What is Bone marrow transplant ( BMT Surgery)

Bone Marrow Transplant (BMT) is a procedure that is performed to replace unhealthy blood-forming cells with healthy ones. It is a special therapy for patients who are suffering from certain types of cancers or other diseases. The treatment is also known as stem cell transplant and involves the transplantation of blood stem cells to the bone marrow where they produce new blood cells and promote the growth of new marrow.

A Bone Marrow is the soft, spongy tissue that is found inside bones. It contains specialized cells termed stem cells, which produce red cells, white cells and platelets. The transplant has been successful in treating several dreadful diseases like leukaemias, lymphomas, aplastic anaemia, immune deficiency disorders, and some solid tumour cancers.

Which are the different types of BMTs?

Depending on the type of the donor different types of BMT are performed such as -

  1. Autologous BMT - This is performed using the patient’s body cells
  2. Allogeneic BMT - It is conducted using the stem cells from a healthy donor. It can be an HLA matched sibling donor, or an HLA matched unrelated donor.
  3. Haploidentical BMT- This is done using stem cells from half HLA-matched donor
  4. Umbilical cord blood transplantation - It is a unique stem cell transplantation that is performed using an umbilical cord product obtained immediately after delivery of an infant

Why is BMT performed and which are the most commonly treated diseases?

Bone marrow transplants are performed when a person has unhealthy bone marrow that is not functioning properly. This can be caused due to chronic infections, diseases, or cancer treatments. There are several other reasons for which a bone marrow transplant is performed -

  1. In cases of aplastic anaemia, a type of a disorder where the bone marrow stops making new blood cells
  2. Cancers like Leukemia, Lymphoma and multiple myeloma affect the bone marrow
  3. Reduction in the production of red blood cells due to genetic disorders such as Pure red cell aplasia
  4. In cases of Thalassemia, a genetic disorder where the body starts making abnormal haemoglobin which is critical for red blood cells

The most commonly treated diseases by BMT are -

  1. Leukaemia
  2. Thalassemia
  3. Sickle cell disease
  4. Severe aplastic anemia
  5. Lymphomas
  6. Plasma cell disorders like Multiple myeloma
  7. Inborn errors of metabolism
  8. Immune deficiency disorders
  9. Some solid-tumour cancers

It is important to note that patients experience diseases differently and BMT may not be appropriate for everyone who suffers from the above diseases.

What are the risks and advantages of BMT?

There are several risks and advantages associated with BMT -

Advantages of BMT

  1. For conditions like leukaemia, aplastic anaemia, and sickle cell anaemia, BMT replaces diseased, damaged and non-functioning bone marrow cells with healthy functioning cells
  2. Renews the immune system to fight leukaemia or other cancers that are not cured by the chemotherapy or radiation used in the transplant
  3. While high doses of chemotherapy or radiation are often required to cure diseases such as lymphoma and neuroblastoma, however, they can permanently damage or destroy the patient’s bone marrow stem cells. In such instances, BMT helps in replacing the patient’s bone marrow and restores its normal function.
  4. In cases of genetic disorders such as Hurler’s syndrome and adrenoleukodystrophy, a bone transplant prevents further damage from a genetic process.

Risks Involved

There are several risks associated with BMT and the complications depend on several factors which include the type of disease or condition, the type of transplant, and the age and health of the person. While some people may experience some problems others may develop serious complications and may require hospitalization. Following are the complications that may occur with a BMT -

  1. Infections
  2. Low platelets and red blood cells
  3. Painful mouth sores and gastrointestinal irritability
  4. Fluid overload leads to pneumonia, liver damage and high blood pressure
  5. Respiratory distress
  6. Organ damage – High doses of chemotherapy, radiation, fluid overload, infection, and graft-versus-host disease can cause temporary or permanent damage to the liver and heart. These organs are at a high risk of damage during the transplantation process.
  7. Transplant Failure
  8. Graft-versus-host disease – It is a serious life-threatening complication where the donor’s immune system reacts against the recipient’s tissue and affects the skin, digestive tract or liver of the recipient
  9. Cataracts.
  10. Infertility

The risks and benefits must be weighed in a thorough discussion with your doctor and specialists in BMTs before the procedure.

What is the procedure for the treatment?

As Bone Marrow Transplant in Bangalore is an extensive treatment, the procedure involves several steps which include -

Recipient Preparation

  1. The BMT team assesses the patient to determine if all the treatment options have been discussed and evaluated for risk versus benefit.
  2. Before the BMT the medical history and overall health status of the recipient's condition are examined which includes multiple tests that evaluate the patient’s blood and organ functions (for example, heart, kidney, liver, and lungs)
  3. A few before the transplant the recipient is asked to visit the transplant centre for hydration, evaluation, placement of the central venous line, and other preparations. During this period, a catheter, also called a central venous line, is implanted in a large vein in the chest or neck area of the recipient to administer the blood products and medications during treatment.

Finding a match for allogeneic patients can be a long process especially if a sibling match is unavailable. Such patients can also look up national and international registers for registered voluntary marrow donors who most closely resemble or match them.

