Bone Marrow Transplantation - Complications and Procedure - Health Education - DesiMD Healthcare - India

Bone Marrow Transplantation - Reviving Faith

Dr.Sachin Jadhav profile Authored by Dr.Sachin Jadhav on 5 Jan 2015 - 12:36.

Bone marrow is a semisolid substance within our bones, where blood cells such as white blood cells, red blood cells and platelets are manufactured from hematopoietic stem cells (HSC). In a bone marrow transplant (BMT) it is actually the HSC which are transplanted to replace damaged or diseased cells in the marrow with the cells of an apparently normal person. This is called an allogeneic hematopoietic stem cell transplant (HSCT).

Where can we get HSCs for transplantation?

HSCT is called BMT when the HSC are obtained from the bone marrow, PBSCT when they are procured from the blood and CBT when the umbilical cord blood, is the source.

What are the common diseases for which stem cell transplantation is done?

Diseases affecting the bone marrow such as aplastic anemia, thalassemia, immune-deficiencies and blood cancers (leukemia) can be cured in some patients with an allogeneic HSCT. Autologous HSCT for relapsed lymphomas and multiple myelomais done by collecting the patient's own HSC before giving chemotherapy and then infusing these back to them after chemotherapy, to help them recover from the side effects of the chemotherapy.

How is hematopoietic stem cell transplantation done?

We first assess the fitness ofthe patient and donor and also confirm that the patient will benefit from HSCT. If an allogeneic transplant is being planned then we test the patient's close relatives or unrelated donors for HLA-matching.

The patient is then admitted for the 'conditioning regimen' which is chemotherapy and sometimes radiation, given over five to seven days. This destroys the patient's original marrow and prepares his body to receive the new stem cells. The donor stem cells are then harvested either from the marrow or the peripheral blood and are then infused in to the patient's veins, just like a blood transfusion. The patient does not have to undergo any surgery.

It takes about 2-3 weeks for the new bone marrow to form and then, if the patient is stable, he or she is discharged and is followed up in the outpatient clinic for 2-4 months to watch for any further complications.

What are the usual complications of HSCT?

In the first few weeks after HSCT, patients are at a risk of infections. Hence they are kept isolated in rooms where the air is filtered to prevent fungal infections (HEPA filter). The patient's food is prepared fresh to keep a low bacterial load.

In allogeneic HSCT, the donor cells can attack the recipient's body, this is called GVHD. Usually this can be prevented and controlled.

Occasionally the donor stem cells may be rejected and thus fail to produce a new marrow.

Does stem cell donation harm the donor?

Less than 1% of the donors will have serious complication. They do not lose anything since their body will continue to produce new stem cells.

What is the success rate of HSCT?

This depends on the reason for which the transplant is being done and also on the fitness of the patient. The success rate varies from 30% in uncontrolled blood cancers to 80% in young, fit patients with aplastic anemia who can be transplanted quickly before they develop serious infections or bleeding.

Restoring Hope:

Arwa is a newly married, 26 years old lady who was diagnosed to have aplastic anemia and was sent to us for a BMT from Yemen. We evaluated her and found out that her sister has a complete HLA match with her. Arwa then received chemotherapy to suppress her own marrow and the donor stem cells were then given to her. The new marrow grew as expected and her blood counts became safe by day 14.

She did not have any major complications during the BMT. We regularly followed her in the outpatient clinic until day 100 post-BMT and then she went back to Yemen. Now she has come for her first post-BMT follow-up. Her new bone marrow is working well and her blood counts are normal.

She does not have any evidence of Graft versus host disease either. Her immunosuppression (cyclosporine) is being tapered and she will continue to return for follow-up every 3 months for at least one more year.

 

 

 

*Disclaimer
*Disclaimer: This is not medical advice. The content is for educational purposes only. Please contact your doctor for any health care issues.