Bone Marrow Transplant

What is a bone marrow transplant?

A bone marrow transplant is a long medical treatment for people with particular diseases. The procedure seeks to replace diseased bone marrow with a healthy one. 

During a bone marrow transplant, your doctor will conduct various examinations and tests to evaluate your general health. The medical team will harvest stem cells from bone marrow, blood, or umbilical cord for storage before transplantation.

You will be subjected to conditioning treatment that may involve the use of radiotherapy or chemotherapy in high doses. Transplanting involves passing the stem cells into your body via a central line.

Transplanting treats various immune and blood diseases. It is also necessary for patients diagnosed with myeloma, leukemia, and other forms of cancer. 

During a bone marrow transplant, your doctor can use cells harvested from your body. If this is not possible, you would need healthy blood cells to form a door. This is usually a sibling, relative, or a match from the national donor list.  

What is bone marrow?

Bone marrow refers to the spongy and soft tissues situated at the center of the bones, particularly the thigh and hip bones. Most of your blood cells are manufactured and stored. 

Stem cells are the immature cells within the bone marrow. Eventually, they develop into white blood cells, platelets, or blood cells. 

Why do you need a bone marrow transplant?

If you have any of the following diseases, you will benefit from a bone marrow transplant:

• Aplastic anemia

• Acute leukemia

• Hodgkin’s lymphoma

• Multiple myeloma

• Chronic leukemia

• Immune deficiencies 

• Neuroblastoma

• Plasma cell disorders

• Brain tumors

• Sarcoma

• Bone marrow failure syndrome 

Types of bone marrow transplants 

Bone marrow transplant can be one of four kinds: 

Allogeneic 

In this type of bone marrow transplant, you require a donor to provide the stem cells.

Your doctor will conduct special tests to determine if you and the donor are a good match. Most donors are family, usually siblings or parents.

You can get a matching donor from the national bone marrow registry even though you share no blood.  

Autologous 

In this type of bone marrow transplant, you are the source of the stem cells. If you are suffering from certain forms of cancer, your oncologist may prescribe an intensive treatment of radiotherapy or chemotherapy at very high doses.

Such kind of treatment is hostile to your immune system and stem cells. Therefore, doctors opt to remove stem cells from your bone marrow prior to the commencement of cancer treatment.

Once radiotherapy or chemotherapy is completed, the doctors will return the stem cells to your body. Your body manufactures blood cells once more, and the immunity improves. 

Haploidentical transplant- It is similar to an allogeneic transplant, but a total match between your stem cells and those of the donor. Stems cells of a parent are a 50% match for those of their children, and vice versa.

Siblings are usually a half-match for each other. A haploidentical transplant encompasses special treatments to minimize the risk of complications owing to the incomplete match.   

Umbilical cord blood transplant  

This bone marrow transplant involves extracting stem cells from cold blood at birth. Such cells are frozen and stored in readiness for a transplant.  

Benefits 

A bone marrow transplant comes with the following benefits:

• It is a cure for certain diseases – Some diseases like lymphoma and leukemia are difficult to treat. Bone marrow transplant offers hope to patients with such diseases

• Long-term survival – The survival rate after a bone marrow transplant is high. Most people resume their normal activities after the procedure

• Improved immune function – Replacing diseased bone marrow with healthy one results in improved overall health and better immune function

Risks

A bone marrow transplant carries certain health risks for the recipient. Risks differ from person to person depending on your age, the transplant in question, the disease leading to a transplant, and overall health.

Certain complications can be life-threatening. Some risks associated with a bone marrow transplant include:

• Graft-versus-host disease (GVHD) -This happens when the donor’s immune system fights the recipient’s stem cells because they are foreign. GVHD can be life-threatening

• Infection – People who have a bone marrow transplant have a very weak immune system and are prone to infections

• Side effects – You are likely to experience hair loss, nausea, fatigue, and vomiting. These are the side effects of radiotherapy or chemotherapy administered as part of a bone marrow transplant

• Relapse – The condition that required a bone marrow transplant may return after the procedure

• Failure to graft – In case the recipient’s body rejects the donor cells, the stem cell transplant will fail

While a bone marrow transplant carries several risks, the benefits associated with the procedure outweigh such disadvantages. 

