All you need to know about bone marrow transplant

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Bone Marrow Transplant

• All you need to know about bone marrow transplant

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What is Rhinoplasty?

• A special type of treatment for those patients
  who are suffering from certain diseases or
  cancers is known as bone marrow transplant (BMT).
  Bone marrow transplant, also known as stem cell
  transplant, includes taking of cells that can be
  found in the stem cells (bone marrow). The aim of
  bone marrow transplant (BMT) is to transfer
  healthy bone marrow cells in a patient when
  their unhealthy bone marrow has been treated for
  destroying the abnormal cells. Following are the
  diseases that can be successfully treated by bone
  marrow transplant (BMT) that includes
• Some solid tumour cancers
• Leukaemia
• Multiple myeloma

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• A bone marrow is the soft, fatty tissue inside
  the bones that contain stem cells which
  produce RBCs, WBCs, and platelets. When the stems
  cells fail to produce healthy blood cells, a bone
  marrow transplant is recommended to replace
  a damaged bone marrow with the healthy one.
  The new stem cells help the marrow make healthy
  blood cells again.

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What are the types of Rhinoplasty?

• Autologous Bone Marrow Transplant.
• Allogenic bone marrow transplant.
• Autologous Bone Marrow Transplant In Autologous
  bone marrow transplant the healthy bone marrow
  cells from the patient itself are collected and
  used for the transplant. The success rate is high
  in Autologous Bone Marrow Transplant as there is
  no risk of genetic mismatch in the bone
  marrow/stem cell. But not always Autologous Bone
  Marrow Transplant is feasible mainly due to
  non availability of healthy bone marrow
  tissues in the patient.

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• A patient is itself a donor. In this Autologous
  Bone Marrow Transplant, stem cells are taken from
  a patient by aphaeresis or bone marrow harvest.
  These cells are then given back to a patient
  after they have been frozen.
• 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.
• Allogenic bone marrow transplant The bone
  marrow from a donor which is a close genetic
  match is used. Allogenic bone marrow transplant
  is a more difficult procedure comparatively as
  there is additional need for identifying a
  potential donor, testing for the genetic match
  etc.

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• Allogenic bone marrow transplant needs a lot
  of tests to confirm the compatibility of the bone
  marrow and finding the right donor. Hence
  the cost is also more for Allogenic 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 allogenic
  bone marrow 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
  sibling's bone marrow is a perfect match.

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Bone Marrow Transplant Treatment Process

• For Bone Marrow Transplant journey, the
  transplant process is divided into seven steps
  that guide a patient. The steps begin with how to
  prepare for the journey and include what to
  expect along the way.
• Preparation
• The starting phase of bone marrow
  transplant begins when the patient arrives at
  the treatment centre and begins the process of
  medical evaluation, orientation, informed
  consent, and other preliminary activities.
• Beginning Medical Evaluation
• Conference for Treatment Plan
• Central Venous Catheter Evaluation and Insertion
• Bone-Marrow/Stem Cells Harvest

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• Conditioning
• The conditioning phase of bone marrow
  transplant begins the actual transplant process.
  During this phase of bone marrow
  transplant, high-dose chemotherapy, radiation
  therapy, or both are initiated. Chemotherapy and
  radiation therapy are given in doses that
  obliterate the marrow function and result in the
  greatest possibility of destroying the disease.
  Depending upon the chemotherapy agents and
  radiation therapy administration schedule, some
  conditioning therapy can be administered in the
  outpatient setting, thus potentially shortening
  the inpatient stay.

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• Transplant
• The transplant phase of bone marrow transplant is
  the infusion of donor bone marrow or stem cells.
  After the conditioning regimen is completed, the
  patient receives the infusion of bone marrow or
  stem cells.
• Waiting for Engraftment
• This phase of bone marrow transplant includes
  close monitoring, supportive treatment, and
  management of complications while waiting for
  signs of engraftment (new cell growth).

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• Engraftment and Early Recovery
• Approximately 10 to 28 days after bone marrow
  transplant, signs that the new bone marrow or
  stem cells are engrafting (growing and
  developing) can be expected. Close monitoring
  will continue along with supportive care.
  Preparation for the return of the patient to the
  referring physician or center will begin.
• Long-Term Recovery
• The long-term recovery phase of bone marrow
  transplant involves leaving the treatment centre,
  dealing with any ongoing clinical issues, and
  re-establishing life patterns. Patients need to
  follow up for long term complications of bone
  marrow transplant (BMT).

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What are the Requirement of a Bone Marrow
Transplant

• A bone marrow transplant is required when high
  doses of radiation therapy or chemotherapy
  treatment has damaged the bone marrow stem cells.
  Bone marrow transplant (BMT) may also be required
  when a disease has destroyed the bone marrow. A
  Bone marrow transplant (BMT) is used for -
• Replacing of a bone marrow with a genetically
  healthy functioning bone marrow. This is done for
  preventing more damage from a genetic disease.
• Replacing of non - functioning and diseased bone
  marrow with a healthy functioning bone marrow.
  This is done in specific conditions like sickle
  cell anaemia, leukaemia and aplastic anaemia.

