What is bone marrow

Bone marrow is a special soft, flexible, spongy, fatty tissue that houses stem cells and it is found inside a few large bones. The development and storage of 95% of the body’s blood cells occurs in the bone marrow. These blood cells are of three kinds:

White blood cells (Leucocytes)- These fight Infection
Red Blood Cells (Erythrocytes)- They carry oxygen to and are responsible for removal of waste products from different organs and tissues.
Platelets- It helps the blood to dot.

Why is a bone marrow transplant needed

The main objective of a bone marrow transplant is to cure various diseases and cancer. It may also be required when a person’s bone marrow has been damaged or destroyed due to a disease or intense treatments of radiation or chemotherapy for cancer. A bone marrow transplant may be used to:

Replace non-functioning bone marrow with a healthy functioning bone marrow. It is generally done in conditions such as leukemia, Aplastic Anemia, and Sickle Cell Anemia.
Replace the bone marrow when a high dose of chemotherapy or radiation is given to treat a malignancy and than it is restored for its normal function. This procedure may be done for diseases such as Lymphoma, Neuroblastoma and Breast Cancer.
Replace bone marrow to prevent it from a genetic disease process such as Hurler’s syndrome, and Adrenoleukodystrophy.

What are the different types of bone marrow transplants

Bone marrow transplantation (BMT) involves taking out stem cells that are normally found in the bone marrow, filter those cells, and give them back either to the patient or to another person. The goal of BMT is to transfuse healthy bone marrow cells into a person after their unhealthy bone marrow has been removed.

There are different types of bone marrow transplants depending on who the donor is. The different types of bone marrow transplant include the following:

Autologous bone marrow transplant: This is often termed as rescue rather than transplant as in this the donor is the patient him/herself. During the procedure stem cells are taken from the patient either by bone marrow harvest or apheresis and then given back to the patient after intensive treatment.
Allogeneic bone marrow transplant: In this procedure stem cells are taken either by bone marrow harvest or apheresis from a genetically-matched donor, generally a brother or sister or parent. It can also be a unrelated bone marrow transplant when the donor is not a relative of the patient but his cells are matching genetically with the patient.
Umbilical cord blood transplant: In this type of transplant stem cells are taken from an umbilical cord immediately after delivery of an infant. These stem cells are than tested, typed, counted, and frozen until they are ready to be transplanted.

Diagnosis

The diagnosis can be carried out with the help of following three methods:

Bone marrow aspiration: This is the removal of a small amount of this tissue in liquid form for examination.
Bone marrow biopsy: It is the removal of soft tissue known as marrow, from inside the bone.
Bone marrow culture: It is an examination of the soft, fatty tissue found inside certain bones. This test is done to find out if there is an infection inside the bone marrow.

Preparing for the Bone Marrow Transplant

The major factor which determine if the transplant is to be carried out or not are the Age, general physical condition, the patient’s diagnosis and the stage of the disease. The patient has to be healthy enough to undergo the severity of the transplant procedure. Before the transplant is done a series of tests are carried out to ensure the patient is physically capable of undergoing a transplant. Tests of various organs like heart, lung, kidney and other vital organ functions are also used to develop a patient “baseline” against which post-transplant tests can be compared to determine if any body functions have been impaired. Along with the test of the recipient the test of the donor are also carried out related to their health, exposure to viruses, and complete genetic analysis to determine the extent of the match.

Most importantly if the donor is other than the patient himself/ herself than the donor and the recipient are matched. Matching involves typing more than hundred human leukocyte Antigen (HLA) tissues. The engraftment of donated marrow is better if more antigens are matched.

Bone Marrow Harvest

Bone marrow harvest is the procedure of collection of the marrow (which a thick, red liquid) from the bone, it is regardless of whether the patient or a donor provides the bone marrow. It is carried out under general anesthesia as it involves nominal discomfort. To extract the marrow a needle is inserted into the cavity of the rear hip bone or “iliac crest” where a large quantity of bone marrow is located. There are no stitches or surgical incisions involved, only skin punctures are there where the needle was inserted. The amount of marrow to be harvested depends on the size of the patient and the concentration of bone marrow cells in the donor’s blood.

The Bone Marrow Transplant Procedure

The main transplant procedure occurs a day or two following the chemotherapy and/or radiation treatment. The bone marrow is infused into the patient intravenously i.e. in the same way in which any blood product is given to a patient. The transplant is not a surgical procedure and it does not require to be carried out in an operating room. During the bone marrow is being infused the patients are checked frequently for signs of fever, chills, hives and chest pains.

Engraftment

The most critical time is the 2-4 weeks period fter the transplant. As the high-dose chemotherapy/ radiotherapy given to the patient during conditioning might have destroyed the patient’s bone marrow thereby crippling the body’s “immune” or defense system. Till the time the transplanted bone marrow migrates to the cavities of the large bones, set up housekeeping or “engraft,” and start producing normal blood cells, the patient will be very susceptible to infection and excessive bleeding. The patient is thus kept on multiple antibiotics and blood transfusions to help prevent and fight infection. Transfusions of platelets are also done to prevent bleeding. Allogeneic patients are given additional medications to prevent and control graft-versus-host disease. Till the time complete engraftment occurs extraordinary precautions will have be taken to minimize the patient’s exposure to viruses and bacteria.

Once the infused bone marrow finally engrafts and begins producing normal blood cells, the patient will slowly be taken off the antibiotics, and blood and platelet transfusions would also be stopped. A Bone Marrow Transplant patient has to typically spend four to eight weeks in the hospital

Recovery

The new bone marrow normally takes almost a year in order to function normally. During this period the patient is to be monitored closely to identify any infections or complications that may develop. The recovery process continues for several months or longer after discharging from the hospital, during which time the patient cannot return to work or many previously enjoyed activities.

