Bone Marrow Transplant

Department of Bone Marrow Transplant

Department of Bone Marrow Transplant

Bone Marrow Transplant

What Is Bone Marrow Transplant?

Bone Marrow is the tissue inside the bones, which contains blood forming cells, known as Hematopoietic Stem Cells (HSC). If this Bone Marrow malfunctions due to reasons like cancer (Leukemia), Thalassemia or Immunological causes (Aplastic Anemia) then deficiency of formed components of blood sets in, resulting in weakness, infections and bleeding ultimately leading to death. Bone Marrow or Hematopoietic Stem cell transplant is a procedure in which Diseased Marrow is replaced by Healthy Marrow or Hematopoietic Stem Cells.

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Sources of Hematopoietic Stem Cells

Bone Marrow:Stem cells from Bone Marrow are collected by using aspiration needles from the iliac crest (hip bone). It is carried out under general Anesthesia, is safe and painless, with donor being discharged on next day Bone Marrow stem cells are preferred in diseases like Thalassemia or Aplastic Anemia. With Bone Marrow as a graft source, recovery period is delayed as compared with peripheral blood stem cells but the risk of graft versus host disease is less.
Peripheral Blood:Stem cells can also be collected from larger veins of body using apheresis technique on a cell separator machine after giving growth factor injections for 4-5 days. It is a very safe and reliable procedure taking only a few hours and does not require Anesthesia. Stem cells can be collected even difficult to mobilize patients with plerixafor and G CSF support. In comparison to Bone Marrow graft, the recovery is earlier by 5-7 days with peripheral blood stem cell graft. This type of transplant is preferred for Leukemia, Myeloma and Lymphomas.
Cord Blood: Blood collected from placenta after birth is a rich source of Hematopoietic Stem Cells, can also be used for allogenic stem cell transplants. Problem is low volume and cell dose resulting in delayed recovery / engraftment failure

Side Effects

Side effects of transplant are due to Chemotherapy / Radiotherapy used in conditioning which is seen both in Autologous and Allogenic Transplants or Immunological Reaction known as graft versus host disease seen in Allogenic Transplants.

Nausea, Vomiting, Loss of Appetite – Usually it is for short period, lasting for few days. With the availability of modern drugs, it can be prevented and controlled to great extent.
Mouth Ulcers – Usually mild, lasting for few days and not requires specific treatment other than pain control. Sometimes it can be severe enough to forbid drinking / swallowing, in that case patients are given nutrition through veins.
Hair Loss – High dose chemotherapy / radiotherapy used in conditioning results in universal hair loss but it is temporary as hairs come back within few months after transplant.
Fever – Patients are prone to infections due to markedly low white blood cell counts before engraftment. To prevent infections patient are kept in strict isolation rooms with filtered air till their blood counts improve.
Bleeding – Platelets are the blood component which prevents bleeding and their count decreased after conditioning, resulting in risk of bleeding in skin, mouth, nose or other sites. To prevent bleeding, platelets are transfused to maintain an acceptable platelet count. Once engraftment occurs, the platelet production starts and bleeding risk disappears.
Fertility – Temporary or permanent sterility may occur in almost all adult / adolescent male and female patients after transplant due to side effects of chemotherapy / radiotherapy although ability to have sex is not affected by transplant. It is advisable for male’s patients, who plan to have family to have their sperm stored for future use.
Graft Versus Host Disease – Once engraftment occurs, one side effect which is seen in Allogenic Transplant is Graft Versus Host Disease (GVHD). It refers to reaction mounted by donor’s blood cell to patient’s body. It occurs in spite of patient and donor being HLA matched hence medicines are given to prevent it from occurring. It is usually mild, affects skin (rashes), liver (jaundice) or intestines (loose motions, pain abdomen) but can be serious and life threatening in a fraction of patients. Once GVHD occurs, it does not mean that transplant has failed. This can be treated with immunosuppressive therapies with good results.
Relapse – Even though transplant is performed with curative intent, some patients with very aggressive disease may relapse. The risk of relapse decreases significantly after 2 years post-transplant. Monitoring the patient regularly for relapse and early intervention with chemotherapy, decreasing immune suppression or donor lymphocyte infusion can be used to salvage relapse in many patients.