Everything That You Need to Know About Bone Marrow Transplant

Understanding Bone Marrow Transplant

Our body contains organs which are all made up of different types of cells. It needs different kinds of cells for its regular functioning and repair. Every day thousands of cells are made and an equal number of cells die out as well. To maintain this rhythmic balance of cell formation and death, the body needs to take help from stem cells. Stem cells are special types of cells which can give rise to new cells and also differentiate or mature into different types of cells as per the requirements of the body. Stem cells are available in multiple parts of the body at different times. For example; the lining of the stomach is a place of high activity, therefore, requires to be renewed every few days, stem cells in this region help create new cells for the digestive system (epithelial cells).  

The stem cells that turn into blood cells are called hematopoietic stem cells. These are found in the core of the big bones of the body (thigh bone/femur). Hematopoietic cells are formed in the bone marrow of these bones, and they later mature into different subtypes of blood cells.

Cancer and even cancer treatment in high doses often damage these hematopoietic stem cells. Once damaged, they cannot transform into RBCs - Red Blood Cells, WBCs - White Blood Cells and Platelets. 

• RBCs

RBCs take oxygen throughout the body and carbon dioxide to the lungs for exhalation.

• WBCs

WBCs fight the viruses and bacteria that can harm our bodies. WBCs are an essential part of our immune system.  

• Platelets

Platelets are needed to stop the bleeding by forming clots.

The soft spongy tissue in the body that stores the hematopoietic stem cells is called Bone Marrow, found at the ends of most long bones and also in flat bones. Sometimes, when a person is affected by a disease (e.g... Cancer) or some genetic condition, their bone marrow cells may not be able to produce enough blood cells or enzymes to fulfil the requirements of the body or the blood cells produced may be defective (Eg. Sickle Cell Anemia, Thalassemia). In such cases, the replacement of the affected bone marrow with healthy bone marrow cells can help improve the condition of the patient. This is called a bone marrow transplant (BMT).

Other times, in the case of certain immune disorders, BMT can be used as an alternative to conventional medical therapy for a lasting curative effect.

Bone Marrow Transplant is a methodology to transplant healthy stem cells into the bone marrow to restore the body's ability to create cells like red blood cells, white blood cells and platelets. Experts may also decide to transplant healthy stem cells into the blood. Visit Manipal Hospitals to learn more about Bone Marrow Transplant in Jaipur.

Ways to Carry Out Bone Marrow Transplant

Bone Marrow Transplant is carried out in two phases or major steps.

• Conditioning

In this phase, the patient's body is prepared for receiving a transplant. The affected bone marrow is treated with chemo, radiation or sero therapy to wipe out all infected cells from the bone marrow. Combination therapy may be prescribed by the doctor.

• Transplant

The patient receives a stem cell transplant, along with medication therapy to help the cells thrive in the new environment.

A Bone Marrow Transplant, also known as the Stem Cell Transplant, may use cells from the own body or a donor. A transfer from own body is known as an Autologous Transplant. In contrast, a transfer from a donor is called an Allogeneic Transplant.

The Bone Marrow Transplant is known to cure various lymphoma cancer types, such as Leukaemias (Cancer of the blood), and cancer of the lymphatic system. A Bone Marrow Transplant may also treat bone marrow diseases, like blood and immune system diseases. BMT can also prove to be a curative method of treatment in the case of –

• Common diseases are Leukemia (ALL, AML & CML), Lymphoma (Hodgkin & Non-Hodgkin), Thalassemia, Sickle Cell disease, Aplastic Anemia, Bone Marrow failure syndrome (e.g.: Fanconi), primary immune deficiency, Metabolic disease etc.      

• Rare cancer originating in white blood cells. It is called Waldenstrom Macroglobulinemia.

• Cancer develops in plasma cells, a type of white blood cell. It is called Multiple Myeloma.

• A disease that stops producing sufficient new blood cells. It is called Amyloid.

• A rare form of bone marrow cancer disrupting the production of blood cells. It is called Myelofibrosis.

• Abnormal growth of blood cells in the bone marrow. It is called Myeloproliferative Disorder.

• Developments of cells forming reproductive cells. It is called a Germ Cell Tumour.

• Cancer originates in bones and soft tissue. It is called Sarcoma.

Classifications of Bone Marrow Transplant

The two main kinds of Bone Marrow Transplants are:

Autologous Transplant

When the stem cells for transplant come from our own body, it is called an Autologous transplant. The stem cells and immune system are often damaged in cancer treatment using chemotherapy or radiation. Doctors may salvage your stem cells from bone marrow or blood before cancer treatment starts and restore them after the treatment.

The Autologous transplant helps the body retain its ability to produce the required blood cells and fight infections. Chances of transplant rejection are also reduced in this type of transplant.

Allogeneic Transplant 

When the stem cells for transplant come from a donor, it is called an Allogenic transplant. The patient receives the donor's stem cells after undergoing chemotherapy or radiation.

In most cases, the new stem cells identify and destroy the cancer cells remaining in the body, treating cancer. Consult with the Bone Marrow Transplant expert in Jaipur about the treatment procedures and the risks involved.

The donor's blood proteins, human leukocyte antigens (HLA), have to match yours for a donation to be possible. While the best match happens among blood relatives and or siblings that have the same set of parents, a match is possible from an unrelated donor as well. In case of a sub-par matching of blood proteins, there are chances of acquiring a severe side effect called graft-versus-Host Disease (GVHD), where the healthy cells attack your cells, mistaking them as intruders. 