Home Care

Preventing Infections after Bone Marrow Transplant is the most important lookout once the patient is discharged from hospital. As the immune system is weak after the transplant and patient is more prone to catch infection. High levels of hygiene shall be maintained at all times, which includes regular hand washing, preventing direct contact with items outside the house, prevention from any sort of respiratory or other infection.

Risks

All bone marrow transplants are quite risky procedures, and the risk involved may be higher or lower depending on kind of disease, treatment, age, health status etc. the different complications that may occur are:

Infection
Bleeding from intestines, lungs, bran or any other body part.
Anemia and weakness.
Diarrhea, vomiting, and nausea
Pain
Inflammation and discomfort in the mouth, throat, esophagus, and stomach
Cataracts
Premature menopause
Graft failure, which means that the new cells do not settle properly into the body and so not produce stem cells
Graft-versus-host disease: I.e. when the donor’s cells attack the recipients body.
Children getting transplants may have deferred growth.

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Bone marrow transplant process at Healthyatra.com

At Healthyatra.com, doctors from many specialties work as a team to develop the most appropriate plan of care for you. They take the time to listen to your questions and concerns and provide comprehensive care, including care for nutritional, social, financial and spiritual issues. They follow you before, during and after your bone marrow transplant to ensure the best possible results and quality of care.

Before Your Transplant

HealthYatra.com doctors trained in bone marrow transplantation and others will evaluate you to determine if a bone marrow transplant or stem cell transplant will be safe and beneficial for you.

Your evaluation may last many days and may include:

Physical examination
Blood tests, including blood and tissue type analysis
Imaging tests, including chest X-rays, CT scans or other tests
Tests of small pieces of your bone marrow (biopsy) to evaluate your condition
Consultations with a mental health specialist (psychologist), social worker and others
If doctors determine you’re eligible for a bone marrow transplant, you’ll be prepared for the procedure. Surgeons will insert a long, thin tube (catheter) into a vein in your chest near your neck. Your treatment team uses the catheter, also called a central line, to infuse the transplanted stem cells and other medications and blood products into your body.

Bone marrow transplants may use stem cells from your own body (autologous transplant), from a donor’s body (allogeneic transplant) or from an identical twin (syngeneic transplant).

Doctors have experience performing bone marrow transplants using stem cells from the bone marrow, from peripheral blood or from umbilical cord blood.

Collecting Cells

You or a donor may have a procedure to remove stem cells from your blood (apheresis) or from your bone marrow. Doctors collect the cells to use in a bone marrow transplant. Stem cells may be frozen until they’re needed for bone marrow transplant.

In apheresis, your blood, or your donor’s blood, is removed through a catheter and circulated through a machine, which removes and collects stem cells from your blood or your donor’s blood. Your blood then returns to your body through a catheter. This procedure usually takes about five hours, and it may take three days or more to gather an adequate number of stem cells.

In surgery to remove stem cells from your bone marrow, doctors insert needles through the skin and into the bone to remove marrow from the pelvic (hip) bones.

Conditioning

After you’re approved for a bone marrow transplant, you’ll have conditioning treatment to kill cancer cells in your body and suppress your immune system before a bone marrow transplant. Conditioning may include chemotherapy, radiation or reduced-intensity conditioning.

Bone Marrow Transplant Procedure

In a bone marrow transplant, doctors infuse or inject healthy stem cells into your body to renew and repair tissue.

After your bone marrow transplant, you may notice some minor side effects, such as a flushed face or nausea, due to the preservatives used to freeze the stem cells. Medications may help with these side effects. You’ll also likely be given IV fluids (hydration) before and after the bone marrow transplant to help rid your body of the preservative.

Cost of Bone Marrow Transplant in India

Country	Autologous bone marrow transplant	Allogeneic bone marrow transplant
India	16,500 – 20,500 USD	22,000 – 28,000 USD
Mexico	30,000 USD	35,000 USD
Brazil	35,000 USD	40,000 USD
USA	140,000 USD	200,000 USD

After Your Bone Marrow Transplant in India

Usually you can leave the hospital after your bone marrow transplant, unless you’re experiencing allergic reactions or your treatment team needs to watch you closely. You’ll usually need to stay close to the hospital for three to six weeks after your transplant. You’ll have daily appointments to check for infections and complications and to evaluate your blood cells.
Your transplanted stem cells will begin to create new blood cells. It may take several weeks for your blood counts to recover. Your doctors will conduct blood tests and other tests to monitor your condition and check to see if your transplanted cells are producing new blood cells.
Follow-up care. Your doctor will update your primary health care provider about your progress and give recommendations for your care at home. In addition, your transplant team will provide follow-up care, answer your questions, and communicate with you and your primary health care provider. You’ll have follow-up appointments at Mayo Clinic every one to three months for the first year, and less frequently after that.
You may experience chemotherapy or radiation side effects. Your treatment team can answer your questions about side effects and help you manage them.
Medications. You may need to take many medications daily after your bone marrow transplant. Your transplant team will discuss your new medications in detail.
Returning to wellness. The transplant team considers your return to wellness after your bone marrow transplant a priority. You’ll be given specific guidelines to return to wellness through an exercise plan and a nutrition plan. Staff may give you other lifestyle guidelines, such as practicing hand hygiene, wearing sunscreen and not using tobacco products.
After a bone marrow transplant, your body is more susceptible to infections and skin cancer, and making certain lifestyle choices may help prevent these conditions. Your transplant team will work with you to help you make healthy lifestyle choices to achieve the best possible transplant outcome.