Complications

A bone marrow transplant can also manifest in the following complications:

• Infections – In case of severe bone marrow suppression, you may get bacterial, fungal, or viral infections. This will hinder engraftment

• Stay in the hospital will be longer. Infections can cause permanent organ damage. Your doctor will prescribe medication to treat such infections

• Pain – High doses of radiation and chemotherapy may lead to severe inflammation of the gastrointestinal (GI) tract and month

• Fluid overload – Fluid overload may lead to high blood pressure and pneumonia. It can also cause liver damage. You will receive nutrition, medicines, and blood products via a central line during transplanting

• Your kidney may not cope with such large amounts of fluids, leading to fluid overload. Radiation, antibiotics, and infections can also cause kidney damage 

• Graft failure – This could be due to recurrent disease or infection. Also, in case the donated marrow has inadequate stem cell count, this may lead to engraftment

• Anemia and thrombocytopenia – Low blood cells and low platelet count (thrombocytopenia) could happen if the bone marrow is not functioning properly. It can lead to severe bleeding in the brain, lungs, and GI tract

• Respiratory distress – A bone marrow transplant can compromise your respiratory systems through fluid overload, infection, or bleeding.   

Explore the benefits and risks of a bone marrow transplant with a bone marrow transplant specialist before the procedure so that you can plan for proper care.  

Preparing for a bone marrow transplant

Tests and examination

Your doctor will recommend a battery of examinations and tests to determine whether you are fit enough to withstand the procedure. 

If you are not in good health condition, this might lead to complications after a bone marrow transplant.

Some tests that your doctor might ask for are as follows:

• An echocardiogram – To check the state of blood vessels and the heart 

• Computerized tomography (CT) scan – To check the state of the liver, lungs, and other organs

• Electrocardiogram (ECG) – To determine your heart’s electrical activity and rhythm 

• Blood work – To determine the functionality of your kidneys and liver. The test also checks your blood levels

• COVID-19 test – You will need to be tested for coronavirus and your donor as well. In case either of the tests comes out positive, your doctor may decide to delay the procedure

• Persons who have been diagnosed with cancer will also require a bone marrow biopsy. This entails removing a small sample of the cancerous cells for analysis

• A biopsy reveals if the cancer is in remission or whether it might recur after a bone marrow transplant

• Your transplant team will implant a central line (an intravenous catheter) into one of the large veins in your neck or chest

The central line remains implanted to allow for the entry of medication and harvested stem cells into the body.   

Collecting stem cells

Stem cells can be collected in one of three ways:

• From bone marrow – You will undergo a procedure so that the transplant can remove the sample of bone marrow

• From blood – The transplant team uses a special machine to extract stem cells from your blood

• Cord blood stem cells can also be harvested for a newborn’s umbilical cord or placenta

If you are undergoing chemotherapy or radiotherapy to treat cancer, your transplant team can remove stem cells from your bone marrow or blood.

Such stem cells are transplanted once the cancerous cells are gotten rid of. The transplant team may also rely on bone marrow or a donor as the source of stem cells.

Stem cells are primarily collected by temporarily removing blood from your boy. The circulating stem cells are separated from the rest of the blood and thereafter blood is returned to the body.

The transplant team may give medication to boost the production of stem cells a few days before the procedure.

The team will also conduct a blood test to determine the levels of stem cells after stimulation.

Once the medical team ascertains you have sufficient stem cells, they will connect your veins to a cell separator machine via tubes.

Blood is pumped from one arm to the cell separator machine via a filter. The filtered blood is pumped back to your body via another arm.

The procedure takes about 3-4 hours and is not painful.

You will be awake during the entire process.          

The transplant team may also collect stem cells from a bone marrow sample from your hip bone. 