Donor Preparation

A donor undergoes a series of tests related to his/her health, exposure to viruses, and genetic analysis to determine the extent of his/her match before the transplant. The donor is also given a series of instructions on the entire procedure of bone marrow donation.

Preparation during the procedure

BMT preparations vary from one transplant to the other depending on the type of the transplant, the kind of disease the patient is suffering from and their tolerance to certain medications. Therefore a conditioning process prepares them for the transplant. During this process the doctors inform the recipients about the impact of the high doses of chemotherapy and/or radiation on the disease which are mostly used to destroy the cancer cells in malignancy cases, suppress one’s immune system and prepare the bone marrow to generate new cells.

Once the chemotherapy and/or radiation is administered, the stem cell transplant is started. On the day of the transplant, the stem cells are delivered to the body through the central venous catheter (a non-surgical procedure) into the bloodstream. The stem cells then make their way into the bone marrow and start reproducing new and healthy blood cells.

As the recipient is awake during the entire process, they experience the following during the infusion of bone marrow -

  1. Pain
  2. Chills
  3. Fever
  4. Hives
  5. Chest pain

Post-transplant care

Supportive care is given to patients after the transplant to treat infections, side effects of treatments, and complications such as nausea, diarrhoea or extreme weakness. Patients may require medicines to manage these complications.

The doctors will also perform frequent blood tests, monitor vital signs and will measure the fluid input and output. To evaluate the initiation and progress of engraftment, blood counts will be checked frequently post the transplant. Since platelets are the last blood cell to recover, therefore patients may require periodic transfusions of red blood cells and platelets until their bone marrow starts producing enough of those cells on its own.

Due to infection, medications, low donated stem cell count, or graft failure, the engraftment process can be delayed. Even though the new bone marrow starts making cells in the first 30 days of the transplant, it usually takes months or even years for the entire immune system to fully recover.

Patients may spend several weeks in the hospital once the infusion is completed. During this time the recipients need to take note of the following -

  1. You may be susceptible to infection and hence confining to a clean environment is important
  2. You may experience excessive bleeding
  3. Ensure you take the prescribed antibiotics and other medications
  4. Proper medication is extremely important In allogeneic cases to prevent any graft-versus-host disease
  5. Undergo continual laboratory testing.
  6. You may experience temporary mental confusion and emotional or psychological distress

Recovery

The recovery process takes several months and it takes time for a patient to return to work or previously enjoyed activities. During this time, patients must make frequent follow-up visits to the hospital or doctor’s office.

It usually takes up to one year for a patient to recover fully after the transplant. A BMT may completely or partially cure your illness and ensure that you return to your normal life as soon as you attain your overall health.

Are you the right candidate for BMT?

The doctors conduct a Human Leukocyte Antigen (HLA) tissue matching to evaluate and determine a match between a patient and a recipient. Even though there are 100 HLA that are present on the surface of special white blood cells and determine the genetic makeup of a person’s immune system, however, out of these, only a few major antigens determine the match between a donor and a recipient.

Engraftment of the stem cells occurs only when the donated cells make their way to the marrow and start producing new blood cells. The success of the engraftment of the donated marrow depends on the number of antigen matches. The more the antigens match the better will be the engraftment of the donated marrow.

While determining a complete match, preference is given to siblings of the patient as they have a one in four chance of having the same set of chromosomes. A normal human being has only two of each chromosome, one received from each of our parents therefore the chances of finding a match with one’s sibling are higher.

Once a complete match is found, the BMT team then conducts an extensive evaluation to determine whether or not you can undergo a BMT. This depends on several factors including -

  1. Your age, overall health, and medical history
  2. The extent of the disease
  3. Availability of a donor
  4. Your tolerance for specific medications, procedures, or therapies
  5. Coping with the disease and the transplant
  6. Your opinion or preference

BMT treatment has been performed at Aster CMI Hospital for the following diseases Blood Cancer and related disorders

  • Multiple Myeloma
  • Acute Myeloid Leukemia
  • Acute Lymphoblastic Leukemia
  • Relapsed Non-Hodgkin's Lymphoma
  • Hodgkin's Lymphoma
  • Myelo Dysplastic Syndrome (MDS)
  • Solid Tumour
  • Neuroblastoma
  • Ewing's Sarcoma
  • Other relapsed Solid Tumors
  • Non Cancerous Conditions
  • Aplastic Anaemia
  • Thalassemia Major
  • Primary Immune Deficiency Syndrome
  • Multiple Sclerosis
  • Other Haematological and storage disorders

Facilities:

  1. Bone Marrow Transplant at Aster CMI Hospital facilitates Autologous and Allogeneic Bone Marrow Transplantation (BMT)
  2. Bone Marrow Transplant wing comprising nine state-of-the-art HEPA Filter transplant rooms
  3. Excellent blood bank facilities for Collection, Processing, Enumeration and Cryopreservation of Stem Cells
  4. Laboratory facilities are fully equipped in conducting routine and special tests like HLA testing, drug blood levels, bacterial and fungal cultures and viral analysis
  5. Dedicated HEPA filtered rooms for BMT with a team of trained nurses for round-the-clock care

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