Bone Marrow Transplantation

Introduction

Bone marrow transplantation (BMT) is a crucial medical procedure. It replaces diseased or damaged bone marrow with healthy bone marrow. Bone marrow plays a vital role in blood cell production. Its failure can lead to serious conditions. These include leukemia, lymphoma, anemia, and other blood disorders. Bone marrow transplants are becoming more common in India. They offer a lifeline to many patients.

In this article, we will discuss the BMT process. We will cover its different forms, advantages, and disadvantages. We will also explore the costs and the rehabilitation process. Also, we are going to discuss the leading hospitals in India that have expertise in this life-saving surgery.

What is Bone Marrow Transplantation?

Bone marrow transplantation (BMT) is a medical intervention in which the diseased/damaged bone marrow of a patient is replaced with healthy marrow. Bone marrow is the soft, cancellous tissue in the bones, and it yields various blood cells, such as erythrocytes, lymphocytes, and platelets. When bone marrow is deficient through disease, injury, or genetic reasons, the body is unable to make these critical blood cells.

Bone marrow transplants are most commonly used in the treatment of blood-related diseases such as:

• Leukemia
• Lymphoma
• Multiple myeloma
• Aplastic anemia
• Sickle cell disease
• Thalassemia

Why is Bone Marrow Transplantation Performed?

Stem cell transplantation is carried out as a treatment for patients with life-threatening hematological diseases. The method is most frequently applied in the following situations:

• Blood Cancers: Patients with leukemia or lymphoma may need a bone marrow transplant as a treatment component to eradicate malignant cells and restore normal bone marrow function.
• Blood Disorders: Diseases like aplastic anemia, sickle cell disease or thalassemia may lead to the bone marrow being unable to produce sufficient good blood cells. A transplant can restore normal function.
• Immune System Disorders: Patients with autoimmune disorders of bone marrow, e.g., severe combined immunodeficiency, can also need a bone marrow transplantation.
• Inherited Disorders: Doctors can treat genetic blood disorders involving bone marrow dysfunction with Stem cell transplantation, especially when other treatments have failed.

Types of Bone Marrow Transplantation

1. Autologous Bone Marrow Transplant (self-transplant):

• Healthcare providers harvest and preserve the patient’s healthy bone marrow cells in an autologous transplant before they administer chemotherapy agents or radiation to eliminate the diseased bone marrow.
• They further transplant the stored cells back into the patient’s own body to reestablish healthy bone marrow.
• Doctors typically use this type of transplant for conditions like lymphomas and multiple myelomas.

2. Allogeneic Bone Marrow Transplant (Donor Transplant):

• In allogeneic transplants, healthcare providers characterize hematopoietic stem cell transplantation and infusion from a donor other than (more specifically, a) bone marrow donor by matching the patient with a donor’s bone marrow, such as from a sibling, relative, or unrelated donor on a bone marrow registry.
• In general, medical professionals apply this type of transplantation to diseases such as leukemias, aplastic anemia, and genetic disorders.
• Selecting an appropriate donor is of great importance to ensure the transplantation is successful and to minimize the risk of GVHD.

3. Umbilical Cord Blood Transplant: 

• For example, doctors can apply stem cells obtained from umbilical cord blood in the transplantation process, although they may not find a compatible bone marrow donor in specific situations.

Procedure Steps for Bone Marrow Transplantation

The steps for bone marrow transplantation may differ from an autologous or allogeneic transplant. However, the following is the general protocol:

1. Pre-Transplant Evaluation:

• Before performing the transplant, the patient has a test schedule to check the global health and to decide if the patient is a good candidate participant for the transplantation. This involves blood work, imaging studies, and occasionally a biopsy.

2. Harvesting Bone Marrow (for Allogeneic Transplant):

• Surgeons obtain a bone marrow graft from the allogeneic transplant as a surgical procedure. They conventionally obtain bone marrow from the hip bone under general anesthesia. Alternatively, they can collect peripheral blood stem cells by the method of apheresis.

