Bone Marrow or Stem Cell Transplant

Bone Marrow Transplant: Types, Risk Factors & Facts | Doctors in India

A BMT or a Stem Cell Transplant, at its most basic level, is a potentially lifesaving procedure. It involves the destruction of any unhealthy blood cells and replacement with stem cells removed from the blood or bone marrow. These new healthy stem cells can then make new and healthy blood cells.

Stem Cells are special cells that are produced by the bone marrow – a spongy, gelatinous tissue found in the center of some bones. These stem cells can replicate itself or differentiate into many different types of blood cells – white blood cells which fight infection, red blood cells which carry oxygen and platelets with aid in blood clotting. 

What Diseases/conditions are typically treated with Bone Marrow or Stem Cell Transplant?

Bone Marrow or Stem Cell Transplant is generally used to treat diseases of the blood, the immune system, or genetic disorders. It can replace unhealthy blood-forming cells with healthy ones, or it can replenish blood-forming cells if chemotherapy and radiation therapy destroy them. 

The diseases and disorders treated with bone marrow transplant include: 

  • Leukemias – Acute Myelogenous Leukemia (AML), Acute Lymphoblastic Leukemia (ALL), Chronic Myelogenous Leukemia (CML), Chronic Lymphocytic Leukaemia (CLL)
  • Lymphomas – Hodgkin and Non-Hodgkin Lymphoma
  • Multiple Myeloma and other Plasma Cell Disorders
  • Myelodysplastic Syndromes – Refractory Anaemia, Refractory Anaemia with Excess Blasts, Refractory Cytopenias etc. 
  • Thalassemia Major
  • Severe Aplastic Anaemia 
  • Inherited Immune System Disorders
  • Inherited Metabolic Disorders

Different Types of Bone Marrow Transplant:- Depending on the donor of the stem cells, a BMT or a Stem Cell Transplant is of the following types: 

  • Autologous Transplant – the patient donates his/ her own stem cells prior to the treatment for reinfusion later
  • Allogeneic Related Transplant – the person donating the stem cells is a biologically-related family member (usually a brother or sister)
  • Allogeneic Unrelated Transplant – the person donating the stem cells is not related to the patient but has been adequately tissue-matched
  • Syngeneic Transplant – the person donating the stem cells is an identical twin. 

What Does a Bone Marrow or Stem Cell Transplant Involve?

A BMT can be an intensive and a challenging experience – the patient would need to stay in the hospital for a month or more until the transplant starts to take effect and it can take a year or two to fully recover. 

A BMT is a long and complicated process that involves five main stages: 

  • Tests & Examinations – to assess the general level of health of the patient The tests might include an Electrocardiogram (ECG), an Echocardiogram, an X-Ray, a CT Scan and a Complete Blood Count (CBC).
  • Harvesting – the process of obtaining the stem cells to be used in the transplant, either from the patient or a donor. There are three main ways stem cells can be harvested – from the blood, from the bone marrow or from the cord blood.
  • Conditioning – treatment with chemotherapy and/ or radiotherapy to prepare the body for the transplant. This helps destroy existing bone marrow cells, destroy any existing cancer cell and to stop the immune system from working to reduce the risk of the transplant getting rejected. 
  • Transplanting the stem cells – It is usually carried out a day or two after conditioning has finished. The stem cells are passed slowly in the body through the central line and the entire process takes around a couple of hours. 
  • Recovery – Once the transplant is finished, the patient will need to stay in a hospital for a few weeks to allow the stem cells to settle in the bone marrow and start producing new blood cells. 

What are risks of Bore Marrow Transplant?

Since a BMT is a complicated procedure, there are significant risks involved with it. However, younger people who don’t have any other serious conditions or those who receive transplants from a closely matched sibling are less likely to experience serious problems. Patients receiving transplants of their own stem cells (autologous transplants) are also less likely to experience serious side effects. 

The main risks associated with a BMT are: 

  • Graft versus Host Disease (GvHD) – this occurs in Allogeneic Transplants when the transplanted cells start to attack the other cells in the body.
  • Reduced Number of Blood Cells – this can lead to Anaemia. 
  • Chemotherapy Side Effects – including sickness, tiredness, hair loss, infertility, mouth ulcers, loss of appetite, diarrhea, rashes.

Some of the Myths associated with a Bone Marrow Transplant

MYTH: DONATING A MARROW IS PAINFUL.

FACT: Donors feel little to no pain during the procedure, and usually feel no more than aches or pains like a pulled muscle.

MYTH: A MALE DONOR CAN ONLY DONATE TO A MALE PATIENT.

FACT: A good match is determined more by the specific proteins in a donor’s blood, not by gender.

MYTH: SINCE MOTHERS ARE RELATED SO CLOSELY TO THEIR CHILDREN, THEY WILL BE THE BEST MATCH.

FACT: Most people – 70% of patients – do not have a close enough match for their families. Each person inherits blood markers from both parents, so the closest match within a family would be an identical twin, a brother or a sister from the same parents.

MYTH: GETTING A BMT MEANS YOU WOULD NEED TO STAY IN HOSPITAL FOR SEVERAL MONTHS.

FACT: With today’s technology and advanced treatment, some BMT patients can receive the treatment without staying overnight at a hospital. The actual transplant is usually conducted in a hospital, but much of the follow-up care can be done on an outpatient basis.

MYTH: DONATING BONE MARROW IS DANGEROUS AND WEAKENS THE DONOR.

FACT: While no medical procedure is without risk, chances of any long-term effects from donating are extremely rare. And only 5% or less of a donor’s marrow is needed to save a life – the body replaces these cells in 4-6 weeks.

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Dr. Vikas Dua

Head and Senior Consultant, Pediatric Hematology Oncology, and Bone Marrow Transplant

Dr. Vikas Dua is Paediatric Hemato Oncologist and bone marrow transplant specialist of the generation. Dr. Dua's results in the field of Paediatric Haematology Oncology and BMT have been some of the best. He and his team has done 200 + paediatric transplants. 

About Dr. Rahul Bhargava

Hematologist, Hemato-oncologist & Stem Cell Transplant Physician

With over 20 years of experience, Dr. Rahul Bhargava is currently the Director of Haematology, Paediatric Haematology, Immunology and Stem Cell Transplant at Fortis Memorial Research Institute (FMRI), Gurgaon – India’s first integrated Centre of Excellence in Haematology, Paediatric Haematology, and Stem Cell Transplant.

Dr. Aniruddha Dayama

Hematology, Pediatric Oncology & Bone Marrow Transplant Specialist

Dr. Aniruddha Dayama in 2015 led the efforts to get NMDP, USA approval for one of the leading hospitals in Gurgaon. He and his team have popularised autologous transplants in multiple sclerosis. The team has been credited for establishing six low-cost centers across North India.