Bone Marrow Transplant

Overview

Bone Marrow Transplantation (BMT) is a medical procedure that involves replacing damaged or diseased bone marrow with healthy bone marrow stem cells. This procedure is typically used to treat blood cancers such as leukemia, lymphoma, and multiple myeloma, as well as other disorders such as sickle cell anemia and thalassemia.

Types

There are two main types of Bone Marrow Transplantation (BMT): autologous and allogeneic.

1. Autologous BMT: In this type of transplant, the patient's own stem cells are collected before the high-dose chemotherapy and/or radiation therapy is given. The stem cells are then frozen and stored. After the chemotherapy and radiation therapy, the stored stem cells are thawed and returned to the patient's body. This type of transplant is used when the patient's own cells are not damaged or diseased, but are being used as a rescue therapy after high-dose chemotherapy or radiation therapy.
2. Allogeneic BMT: In this type of transplant, stem cells are taken from a donor (usually a close relative or sibling) and given to the patient. The donor's cells are a genetic match to the patient's, which reduces the risk of rejection. This type of transplant is used when the patient's own cells are damaged or diseased. The donor's stem cells will engraft in the patient's bone marrow and start producing new blood cells.

The sub types of Allogeneic BMT are:

• Haploidentical BMT: Haploidentical transplant, also known as half-matched transplant, is a type of allogeneic transplant where the donor and the recipient are not a perfect match but share one haplotype (half of the genetic material) in common. A haploidentical transplant can be done from a family member such as a parent, sibling, or child. The donor's cells are not as well matched to the patient's cells as in a standard allogeneic transplant, which increases the risk of complications such as graft-versus-host disease (GVHD) and graft rejection. To reduce the risk of these complications, special techniques are used to purify the donor's stem cells before transplantation.
• Cord blood transplant: Cord blood transplant is a type of allogeneic transplant that uses stem cells from the umbilical cord of a newborn baby. Cord blood is a rich source of hematopoietic stem cells, which can develop into all the different types of blood cells. Cord blood transplants are an alternative to using stem cells from a matched adult donor. The main advantage is that cord blood cells are less mature than adult stem cells, which makes it less likely for the patient's immune system to reject the transplant. However, cord blood units often have fewer stem cells than a bone marrow or peripheral blood transplant, which can increase the time it takes for the patient's blood counts to recover.

Both haploidentical BMT and cord blood transplant are considered alternative options for patients who do not have a suitable matched donor. They come with their own set of risks and benefits, and the decision to use them will depend on the patient's specific circumstances and the availability of a suitable cord blood unit or haploidentical donor.

Why Bone Marrow Transplant Done?

There are several reasons why a bone marrow transplant may be necessary. One of the most common reasons is to treat blood cancers such as:

• Leukemia
• Lymphoma
• Multiple myeloma
• Neuroblastoma
• Hodgkin's disease
• Solid tumors (in some cases)

Another reason for a bone marrow transplant is to treat inherited blood disorders such as:

• Sickle cell anemia
• Thalassemia

Bone marrow transplants can also be used to treat immune system disorders such as:

• Aplastic anemia

In addition to these medical reasons, bone marrow transplants are also used to treat genetic disorders such as:

• Fanconi anemia
• Lesch-Nyhan syndrome
• Bone marrow failure syndromes such as severe aplastic anemia and PNH
• Metabolic disorders such as Hurler's syndrome and Krabbe's disease
• Autoimmune diseases such as systemic lupus erythematosus and scleroderma

Risks

This medical procedure carries certain risks and potential complications. Some of the potential risks of a bone marrow transplant include:

1. Graft-versus-host disease (GVHD): This occurs when the donated cells attack the patient's own cells in case of allogeneic transplant. It can affect the skin, liver, and gut and can be severe or life-threatening in some cases.
2. Graft failure: This occurs when the donated cells do not engraft or grow properly in the patient's bone marrow. This can lead to a lack of blood cells and can be life-threatening.
3. Infections: Patients who have had a bone marrow transplant are at an increased risk of infections due to the suppression of their immune system. These infections can be serious and even life-threatening. So it is important to follow proper medications and routine.
4. Bleeding and blood clots: These can occur as a result of low blood cell counts or other complications.
5. Organ damage: Some of the preparatory treatments used before a transplant, such as chemotherapy and radiation, can cause damage to organs and tissues.
6. Cancer recurrence: In some cases, the cancer can return after a bone marrow transplant.
7. Secondary malignancy: Some of the treatments used before a transplant, such as chemotherapy and radiation, can increase the risk of developing a secondary cancer.
8. Death: Bone marrow transplants can be life-saving, but they also carry a risk of death.

