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Bone Marrow Transplant (BMT)

What is bone marrow?

A special soft, flexible, spongy, fatty tissue that houses stem cells and it is found inside a few large bones is called Bone marrow. In the bone marrow the development and storage of 95% of the body’s blood cells occurs. There are three kinds of blood cells:
  • White blood cells (Leucocytes)- These fight Infection
  • Red Blood Cells (Erythrocytes)- They carry oxygen to and are responsible for removal of waste products from different organs and tissues.
  • Platelets- It helps the blood to dot.

Why is a bone marrow transplant needed?

With the help of a bone marrow transplant surgeons are able to cure various diseases and cancer. When a person's bone marrow has been damaged or destroyed due to a disease or intense treatments of radiation or chemotherapy for cancer, this treatment modality may be adopted. A bone marrow transplant may be used to:
  • A non-functioning bone marrow is replaced with a healthy functioning bone marrow. Leukemia, Aplastic Anemia, and Sickle Cell Anemia conditions generally warrant this treatment.
  • To restore the bone marrow to its normal function when a high dose of chemotherapy or radiation is given to treat a malignancy by replacing the bone marrow. In diseases such as Lymphoma, Neuroblastoma and Breast Cancer this procedure may be done.
  • To prevent it from a genetic disease process such as Hurler's syndrome, and Adrenoleukodystrophy replacement of bone marrow.

What are the different types of bone marrow transplants?

Stem cells that are normally found in the bone marrow are taken out in Bone marrow transplantation (BMT), filtered, and given back either to the patient or to another person. Transfusion of healthy bone marrow cells into a person after their unhealthy bone marrow has been removed is the goal of BMT.

Depending on who the donor is there are different types of bone marrow transplants. The different types of bone marrow transplant include the following:
  • Autologous bone marrow transplant: As in this the donor is the patient him/herself this procedure is often termed as rescue rather than transplant Stem cells are taken from the patient either by bone marrow harvest or apheresis. During the procedure and then given back to the patient after intensive treatment.
  • Allogeneic bone marrow transplant: Stem cells are taken either by bone marrow harvest or apheresis from a genetically-matched donor, in this procedure generally a brother or sister or parent. When the donor is not a relative of the patient it can also be an unrelated bone marrow transplant but his cells match genetically with the patient.
  • Umbilical cord blood transplant: Stem cells are taken from an umbilical cord in this type of transplant immediately after delivery of an infant. Until they are ready to be transplanted these stem cells are than tested, typed, counted, and frozen.

Diagnosis

The diagnosis can be carried out with the help of following three methods:
  • Bone marrow aspiration: A small amount of tissue in liquid form is extracted in it for examination.
  • Bone marrow biopsy: Soft tissue known as marrow is removed from inside the bone.
  • Bone marrow culture: The soft, fatty tissue found inside certain bones is examined in this procedure. Any infection inside the bone marrow is tested with this examination.

Preparing for the Bone Marrow Transplant

Age, general physical condition, the patient's diagnosis and the stage of the disease are the major factors which determine if the transplant is to be carried out or not. To undergo the severity of the transplant procedure the patient has to be healthy enough. Before the transplant is done to ensure the patient is physically capable of undergoing a transplant a series of tests are carried out. To develop a patient "baseline" Tests of various organs like heart, lung, kidney and other vital organ functions are also used. to determine if any body functions have been impaired post-transplant tests can be compared against this baseline. To determine the extent of the match along with the test of the recipient the test of the donor are also carried out related to their health, exposure to viruses, and complete genetic analysis.

If the donor is other than the patient himself/ herself most importantly than the donor and the recipient are matched. Matching involves typing more than hundred human leukocyte Antigen (HLA) tissues. If more antigens are matched the engraftment of donated marrow is better.

Bone Marrow Harvest

The procedure of collection of the marrow (which a thick, red liquid) from the bone is called Bone marrow harvest, it is regardless of whether the patient or a donor provides the bone marrow. As it involves nominal discomfort it is carried out under general anesthesia. A needle is inserted into the cavity of the rear hip bone or "iliac crest" to extract the marrow where a large quantity of bone marrow is located. Skin punctures are there only where the needle was inserted & there are no stitches or surgical incisions involved. The size of the patient and the concentration of bone marrow cells in the donor's blood determine the amount of marrow to be harvested.

The Bone Marrow Transplant Procedure

A day or two following the chemotherapy and/or radiation treatment the main transplant procedure occurs. The infusion of bone marrow into the patient is done intravenously i.e. in the same way in which any blood product is given to a patient. The transplant does not require to be carried out in an operating room as it is not a surgical procedure. The patients are checked frequently for signs of fever, chills, hives and chest pains during the bone marrow infusion.

Engraftment

2-4 weeks period after the transplant is the most critical time. The patient's bone marrow is sometimes destroyed crippling the body's "immune" or defense system by the high-dose chemotherapy/ radiotherapy given to the patient during conditioning. Thus the patient will be very susceptible to infection and excessive bleeding till the time the transplanted bone marrow migrates to the cavities of the large bones, set up housekeeping or "engraft," and start producing normal blood cells. To help prevent and fight infection the patient is thus kept on multiple antibiotics and blood transfusions. To prevent bleeding Transfusions of platelets are also done. To prevent and control graft-versus-host disease allogeneic patients are given additional medications. Extraordinary precautions will have to be taken till the time complete engraftment occurs to minimize the patient's exposure to viruses and bacteria.

The patient will slowly be taken off the antibiotics, once the infused bone marrow finally engrafts and begins producing normal blood cells, and blood and platelet transfusions would also be stopped. Typically a Bone Marrow Transplant patient spends four to eight weeks in the hospital

Recovery

In order to function normally the new bone marrow normally takes almost a year. To identify any infections or complications during this period the patient is to be monitored closely. After discharging from the hospital the recovery process continues for several months or longer, during which time the patient cannot return to work or many previously enjoyed activities.

Home Care

The most important lookout once the patient is discharged from hospital is preventing infections after Bone Marrow Transplant. Patient is more prone to catch infection as the immune system is weak after the transplant. It is important to include regular hand washing, preventing direct contact with items outside the house, prevention from any sort of respiratory or other infection and other high levels of hygiene in ADLs.

Risks

The risk involved in bone marrow transplants may be higher or lower depending on factors like disease, treatment, age, health status etc. the different complications that may occur are:
  • Infection
  • Bleeding from intestines, lungs, bran or any other body part.
  • Anemia and weakness.
  • Diarrhea, vomiting, and nausea
  • Pain
  • Inflammation and discomfort in the mouth, throat, esophagus, and stomach
  • Cataracts
  • Premature menopause
  • Graft failure, which means that the new cells do not settle properly into the body and so not produce stem cells
  • Graft-versus-host disease: I.e. when the donor’s cells attack the recipients body.
  • Children getting transplants may have deferred growth.
Bone Marrow Transplant Package

Inclusions

  • Airport Pick-up and Drop
  • Hospital Stay in a Private Room as indicated above. One attendant can stay with the patient.
  • Nursing & Diet charges.
  • Routine lab tests
  • Admitting Consultant's visit charges
  • Surgeon’s Fees and OT Charges

Exclusions

  • Hospital stay after the said period.
  • Visit charges after the said period.
  • Cross consultations, if any.
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