Bone marrow transplant

Bone Marrow Transplant


Bone marrow transplantation is the surgical process performed to replace destroyed and diseased bone marrow with healthy bone marrow stem cells from a donor. The procedure involves extracting the bone marrow which contains normal stem cells from the healthy donor and replacing it in the patient. The transplant aims to reproduce the patient’s blood cells to cure disease and built immunity.

Bone marrow is sponge-like tissue. It is found within the central hollow of the long bones. It contains stem cells which produces new blood cells.

Types of bone marrow transplant:

  • Autologous bone marrow transplant- The patient’s own stem cells are taken before radiation or chemotherapy
  • Allogeneic bone marrow transplant- Stem cells are taken from the donor who is usually  close family member of the patient, or another matching donor
  • Umbilical cord blood transplant-  Stem cells from umbilical cord are taken, immediately after birth of the infant.

 

Why is it needed?

Bone marrow transplants are prescribes when the patient’s body is unable to produce blood cells, in conditions like:

  • Cancerous conditions – lymphoma, leukemia, and multiple myeloma
  • Diseases like
    • Sickle cell anaemia
    • Thalassemia
    • Aplastic anaemia
    • Severe immunodeficiency syndromes
    • Congenital neutropenia

 

  • Destruction of bone marrow because of chemotherapy used to treat some cancers and Hodgkins disease.

 

Facts and figures

  • E. Donnel Thomas first theorized transplanting bone marrow. He received Nobel Prize in Physiology-Medicine
  • Minnesota University’s Robert A. Good performed first allogenic transplantation (successful)
  • National Bone Marrow Donor Registry / National Marrow Donor Program was founded in 1986. More than 4 million donor volunteers provide  services in approx. 14 countries

 

Advantages

  • After transplantation, the donor’s marrow reaches patient’s bone cavity to produce normal quantity of healthy blood cells

 

  • Extends patient’s life and improves life quality

 

Disadvantages

  • Risk to develop Graft –Versus- Host disease
  • Growth of children may be delayed after transplant

 

Risk, complications and side effects:

  • Serious infections
  • Anaemia and bleeding
  • Severe mucositis
  • Diarrhoea, vomiting and nausea
  • Damage to kidney, lungs, liver and heart
  • Cataracts
  • Early menopause
  • Headache
  • Graft failure
  • Skin rashes

 

 

Risks to donor is less. Soreness and stiffness may occur at site of extraction. Donor may experience fatigue for few days.

Preoperative preparation

  • Full body physical examination
  • Blood test, liver and kidney function tests
  • Urinalysis
  • USG of abdomen, CT scan
  • Relatives and patient are informed regarding procedure, including risks and follow up care
  • Surgeon consultation week before to ascertain medicine required and medicines stopped
  • Have arrangement with family and/or friends for help after surgery
  • Arrangement of blood transfusion, if required during or post surgery
  • Preparation of  home as required for recovery after surgery
  • Do not drink or eat post after midnight, night before surgery
  • Medical tourist is advised to plan maximum time for trip
  • Upto 2 catheters is inserted to large blood vessels before transplantation to receive fluids, treatment etc

 

Post operative care

Usually 6-4 weeks hospital stay is prescribed post surgery. Vital signs are monitored and medication given to avoid infection.

Some patients require blood transfusion.

Intravenous fluids are given till diarrhoea, mouth sores and nausea are cleared.

Engraftment

Engraftment is the process when bone marrow is accepted by patient’s body. Regular blood count is taken to monitor engraftment.

Full recovery can happen within 3-6 months.