Bone Marrow Transplantation India

A part of bones called “bone marrow” create blood cells. Marrow is the soft, spongy tissue inside your bones. Bone marrow produces blood cells called “hematopoietic” stem cells. These cells will develop into many different kinds of cells. They can turn into more bone marrow cells. Or they can turn into any type of blood cell.

Certain cancers and different types of diseases keep hematopoietic stem cells from developing normally. If they’re not normal, neither are the blood cells that they make. A stem cell transplant provides you new stem cells. The new stem cells can make new, healthy blood cells. It creates the following parts of the blood.

1. Red Blood Cells: which carry oxygen and nutrients throughout the body.
2. White Blood Cells: which fight infection.
3. Platelets: which are responsible for the formation of clots.
   

Bone Marrow Transplant (BMT) is a special therapy for patients with certain cancers or other diseases. A Bone marrow transplant involves taking cells that are normally found in the bone marrow (stem cells), filtering those cells, and giving them back either to the donor (patient) or to another person. The goal of BMT is to transfuse healthy bone marrow cells into a person after his or her own unhealthy bone marrow has been treated to kill the abnormal cells.

A bone marrow transplant, also called a stem cell transplant, is a treatment for some types of cancer. For example, you might have one if you have leukemia, multiple myeloma, or some types of lymphoma. Doctors also treat some blood diseases with stem cell transplants.

A bone marrow transplant, also called a blood stem cell transplant or BMT, can treat many diseases. For some diseases, BMT is the only potential cure. There are over 70 diseases that can be treated by BMT. Some of them are listed here.

Patients undergo transplant for a wide variety of malignant and non-malignant conditions including:

Malignant conditions

Hematologic Malignancies

1. Acute lymphoblastic leukemia (ALL)
2. Acute myeloid leukemia (AML)
3. Chronic myeloid leukemia (CML)
4. Hodgkin’s Lymphoma
5. Non-Hodgkin’s Lymphoma

Solid Tumors

1. Neuroblastoma
2. Brain tumors
3. Ewing sarcoma
4. Rhabdomyosarcoma

Non-Malignant Conditions

Bone Marrow Failure Syndromes

1. Aplastic anemia
2. Fanconi Anemia

Hemoglobinopathies

1. Sickle cell anemia
2. Thalassemia

Primary Immune Deficiencies

1. Severe combined immunodeficiency syndrome (SCID)
2. Wiskott-Aldrich syndrome
3. Chronic Granulomatous Disease
4. Hemophagocytic Lymphohistiocytosis
5. Langerhans Cell Histiocytosis

The objective of a bone marrow transplant is to treat many diseases and types of cancer. When the doses of chemotherapy or radiation needed to treat a cancer are so high that a person’s bone marrow stem cells will be permanently harm or destroyed by the treatment, a bone marrow transplant may be needed. Bone marrow transplants may also be required if the bone marrow has been destroyed by a disease.

A bone marrow transplant can be used to:

1. Replace diseased, nonfunctioning bone marrow with healthy functioning bone marrow (for conditions such as leukemia, aplastic anemia, and sickle cell anemia).
   
2. Regenerate a new immune system that will fight existing or residual leukemia or other cancers not killed by the chemotherapy or radiation used in the transplant.
   
3. Replace the bone marrow and restore its normal function after high doses of chemotherapy and/or radiation are given to treat a malignancy. This process is often called rescue.
   
4. Replace bone marrow with genetically healthy functioning bone marrow to prevent more damage from a genetic disease process (such as Hurler’s syndrome and adrenoleukodystrophy).
   
5. The risks and benefits must be weighed in a thorough discussion with your healthcare provider and specialists in bone marrow transplants before the procedure.

There are certain conditions for which BMT is recommended.

