Hemato Oncology

Department of Hemato Oncology

What is Bone Marrow Transplant?

Bone marrow transplantation is a procedure wherein stem cells from bone marrow that produce various blood cells like red blood cells, white blood cells and platelets are injected into a recipient after a short course of chemotherapy called conditioning. These stem cells are also referred to as hematopoietic stem cells. Nowadays, hematopoietic stem cells may also be obtained from peripheral blood after treatment with certain growth factors or from umbilical cord. Thus, the term “Hematopoietic stem cell transplantation” is now preferred to “Bone marrow transplantation” to include these other sources of hematopoietic stem cells.

What are the types of BMT?

The type of bone marrow that is used for the transplant distinguishes the different types of BMT.

- Autologous BMT is done by using the patient's own stem cells.

- Allogeneic BMT involves using the stem cells of a donor. It may be

    • matched related , where donor is HLA matched relative, usually sibling
    • matched unrelated where donor is not a relative of a patient and usually found from one of the various national or international registries.
    • Partially matched related – donor is from patient’s family but partially matched (haploidentical)

Who requires BMT?

Conditions for which hematopoietic stem cell transplant is offered.

1.  Non Cancerous Conditions:

    • Thalassemia, sickle cell anemia, transfusion dependent anemia
    • Aplastic anemia
    • Fanconi anemia, pure red cell aplasia
    • Metabolic disorders
    • Immunodeficiency states

2.  Blood cancers

    • Multiple Myeloma
    • Hodgkin Lymphoma
    • Non-Hodgkin Lymphoma
    • Acute Lymphoblastic leukemia (ALL)
    • Acute Myeloid Leukemia (AML)
    • Chronic Myeloid Leukemia (CML)
    • Myelodysplastic syndrome.

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.

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.

The main risks associated with a bone marrow transplant are discussed below.

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:

Acute GvHD

Acute GvHD – which 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)

Chronic GvHD

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

2. Infection

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).

What are the chances of success after BMT?

This usually depends on diseases. For autologous BMT, success rates are close to 90%. For thalassemia success rates are >80%.

Can donor go back to work after procedure?

Ideally donor should stay near transplant centre for a week or so after transplant as patient may require platelet support from his donor.

Will patient ever lead a normal life?

Yes, patient can return to his normal routine in 6 months – 1 year post successful transplant. However, he needs to follow up with transplant centre as advised.

What about post BMT follow up?

It depends upon the disease and type of transplant whether autologous or allogenic. In case of autologous transplant, patient needs to follow up for around 1-2 months, whereas in Allogenic transplant at least 3 months follow up is necessary. In case patient develops any complications a longer follow up is required

What is special about BMT at Action cancer Hospital?

    • The Centre is equipped with ultra modern infra structure and internationally trained widely experienced faculty.
    • Team of trained and dedicated BMT nurses.
    • Large spacious rooms with High Efficiency Particulate Air filter (HEPA filter) with positive pressure for protective isolation so that risk of infections is minimised.
    • Medical and paediatric Intensive care unit with isolation beds.
    • Round the clock services for blood components.
    • Day Care facility for outpatient chemotherapy/ Immunotherapy/ blood transfusions.
    • Gamut of support services
    • Excellent administrative services like appointment, billing and admissions are managed by dedicated standalone teams.