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• Replacing the bone marrow for restoring its
  normal functioning after being given high-doses
  of radiation therapy and chemotherapy for
  treating a disease. This procedure is known by
  the name of rescue for conditions
  like neuroblastoma and lymphoma.
• Regenerating a new immune system that will help
  to fight off other cancers that are not destroyed
  by the radiation therapy or chemotherapy used in
  the transplant, or residual or existing
  leukaemia.

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Complete Bone Marrow Transplant Procedure

• A bone marrow transplant depends on following
  conditions such as a patient's ability to
  tolerate certain medications, the type of
  transplant and the disease that requires a
  transplant. The bone marrow transplant includes
  the following
• The preparation of a bone marrow transplant
  involves high doses of radiation therapy and/or
  chemotherapy. This is required for treating a
  specific disease and also to create a sufficient
  room in the bone marrow for the new cells to
  develop. Myeloablative or ablative is the name
  given to this therapy due to its effect on the
  bone marrow.

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• The bone marrow transplant is given from the
  central venous catheter in the bloodstream after
  administering radiation therapy and/or
  chemotherapy. Bone Marrow Transplant is not
  considered as a surgical procedure. The stem
  cells start to grow into healthy blood cells by
  making their way into the bone marrow.
• A supportive care is offered after the bone
  marrow transplant for preventing complications,
  infections and side effects. This care involves
  providing a clean environment, frequent blood
  tests, and daily weigh-ins, strict measurement of
  fluid input and output, and monitoring of vital
  signs.

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Who can be a donor for an Allogenic Bone Marrow
transplant?

• Matching bone marrow is done by blood tests
  alone. It is not necessary to test the donor's
  bone marrow at this stage.
• It is usual to start by testing the brothers and
  sisters, as they are likely to provide the best
  match parents are not usually good matches.
• The donor should be in good health. He or she
  will be given a thorough medical check up to make
  sure that there will be no risk to his or her own
  health from the procedure.

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How Doctors Collect bone marrow

• About a week or two before the bone marrow
  harvest is done, the patient (or the donor, for
  an Allogenic transplantation) may have 1 to 2
  units of blood withdrawn. This will be given back
  during the bone marrow harvest.
• The harvest itself is carried out under general
  anesthesia, so one will feel nothing. It involves
  the removal of some marrow from inside the bones
  at the back and front of the pelvis (the hip
  bones).
• The patient or donor will have to stay in
  hospital overnight to recover fully from the
  general anaesthesia. Usually it feels sore for a
  few days and mild painkillers may be required.
  These will be administered by the nurses or
  doctors.

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How are the stem cells collected?

• Stem cell harvesting is done following a course
  of daily injections of a growth factor. This
  procedure takes about 3 hours. The patient will
  be made to lie down on a couch and a transfusion
  will be put into the vein of each arm. Blood will
  be collected from one arm, into a machine called
  a centrifuge, which spins it to separate out the
  stem cells. These are collected, and the
  remaining blood is returned through the IV in the
  other arm. The stem cells can even be frozen.
• What is Umbilical Cord Blood Transplantation?
• Many children and young adults with serious blood
  diseases such as leukaemia need a bone marrow
  transplantation to give them

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• A chance to live. Unfortunately a marrow donor
  cannot always be found. Sometimes searching for a
  donor takes so long that the patient dies before
  a compatible donor is available.
• However, now a new source of blood forming stem
  cells has been found - Umbilical Cord Blood.
• The stem cell in the cord blood is of high
  quality and very potent in producing blood cells.
  Cord blood transplants appear to cause less
  serious immunological side effects. The
  'matching' between donor and recipient appears to
  be less critical. This means that the chance of
  finding suitable cord blood for transplantation
  is much greater than that of bone marrow.

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Which are the best hospitals for Bone Marrow
Transplant in India?

• Some of the best hospitals for Bone Marrow
  Transplant in India are
• Apollo Hospital Delhi
• Fortis Memorial Research Institute Gurgaon
• Wockhardt Hospitals Delhi
• Medanta - The Medicity Gurgaon
• Artemis Hospital Gurgaon
• BLK Super Specialty Hospital Delhi
• Kokilaben Hospital Mumbai
• Sri Ramachandra Medical Center, Chennai
• American Oncology Institute, Hyderabad

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• Indraprastha Apollo Hospitals, New Delhi
• Dharamshila Hospital, India
• Aster Medcity, Kochi
• Krishna Institute of Medical Sciences,
  Secunderabad
• Global Hospital, Hyderabad
• Aware Global Hospital, Hyderabad
• Narayana Institute of Cardiac Sciences, Bangalore
• SevenHills Hospital, Mumbai

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