3. Conditioning Treatment:

• Before transplantation, medical professionals subject the patient to conditioning, which can include chemotherapy and/or radiotherapy. In this procedure, they destroy diseased marrow and condition the body to be able to accept the transplanted marrow.

4. Transplantation:

• The bone marrow is implanted in the body of the patient, most commonly by intravenous (IV) infusion. The healthy marrow or stem cells begin to produce new blood cells.

5. Post-Transplant Care:

• After a graft, the recipient is actively supervised in the unit for the assessment of complications, such as bacterial infection, hemorrhage, or rejection.
• The patient is at risk of marrow rejection due to immunosuppressive therapy and may receive immunosuppressive agents.

Benefits of Bone Marrow Transplantation

Several clinically important advantages are associated with bone marrow transplantation, particularly in patients suffering from severe blood disease:

• Potential Cure for Blood Disorders: For patients with leukemia or thalassemia with a cure, routine bone marrow transplantation may be the best option since alternative treatments have failed.
• Improved Blood Cell Production: After a successful transplant, the new bone marrow can regenerate healthy blood cells, improving the patient’s overall health and immune function.
• Increased Life Expectancy: A stem cell transplant can offer life expectancy by the use of many patients, which is an important benefit, especially if the alternative is a life with a chronic disease or an acute dysfunction of bone function.
• Improved Quality of Life: With the restoration of normal bone marrow function, patients can experience a reduction in the symptoms associated with blood disorders, such as fatigue, weakness, and susceptibility to infections.

Cost of Bone Marrow Transplantation

• USA: $150,000 – $300,000 
• UK: $100,000 – $250,000 
• India: $8,000 – $35,000 
• Thailand: $40,000 – $70,000 

Best Hospitals in India for Bone Marrow Transplantation

India has many of the best-of-the-best hospitals performing bone marrow transplantation, offering state-of-the-art facilities and expertise despite the distance. Among the best hospitals for hematopoietic stem cell transplants in India are:

• Medanta—The Medicity, Gurgaon: Known for its advanced facilities and experienced transplant specialists, Medanta offers high success rates for both autologous and allogeneic transplants.
• Fortis Memorial Research Institute, Gurgaon: As one of India’s leading hospitals in performing bone marrow transplantation, Fortis provides one-stop-shop solutions for pre-and post-transplant care.
• Max Super Speciality Hospital, Delhi: Max provides advanced transplant care, such as a long-established bone marrow transplant service.

Risks and Complications

Even though bone marrow transplantation may be a life-saving procedure, there are no guarantees of good health. Some potential complications include:

• Infection: Since bone marrow transplants involve suppressing the immune system, patients are at a higher risk of infections.
• Graft-Versus-Host Disease (GVHD): This is a disorder in which the graft cells attack the body of the patient. It is more common in allogeneic transplants.
• Rejection of Transplanted: The transplanted bone may be rejected, particularly in allogeneic bone marrow transplantation.
• Organ Damage: High doses of chemotherapy or radiation can cause damage to organs like the liver, heart, or lungs.
• Relapse of Disease: In some cases, the disease that caused the bone marrow failure may relapse after the transplant.

Recovery After Hematopoietic stem cell transplant

Recovery from bone marrow transplantation varies from patient to patient but generally includes:

• Hospital Stay: Patients usually remain in the hospital for 3-4 weeks after the transplant for the monitoring of complications.
• Immune System Recovery: The patient’s immune system needs time to restore itself after the transplantation. Whilst in this period, patients need to prevent infections and adhere to strict personal hygiene regimes.
• Long-Term Follow-Up: We require standardized follow-up visits to watch for the emergence of rejection, infection, or relapse of the condition.
• Post-Transplant Medications: It will be necessary for patients to remain on immunosuppressive drugs over a long period to avoid organ rejection.

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