea & nausea following bone marrow transplantation. Nevertheless, patients will invariably remain under close observation following the procedure. They may also need to stay at the hospital for several days or even longer in case they are experiencing infections or other complications. Moreover, the risk of complications depends on the type of bone marrow transplant the patient undergoes & may have to remain near the treatment facility for several weeks to months even after discharge in order to allow close monitoring. Bone marrow transplant patients may also require periodic transfusions of platelets & red blood cells until the time their bone marrow starts producing enough quantity of cells. In any case, the bone marrow transplant patient will be at greater risk of developing infections or other complication for months or even years after having undergone the transplantation procedure.
While bone marrow transplant procedure can cure some diseases, it can put others into remission. However, goals of bone marrow transplant will depend upon individual cases but normally includes curing or controlling of disease along with extending & improving the quality of life of the patient. Bone marrow transplant for some patients is completed with fewer side effects & complications while others can experience a number of challenging problems in both short term & long term. The success of the procedure & the severity of side effects vary from one patient to another & in quite a few cases may even be difficult to predict at the start of bone marrow transplant procedure. Stem cell transplantation can be discouraging when significant challenges arise during treatment. Nevertheless, it is quite helpful for patients to remember that several survivors who also had experienced quite some difficult times during bone marrow transplant have ultimately undergone successful procedures & have subsequently returned to normal activities along with a fairly decent quality of life.
Doctors associated with IndianMedTrip have experience in using bone marrow transplants as a treatment for a variety of medical conditions including blood cancers. IndianMedTrip is associated with leading multispecialty hospital facilities in the country & are well placed to provide bone marrow transplant procedures at reasonable costs to international patients without any waiting period. Your bone marrow transplantation team will normally include oncologists, hematologists, psychologists, psychiatrists, BMT scheduling coordinator, trained, specialized & transfusion medicine nurses, physician assistants, dieticians, pharmacists & a child life specialist for children as & when required for your bone marrow transplant. Patients from all around the globe who choose IndianMedTrip as their healthcare service provider receive the comprehensive, compassionate & a personalized attention which takes care of all their requirements to the minutest detail which is needed to undergo a hassle-free medical experience of undergoing treatments in a foreign country.