Bone Marrow Transplant: Way to cure

More than 2000 Bone marrow transplant happens in India every year and numbers are steadily increasing. Largely contributed by increasing BMT centres, access to standardised care and newer technologies making it safe procedure. Bone marrow transplant (BMT) or stem cell transplant is a lifesaving therapy in which healthy blood-forming stem cells are transfused into body to replace diseased bone marrow that is not producing enough healthy blood cells or if it is affected by cancers.

It is beneficial in treatment of Acute/Chronic leukaemia’s, Lymphomas, Multiple myeloma, Neuroblastoma, Myelodysplastic syndromes, Aplastic anaemia, Haemoglobinopathies like thalassemia, Immune deficiencies, Inborn errors of metabolism.

Bone marrow is the soft, spongy tissue found inside bones. It is the site where most of the body’s blood cells develop, stored and finally released in peripheral circulation. Stem cells are the parent cells generally found in marrow & are capable of differentiating into white blood cells, red blood cells, platelets. These stem cells are used for BMT.

Stem cell transplant can be an Autologous or Allogenic. In autologous transplant, the donor is the patient himself. Stem cells are taken from the patient either by bone marrow harvest or apheresis (a process of collecting peripheral blood stem cells), frozen, and then given back to the patient after intensive treatment. Whereas in allogeneic bone marrow transplant, stem cells are taken from a genetically matched donor, usually a brother or sister & rarely from parents or genetically matched unrelated donors, which can be searched on national bone marrow registries. Another type of allogeneic transplant uses stem cells from the blood of umbilical cords (cord blood transplant).

Genetic matching is done in specialised transplant immunology (HLA) labs where donor and recipient blood are tested for Human leukocyte (HLA) antigen. Following initial transplant work up, recipient goes through a process known as conditioning where he receives chemotherapy and possibly radiation to destroy cancer cells that may spread to other parts of the body, to suppress immune system & to prepare bone marrow for the new stem cells.

After this myeloablative therapy, stem cells are infused into the bloodstream, similar to blood transfusion. The transfused stem cells find their way into the bone marrow and begin reproducing and growing new, healthy blood cells, this process is known as engraftment. Depending on type of transplant and disease being treated, engraftment generally happens around day 15 th or 30 th day.

Regular blood counts are checked for monitoring of successful engraftment. Intercurrent infections, low donor stem cells count, graft failure & medicines can lead to delayed engraftment. After bone marrow transplant, some of the patients can have complications like infections, respiratory distress, bleeding due to low platelets, graft failure and Graft vs host disease. Graft-versus-host disease (GVHD) can be a serious and life-threatening complication of a bone marrow transplant. GVHD occurs when the donor’s immune system reacts against the recipient’s tissue. The long-term outcome of BMT depends on patient age & overall health, type of transplant, HLA matching, type and severity of disease being treated, disease response to treatment, and compliance to medications, severity of complications etc. and it varies from patient to patient.?

With number of increasing transplant done for various diseases and advancement in medical field, newer technologies have greatly improved the outcome for bone marrow transplant. Continuous follow up care is essential for the patient following a bone marrow transplant. Team of transplant specialists consisting of Medical oncologist/ Haematologist specialised in transplant, Lab Transplant immunologist, Nurse Cordinator, Social worker, Dietician, and physiotherapist, GI & respiratory

specialist, all individuals work together to give the best chance for a successful bone marrow transplant. Still there is large gap between demand and supply, which needs to be bridged & BMT should be made at viable costs.

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