What is Bone Marrow Transplant?

Bone marrow is an essential spongy, fatty tissue substance present inside the bones of the human body. It produces the blood-forming cells in the human body that include :

• Red blood cells that carry oxygen and essential nutrients throughout the body
• White blood cells that protect our body from any infections
• Platelets for blood clot formation to prevent excessive blood loss during injury.

Apart from these cells, the bone marrow also contains hematopoietic stem cells (HSC) which are unspecialized and immature stem cells that have the ability to divide and become either the stem cell or differentiate and mature into other different kinds of blood cells.

Bone marrow cells start to malfunction as a result of diseases like leukemia, aplastic anemia, cancers, or other immune deficiency disorders and start yielding defective or abnormal blood cells that affect the normal functioning of the human body.

Bone marrow transplant is required when the bone marrow in the human body is not healthy enough to perform its normal function which can be due to any disease, chronic infections, or aggressive cancer treatments.

Some of the common reasons to undergo bone marrow transplant include:

• Cancers like leukemia, lymphoma, and multiple myeloma that affect the bone marrow cells.
• Aplastic anemia in which the bone marrow stops producing new blood cells.
• Inherited blood disorders like sickle cell anemia and thalassemia
• Congenital neutropenia resulting in recurrent infections
• Damage to bone marrow due to aggressive chemotherapy etc.
• Bone Marrow Transplant is a major and complex procedure and requires thorough and meticulous planning and forethought.

Bone marrow transplant is of two types:

Allogeneic bone marrow transplant: When the donor is some other person whose tissue has the same genetic type as the patient, the bone marrow transplant is termed as allogeneic transplant. The donor is most likely to be a brother or sister of the patient. However, it is only in 35% of the cases that a sibling’s marrow is a perfect match.

Autologous bone marrow transplant: When healthy stem cells are taken from the patient’s own body and replaced with diseased blood cells, the procedure is termed as autologous bone marrow transplant.

When is a Bone Marrow Transplant Required?

Bone Marrow Transplant is a complex and major procedure. There are risks and complications associated with the procedure and the procedure is thus recommended to select few patients when other treatments have failed.

Bone Marrow Transplant is recommended if other treatments are not working and there is a higher risk of the condition returning without the transplant and if the physician feels that the benefits of the transplant outweigh the risks associated with the procedure. The best candidates for bone marrow transplant are those in otherwise good health and have stem cells available from a sibling, or another family member.

How is a Bone Marrow Transplant done?

The procedure needs meticulous planning and the surgeon thoroughly assesses the patient to make sure that he/she is healthy enough to survive and accept the transplant. For this, a series of tests are done to assess the patient’s vital organs like heart, lungs, kidneys, and liver to ensure the patient is physically capable of accepting the transplant.

If the surgeon thinks that a transplant can be done, he proceeds with harvesting of stem cells.

Harvesting stem cells:

If the patient is undergoing an allogeneic transplant, bone marrow is harvested from the donor one or two days prior to the transplant procedure. The stem cells are collected in two ways:

• Bone marrow harvesting: The donor is given general anesthesia and the cells are collected using a needle from the rear part of the hip bone or the iliac crest where the stem cells are located in abundance.
• Leukapheresis: This is done in cases of autologous transplant in which the blood is drawn intravenously from the patient’s body and the machine is used that separates the white blood cells containing stem cells from the blood.

Preoperative regimen:

Before the transplant, the patient undergoes chemotherapy or radiation therapy to kill the cancerous cells and to make room for the new bone marrow cells often known as conditioning of the patient.

Stem cell transplant:

For transplant, the central venous catheter or a port is installed on the upper right portion of the chest wall of the patient and the new stem cells are infused through this port that helps them to flow directly to your heart from where they are dispersed all over the body through the blood. Gradually the cells become established in the bone marrow to grow.

Engraftment:

The post is kept at the same place as the infusion is done in multiple sessions that aid the new stem cells to integrate into the body. This process is known as engraftment. The patient receives the blood transfusion, fluids, antibiotics, and platelet transfusion through this port so as to fight the infection and to help your body accept the new marrow.

Monitoring for complications:

After the infusion, you will be closely monitored for any signs of complications or rejection. Precautions are taken to prevent any infections. The patient is constantly monitored to check if engraftment has occurred or not and to monitor organ function. Once the healthy bone marrow begins to produce normal cells, transfusion is stopped.

What is the Recovery after Bone Marrow Transplant like?

Recovery after a bone marrow transplant is a long and stressful process for both the patient and the family. The initial few weeks are very critical as there are high chances of complications and rejections of the transplant.

But, subsequently, the patient starts to feel better as the blood count begins to grow and his immune system becomes stronger. Full recovery may take up to a year or two.

You shall need a total of 16-18 weeks for a bone marrow transplant in India after which you can fly back to your country.