The procedure is performed under general anesthesia, and a needle and syringe are needed.

Conditioning

During the conditioning process, you will receive radiotherapy or chemotherapy treatment at high doses before the transplant. Conditioning helps to:

• Destroys all cancer cells

• Create rooms for stem cells being transplanted by eliminating existing bone marrow cells

• Pausing your immune system to minimize the risk of a failed transplant

Conditioning takes 1-2 weeks. The transplant team will inject different medicines via a central line.

You may experience certain side effects during conditions:

• Hair loss

• Infection

• Anemia

• Nausea and vomiting

• Bleeding

• Mouth sores

• Fatigue 

You need not worry as these are temporary symptoms that will clear once the conditioning treatment is over. 

Make sure you have explored the risk of conditioning with your healthcare team at length before the procedure.

Your bone marrow transplant team may recommend lower doses of conditioning depending on your overall health and age.

Transplant

The transplant takes place a few days following the completion of conditioning. The transplant team passes the new stem cells into your body via a central line.

The procedure takes a few hours. The new stem cells mature into white blood cells, platelets, and red blood cells through the engraftment process. 

It takes between 2 and 4 weeks before the new cells can mature.

During infusion, you are likely to present with the following symptoms:

• Fever/chills

• Chest pain

After the procedure

After a bone marrow transplant, you will remain in the medical center or hospital unit that specialize in treating such a condition for a few weeks.

This is to allow for the settling of stem cells in your bone marrow and promote the manufacturing of new blood cells. It also minimizes your risk of infection.

Your length of stay in the medical center or hospital will be determined by:

• Type of transplant

• Tests and procedures administered

• Whether the transplant had any complications

The healthcare team will be on standby to monitor your vital signs and blood count.

Your doctor will prescribe medication to prevent infections and GVHD.

You will get a blood transfusion if the transplant team ascertains you require one. You will continue medication and nutrition intravenously until mouth sores have cleared.

Recovery

You may go home once your doctor has established you are out of risk and that there are no complications after the transplant. You will undergo the following as part of your recovery:

• Regular blood transfusions to increase your platelet and red blood cells

• You may experience a loss of appetite, feel weak, or diarrhea

• You remain at risk of infections for up to 12 months as your immunity has not regained its full strength

• Your healthcare team will advise you to wear protective clothing or stay in a room free of germs to prevent infections

• If the stem cells are from a donor, your doctor will prescribe immunosuppressants. These drugs ensure your body does not attack the transplanted cells 

You will be referred to a dietician to develop a diet plan that works for you. Your dietician may advise you to:

• Take supplements or multivitamins 

• Avoid alcohol

• Stay away from drinks and foods that would increase the risk of food-borne illness

Your doctor may also recommend the following lifestyle changes:

• Avoid tattoos or body piercing

• Stop smoking

• Avoid direct sunlight

• Improve your oral hygiene to prevent cavities

• Ensure your home is free of mold

Cost of bone marrow transplant in India   

A bone marrow transplant in India ranges between Rs. 12,15,000 and Rs. 53,00,000. 

Several factors account for this wide variation in cost: 

Pre-transplant tests and assessments – Your doctor will order various tests and assessments to establish if you can undergo a transplant and the most suitable type of transplant. 

Type of bone marrow transplant – The cost of an autologous bone marrow transplant is less than that of allogenic bone marrow transplant. In the case of an unrelated donor, the cost is even higher.

Surgical procedures – the cost of transplanting stem cells differs from one state to another based on your duration of stay in a healthcare facility and type of healthcare facility. The type of transplant also determines surgical procedures and their costs. 

Hospital location – Healthcare facilities in Indian metro cities is higher than that of neighboring towns due to the higher running costs in metros, including high doctor’s fee.

Post-transplant care – You will receive ongoing care after transplant to reduce the risk of complications. 

Your doctor will prescribe certain medications to reduce nausea, diarrhea, and other symptoms.  

Periodic transfusions and ongoing monitoring post-transplant will also increase the overall cost of the procedure.  

References

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