Pretransplant Tests and Procedures

Before a bone marrow transplant (BMT) can take place, a series of tests and procedures are performed to ensure that the patient is a suitable candidate and to prepare them for the transplant. These pre-transplant tests and procedures are critical for the success of the transplant and for the patient's safety.

One of the first steps in the pre-transplant process is the evaluation of the patient's overall health. This includes a physical examination, blood tests, biopsy and imaging tests such as CT scans and MRI's to determine the stage of the disease and to identify any underlying health conditions that may affect the patient's ability to tolerate the transplant.

The next step is to find a suitable donor. For an allogeneic transplant, which uses stem cells from a donor, the patient's HLA (human leukocyte antigen) type must match the donor's. HLA is a protein found on the surface of cells that helps the immune system identify which cells belong in the body and which do not. The closer the match between the patient and the donor (sibling can be a perfect match), the better the chances of a successful transplant. If the patient has a family member who is a match, they will be the first choice for a donor. However, if no suitable family member is available, the patient may be added to the national bone marrow registry in search of an unrelated donor.

Once a suitable donor is found, the patient will undergo a series of tests to prepare for the transplant. These tests include blood tests, such as a complete blood count (CBC) and a coagulation panel to evaluate the patient's blood cell counts and clotting ability. Other tests, such as a chest x-ray, an ECG, and a pulmonary function and fitness test for organs like lungs, heart and kidney are done to check for any problems. Patients will also have a dental examination and any necessary dental work done before the transplant.

Patients will also undergo a psychological evaluation to ensure that they are mentally and emotionally prepared for the transplant and the recovery period. They will be educated about the transplant process and the potential risks and side effects.

Before the transplant, the patient will undergo a conditioning regimen, which is a series of treatments designed to prepare the patient's body for the transplant. This may include chemotherapy, radiation therapy, or a combination of both. The conditioning regimen is done to destroy any remaining cancer cells and to suppress the patient's immune system, making space for the new healthy cells.

After the conditioning regimen, the patient will be admitted to the hospital for the transplant. The donor's stem cells will be collected and then infused into the patient's bloodstream. This is done through a central venous catheter or a peripheral IV.

After BMT Procedure, Care and Medications

After a bone marrow transplant (BMT), patients will need to undergo a series of post-transplant tests, care, medications, and procedures to ensure the success of the transplant and to monitor for any potential complications.

One of the first steps in post-transplant care is to stay in isolation rooms and monitor the patient's vital signs, such as blood pressure, heart rate, and temperature, to ensure that they are stable. Blood tests, such as complete blood count (CBC) and coagulation panel, will also be done to monitor the patient's blood cell counts and clotting ability. Imaging tests, such as CT scans and MRI's may also be done to check for any signs of infection or rejection.

Patients will also need to take a number of medications after the transplant to help prevent infections and to manage any potential side effects. These medications may include antibiotics, antiviral drugs, and immunosuppressants.

To prevent and manage graft-versus-host disease (GVHD), a common complication of allogeneic transplants, patients will be given immunosuppressive drugs. They may also be given topical medications to help ease any skin rashes or other symptoms of GVHD.

Patients will also need to follow a strict hygiene routine to reduce the risk of infection. This may include frequent hand washing, taking care to avoid close contact with people who are sick, and avoiding crowded places.

Physical therapy and rehabilitation may also be necessary to help patients regain their strength and mobility after the transplant.

Cost of Bone Marrow Transplant in India

The cost of a Bone Marrow Transplant (BMT) in India can vary greatly depending on the type of transplant and the specific clinic or hospital. On average, the cost of an allogeneic BMT (using donated bone marrow) starts from $20,000 USD, while the cost of an autologous BMT (using the patient's own bone marrow) can be slightly lower, at around $16,000 USD. In India good BMT hospitals have special BMT units which provide isolation rooms to avoid infections to the patients. However, these figures should be considered approximate, as the cost of a BMT can also depend on factors such as the patient's overall health, the specific treatment plan, and the length of the hospital stay.

Additionally, it's worth noting that many clinics and hospitals in India offer package deals for BMTs, which can include the cost of the transplant itself, as well as pre- and post-transplant care, medications, and other related expenses. Furthermore, many patients choose to travel to India for a BMT because of the lower costs compared to other countries. However, it's important to keep in mind that while cost is certainly a factor to consider, the most important thing is to find a reputable clinic or hospital with experienced staff and a good track record of successful BMTs.