In case a patient is unable to find a suitable donor, the other options available are:

• Umbilical Cord Blood Transplant

When the stem cells from the umbilical cord blood are transplanted, it is called Umbilical Cord Blood Transplant. The umbilical cord blood connects a fetus to the mother before birth. Modern facilities allow the storage of umbilical cord cells and blood. 

• Haploidentical or Mismatched Related Donor Transplant

Doctors often use cells from blood relatives like parents, children, and siblings that are not a perfect match yet offer a 50% resemblance.

How does a Bone Marrow Transplant Work? 

The process starts with conditioning for around ten days involving chemotherapy or radiation to burn the cells and make space for the new cells in your bone marrow. The method also weakens the immune system, allowing new cells to enter. There might be side effects like mouth sores, nausea, hair loss, breathing problems and vomiting. 

Once the new cells enter your bone marrow, they start engraftment, transforming into RBCs, WBCs and platelets. The transformation can take up to four weeks.

The doctors at Manipal Hospitals use a catheter to reduce the number of needle insertions, this is called Hickman Catheter. The doctors may also take a different approach based on the patient's condition and requirements.

Process of Autologous Transplant

1. The doctors collect your stem cells via your arm or chest veins after a few days of medication to increase your stem cells. A stem cell bank stores the stem cells.

2. Doctors administer a high dose of chemotherapy, serotherapy, or radiation for up to 10 days.

3. Doctors conduct infusions to transplant stem cells back into the bloodstream using a catheter. Each dose of insertion takes around thirty minutes.

4. Doctors monitor the growth of cells and take steps to reduce infections, including administering antibiotics.

Process of Allogenic Transplant

1. Doctors help the patient find the right match with a stem cell donor using blood testing for HLA type. A donor can be in the immediate family or from the volunteer donation registry.

2. The team of experts extract the stem cells from your donor. In case the cells are obtained from the bloodstream, the donor undergoes regular medications to boost WBCs before the extraction. However, if the extraction happens from bone marrow, the donor must encounter the bone marrow harvest in the hospital.

3. Doctors administer chemotherapy or radiation to create space for new cells.

4. Medical experts infuse the stem cells obtained from the donor into your bloodstream using a catheter.

5. The healthcare staff observes the patient for any symptoms or infections related to the transplant. Most patients undergo a course of antibiotics, antifungals, antivirals & blood product transfer.

Pre-Transplant Considerations

The doctors at Manipal Hospitals help the patients select the right course of treatment based on their current clinical state and diagnosis. The type of disease allows doctors to choose from an Autologous or Allogenic transplant. Several tests and examinations help choose a suitable donor for an allogeneic transplant. 

The entire team of experts, including a psychologist and insurance coordinator, helps the patients to prepare for the process. 

Recovery After Bone Marrow Transplant

Every patient has a unique recovery process and spends time in the hospital as per their condition and requirements. Doctors monitor the immune system and infections. They also identify the need for blood transfusion, if any.

• Engraftment Check

Doctors conduct frequent blood tests and may extract bone marrow samples to monitor engraftment for the first few weeks.

• Discharge

Once the patient meets the criteria of blood cell count and stable parameters, they may leave the hospital and stay in care. 

• Regular Checks

The patient needs to stay in regular check with the doctor and continue medications as the immune system takes up to a year to recover. Doctors also monitor patients for Graft-versus-Host Disease (GVHD).

• Nutrition

The nutrition experts at Manipal Hospitals create a nutrition plan as per the patient's requirements, and some standard guidelines are:

• Must avoid any food or drinks with a possibility of a foodborne illness.

• Regular consumption of multivitamins or supplements to meet the body's renewed requirements.

• The patient needs to restrict the usage of sodium and sugar if required.

• Patients need to avoid alcohol, smoking & any substance abuse. 

Doctors work with patients to gradually guide them in returning to everyday life. Some general guidelines are:

• As the skin is sensitive with treatment, direct sunlight exposure should be limited.

• Stay away from any body art or body piercing procedures to prevent infections via needles.

• Stay away from any tobacco consumption and passive smoking.

• Stay in a clean space that is free of dirt and moulds.

Signs of a Successful Transplant

There are two critical parameters for a successful transplant.

• Blood Count

When the count of RBCs, WBCs, and platelets in your blood returns to a safe level, the transplant is successful. The blood count drops after the transplant, and doctors often administer blood and platelet transfusions to stabilise the patient. A low blood count puts the patient at risk of infections.

• Control on Cancer

Having no signs of remaining cancer is the goal of a Bone Marrow Transplant. Doctors conduct frequent tests to observe any signs of cancer or other intricacies. These tests are an essential part of the recovery process.

Why Choose Manipal Hospitals?

Manipal Hospitals, Jaipur is the Bone Marrow Transplant Hospital in Jaipur, which offers a world-class facility for treating blood-related diseases under the supervision of India's leading medical experts. We are one of India's leading facilities for Bone Marrow Transplants, equipped with facilities to handle all emergencies and complexities.

Experts across departments provide options for patients to take multiple opinions. The doctors at Manipal Hospitals, Jaipur, conduct cross-department meetings to discuss the best treatment line for every patient. If you are looking for the best hospital in Jaipur for a bone marrow transplant, look no further than Manipal Hospitals, Jaipur.

Manipal Hospitals, Jaipur, offers the best bone marrow transplant services under the guidance of Dr. Satyendra Katewa. Dr. Katewa is a Consultant for Pediatric haematology-oncology and bone Marrow transplants at Manipal Hospitals, Jaipur. 

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