Bone marrow is the soft, spongy tissue located inside the bones which produces the blood cells: red and white blood cells and platelets. The marrow also contains unspecialized Hematopoietic Stem Cells. These cells can turn into many other types of cells such as bone marrow cells or any type of blood cells. Some cancers can prevent these stem cells from developing normally.
Bone Marrow Transplantation (BMT) is one of the complex medical procedures that are performed to treat both the benign and malignant disorders of the blood, when the marrow is incapable of functioning properly. This can be due to chronic infections or cancer treatments like chemotherapy.
Fortis Hospitals is one of the top leukaemia cancer treatment hospitals in India and they take every precaution to ensure effective treatments and perform complex medical procedures in a way that entails the least risk possible for the patients. However, there is still a certain degree of risk involved.
Historically, the stem cells used in this process was collected from the bone marrow. But, now they are collected from the peripheral blood. So, BMT is more aptly referred to as Hematopoietic Stem Cell Transplantation. Contrary to popular perception, there is no painful surgery involved. Basically, the doctors collect the stem cells from donor and after conditioning chemotherapy, where the diseased bone marrow cells are destroyed, they are transfused back into the recipient.
Fortis Hospitals is the top hematology care hospital in Bangalore and constantly endeavours to provide the best possible medical care to its patients. By ensuring that it continually looks into the welfare of the patients and aiming to perform complex surgeries such as bone marrow transplantation and other surgical procedures flawlessly through its dedicated and experienced doctors, it is now known as one of the best blood cancer treatment hospitals in India.
There are mainly two types of BMT:
- Autologous Bone Marrow Transplant: The source of the stem cells is the patient themselves. The stem cells are harvested, or removed, before the patient receives high-dose chemotherapy or radiation treatment which will destroy the bone marrow. After the treatment, the cells are returned to the body to make normal blood cells. The advantage of this method is that there are no adverse effects on immunity since the person’s own cells are returned and there are no foreign agents involved. However, this method can be used only if the person has a healthy bone marrow.
- Allogeneic Bone Marrow Transplant: In this case, the stem cells are collected from another person called the donor. The donor must be a close genetic match. This is further divided into Matched Sibling Donor Stem Cell Transplantation wherein the patient’s own sibling gives the stem cells. Another way is Unrelated Stem Cell Transplantation, where the donor is an unrelated person. Since our country does not have a robust donor registry, sometimes a Half-Match or Haploidentical transplant is also carried out where the HLA is not identical, but half-matched.
Steps Involved In a Bone Marrow Transplant
Fortis Hospitals is one of the best bone marrow transplant centres in India equipped with state-of-the-art infrastructure and qualified doctors for performing complex surgeries and treatments. First, the condition of the patient is ascertained through Pre-Transplantation Assessment. Since BMT is a very intense medical treatment, the patient is first checked to verify whether he/she is fit enough to undergo the treatment. The condition of the heart and lungs, whether the patient has any focus of infection, etc. are determined. There are a number of blood tests and different departmental consults involved in this assessment. Once the Pre-Transplantation Assessment is done and the patient is deemed fit for transplantation, only then are the subsequent procedures carried out.
Some basic questions and answers about BMT are as follows:
- What happens after the stem cells have been transplanted to the patient?
BMT is a very complicated and intensive treatment. The doctor briefs the patient and the caregivers thoroughly regarding this procedure. The patient is given treatment to control the disease which may be refractory or relapsed as much as possible. This is called Salvage Therapy in Lymphomas. After this the patient is taken to a highly sterile ward where they will be given conditioning chemotherapy to destroy the abnormalities in the bone marrow. The stem cells are then collected from a healthy related or an unrelated donor and are infused back into the patient. It may take about 3-4 weeks for those stem cells to go into the bone marrow and start making blood cells. During this period, the patient is kept under strict surveillance for any infections or complications. Once the patient is stable, walking around and orally consuming food, he/she is discharged from the ward. The doctor maintains a close watch on the patient for about 60-90 days after the patient is discharged. This is because, the first hundred days after the transplant are very critical.
- What are the possible side-effects of BMT?
BMT toxicities can be classified into short-term and long-term toxicities. Short-term toxicities can be a result of the chemotherapy and include nausea, vomiting, ulcers in the mouth, severe pain, inability to taste food, loss of appetite, weight loss, diarrhoea and other fungal and viral infections. But then, there are adequate medications to take the patients safely through the critical period.
In the long-term, in allogeneic transplantation, the stem cells can mount an immune attack in some cases. This is called Graft-versus-host disease (GVHD). In rare cases, it may affect their lungs, heart etc. But with each passing year, the Transplant-Related Mortality (TRM) has decreased from 30%-40% historically to 10%-20% in recent years.