BMT (Bone Marrow Transplant)
Bone marrow Transplantation is a medical procedure done to replace damaged bone marrow with healthy bone marrow cells. Mostly, the stem cells are collected via peripheral vein. The whole procedure is like donating blood or platelet. The stem cells from the bone marrow are responsible for producing blood cells like white blood cells, red blood cells and platelets, which later are injected in a recipient after a short course of chemotherapy called as Conditioning.
The procedure is required for treating several cancerous and non-cancerous conditions like leukemia, multiple myeloma, thalassemia and several others. The procedure is extremely safe for the donor and the patient can return to normalcy within 6 months-1 year post successful transplant. The success of bone marrow transplant usually depends on a stage of disease, duration of disease and patient’s condition at the time of transplantation. With modern day medicines and technological advancements, one can expect a cure rate of 90% if BMT is performed at age of 3 years for thalassemia while it drops to 80% if done at the age of 7 years.
Sarvodaya Centre for Blood and Marrow transplantation is equipped to offer Autologous & Allogenic transplants using bone marrow, peripheral blood stem cells and cord blood stem cells for various benign and malignant disorders like Thalassemia, Aplastic Anaemia, Leukemia, Lymphomas, Multiple Myelomas and Advanced Pediatric Solid Tumors. The centre has an excellent team of doctors and support staff who is sensitized to special needs of the patients fighting blood related disorders. It also has very stringent infection control norms which are critical for BMT patients. Sarvodaya Hospital is designed with High-Efficiency Particulate Air filter (HEPA filter) for protective isolation so that risk of infections is minimized. We utilize Brachytherapy system for treating cancers and Flow Cytometry for cell counting and cell sorting.
PROCEDURES & SURGERIES
Q1 WHAT ARE THE TYPES OF BMT?
An interesting observation here is that the type of bone marrow used for transplant is different from the different types of BMT. There are two types of BMT:
Allogenic BMT: Donor and Recipient are two separate individuals and BMT is done using the stem cells of donor. It may be
- Matched Related, where donor is HLA matched relative usually a sibling.
- Matched Unrelated, where donor is not a relative of patient and usually found from one of the various national or international registries.
- Partially Matched Related, where donor is from a patient’s family but partially matched (haploidentocal).
Autologous BMT: Donor and Recipient are same individuals. BMT is done using the patient’s own stem cells. The procedure involves giving high dose chemotherapy to patient in order to remove primary disease. Thereafter, an autologous transplant is conducted to rescue damaged bone marrow. This type of transplant has minimal complication and is preferred for diseases like multiple myeloma.
Q2 STEPS OF TRANSPLANT TREATMENT
Although the experience during these phases may be quite different for each patient, a general overview is provided. There are three main phases to the BMT process, which will be reviewed here:
Transplant Treatment Process
For your transplant journey, the transplant process is divided into five steps to guide a patient. The steps begin with how to prepare for the journey and include what to expect along the way.
1. Preparation – The preparation phase begins when the patient arrives at the treatment centre and begins the process of medical evaluation, orientation, informed consent, and other preliminary activities like
- a. Complete discussion regarding the procedure and its complications
- b. Central Venous Catheter Evaluation and insertion
- c. Bone Marrow/Stem Cells Harvest
2. Conditioning – The conditioning phase begins the actual transplant process. Patient is admitted and during this phase, high-dose chemotherapy, radiation therapy, or both are initiated. Chemotherapy and radiation therapy are given in doses that obliterate the marrow function and result in the greatest possibility of destroying the disease.
3. Transplant – The transplant phase is actually short and involves the infusion of donor bone marrow or stem cells. After the conditioning regimen is completed, the patient receives the infusion of bone marrow or stem cells over half to one hour like blood transfusion.
4. Engraftment and Early Recovery – Approximately 10 to 28 days after transplant, signs that the new bone marrow or stem cells are engrafting (growing and developing) can be expected. Close monitoring will continue along with supportive care. Preparation for the return of the patient to the referring physician or centre will begin.
5. Long Term Recovery-The long term recovery phase involves leaving the treatment center,dealing with any ongoing clinical issues, and re-establishing life patterns. Patients need to follow up for long term complications of BMT.
Q3 WHO REQUIRES BMT?
BMT is required for conditions mentioned below:
- Multiple Myeloma
- Hodgkin Lymphoma
- Non-Hodgkin Lymphoma
- Acute Lymphoblastic leukemia (ALL)
- Acute Myeloid Leukemia (AML)
- Chronic Myeloid Leukemia (CML)
- Myelodysplastic syndrome
Non Cancerous Conditions
- Thalassemia, sickle cell anemia, transfusion dependent anemia
- Aplastic anemia
- Fanconi anemia, pure red cell aplasia
- Metabolic disorders
- Immunodeficiency states
Q4 IS BMT A SURGERY LIKE KIDNEY TRANSPLANT?
No, Bone Marrow Transplant is a medical procedure. Mostly, stem cells are collected via peripheral vein and the whole procedure is like donating blood or platelet. In some patients Bone marrow harvest is done which involves general anaesthesia to the donor.
Q5 ARE THERE ANY RISKS OF BONE MARROW TRANSPLANT?
Yes, Bone marrow transplant is a complex procedure that carries significant risks of serious complications.
Generally, the risks are reduced if:
- you are young – studies have shown the younger you are, the more likely the treatment is to succeed
- you receive stem cell donation from a sibling (brother or sister)
- you have no serious health conditions (apart from the condition you’re being treated for)
The major problem with stem cell transplants is the recipient’s ability to withstand high doses of chemotherapy (and sometimes radiotherapy), which are often needed before the transplant.
Q6 IS THERE ANY RISK TO DONOR? CAN DONOR GO BACK TO WORK AFTER PROCEDURE?
No, there are risks to donor. BMT is an extremely safe procedure for the donor; risk of complications being very small. Most of the times donor may have some bodyache which can be managed by paracetamol tablet alone. The main risks associated with a bone marrow transplant are discussed below:
1. Graft versus host disease
In some cases, the transplanted cells (graft cells) recognise the recipient’s cells as “foreign” and try to attack them. This is known as graft versus host disease (GvHD) and often occurs after stem cell transplantation. GvHD is the most common complication seen in Allogenic BMT. About 40% of the patients develop GvHD.
There are two types of GvHD:
- a. Acute GvHD usually occurs during the first three months following the transplant. It may involve skin (generalized rash or itching), Gut (diarrhoea or abdominal pain), liver (jaundice).
- b. Chronic GvHD can develop at any time between three months and two years after the transplant. The symptoms can persist or may come and go for many years. They can range in severity from mild to life-threatening. Patient can have dry eyes, joint pain, skin changes, breathing difficulty, difficulty in swallowing. It develops from acute GvHD and can cause symptoms for many years.
After having a bone marrow transplant, your risk of developing an infection will increase. This is because the conditioning you receive before the transplant will weaken your immune system. The risk of infection may be increased further if you need to take immune suppressants.
It’s very important to prevent infections developing. If you get an infection it could quickly develop into a more serious condition, such as a lung infection (pneumonia).
An ideal situation for the donor should be to stay near transplant centre for a week or so after transplant as patient may require platelet support from his donor.
Q7 WHAT IF MY PATIENT DOES NOT HAVE A MATCHED SIBLING?
If the patient does not have a matched sibling, the other options available are matched unrelated donor and partially matched sibling donor transplant. However, cost can significantly go up in matched unrelated donor transplant because of costs involved in procuring stem cells. Partially matched transplant is another option but it involves increased risk of GvHD and infections.