Bone marrow transplants are performed when a person’s marrow isn’t healthy enough to function properly. This could be due to chronic infections, disease, or cancer treatments. A few purposes behind a bone marrow transplant include:

1. Damaged bone marrow due to chemotherapy.
2. Aplastic anemia, which is a disorder in which the marrow stops making new blood cells.
3. Thalassemia, which is an inherited blood disorder where the body makes an abnormal form of hemoglobin, an integral part of red blood cells.
4. Cancers that affect the marrow, such as leukemia, lymphoma, and multiple myeloma.
5. Sickle cell anemia, which is an inherited blood disorder that causes misshapen red blood cells.
6. Congenital neutropenia, which is an inherited disorder that causes recurring infections

Chemotherapy, Radiation therapy and other agents used in transplant can cause unpleasant side effects. The following are complications that may happen with a bone marrow transplant. However, each individual may experience symptoms differently. A number of steps are taken to minimize the risk of complications.

1. Type of Bone Marrow Transplant
2. Type of disease requiring transplant
3. Conditioning (preparative) regimen
4. Presence of other medical conditions
5. Age and overall health of the recipient
6. Variance of tissue matching between donor and recipient

Complications

Low platelets and low red blood cells: Thrombocytopenia (low platelets) and anemia (low red blood cells), as a result of a nonfunctioning bone marrow, can be dangerous and even life-threatening. Low platelets can cause dangerous bleeding in the lungs, gastrointestinal (GI) tract, and brain.

Infections: Infections are likely in the patient with severe bone marrow suppression. Bacterial infections are the most common. Viral and fungal infections can be life-threatening. Any infection can cause an extended hospital stay, prevent or delay engraftment, and/or cause permanent organ damage. Antibiotics, antifungal medicines, and antiviral medicines are often given to try to prevent serious infection in the immunosuppressed patient.

Pain: Pain related to mouth sores and gastrointestinal (GI) irritation is common. High doses of chemotherapy and radiation can cause severe mucositis (inflammation of the mouth and GI tract).

Fluid overload: Fluid overload is a complication that can lead to pneumonia, liver damage, and high blood pressure. The main reason for fluid overload is because the kidneys cannot keep up with the large amount of fluid being given in the form of intravenous (IV) medicines, nutrition, and blood products. The kidneys may also be damaged from disease, infection, chemotherapy, radiation, or antibiotics.

Respiratory distress: Respiratory status is an important function that may be compromised during transplant. Infection, inflammation of the airway, fluid overload, graft-versus-host disease, and bleeding are all potential life-threatening complications that may happen in the lungs and pulmonary system.

Organ damage: The liver and heart are important organs that may be damaged during the transplantation process. Temporary or permanent damage to the liver and heart may be caused by infection, graft-versus-host disease, high doses of chemotherapy and radiation, or fluid overload.

Graft failure: Failure of the graft (transplant) taking hold in the marrow is a potential complication. Graft failure may happen as a result of infection, recurrent disease, or if the stem cell count of the donated marrow was insufficient to cause engraftment.

Graft-versus-host disease: Graft-versus-host disease (GVHD) can be a serious and life-threatening complication of a bone marrow transplant. GVHD occurs when the donor’s immune system reacts against the recipient’s tissue. As opposed to an organ transplant where the patient’s immune system will attempt to reject only the transplanted organ, in GVHD the new or transplanted immune system can attack the entire patient and all of his or her organs. This is because the new cells do not recognize the tissues and organs of the recipient’s body as self. Over time and with the help of medicines to suppress the new immune system, it will begin to accept its new body and stop attacking it. The most common sites for GVHD are GI tract, liver, skin, and lungs.

What are the different types of BMT?

There are different types of bone marrow transplants depending on who the donor is. The different types of bone marrow transplant include the following:

Autologous transplant – uses your own blood-forming cells

Allogeneic transplant – uses blood-forming cells donated by someone else

1. Matched Sibling Donor Transplantation
2. Matched Unrelated Donor Transplantation
3. Haploidentical Family Donor Transplantation
4. Unrelated Cord Blood Transplantation

Stages of Bone Marrow Transplant