Bone Marrow Transplantation
The spongy tissue inside the bone is called as the bone marrow. Bone marrow is responsible for the generation of various types of blood cells like RBCs, WBCs and platelets that carry out various important functions. Due to certain diseases affecting the bone marrow, the production of blood cells is interfered with, leading to various serious and potentially fatal complications. In these situations, bone marrow transplantation is the only option to save one’s life.
Now let’s look at the various disorders that can affect the bone marrow:
The most common disorders that affect the bone marrow are the various types of bone marrow cancer. Some of the most important types of Bone Marrow Cancer are:
1. Multiple Myeloma occurs in the plasma cells and is the most common. It is predominantly seen in males over the age of 65.
2. Lymphomas are of two types- Hodgkins and Non-Hodgkins lymphomas. Increased age, exposure to chemicals, radiation, chemotherapy, HIV infections, obesity etc are known risk factors.
3. Leukaemia is of two types-Myeloid or lymphocytic and could be acute or chronic. Acute myeloid leukaemia (AML), chronic myeloid leukaemia (CML), acute lymphocytic leukaemia (ALL) and chronic lymphocytic leukaemia (CLL).
Symptoms of bone marrow cancer:
Symptoms may vary depending upon the type of cancer and may vary from person to person. Some of the common symptoms are:
• Persistent and recurrent fever
• Loss of weight
• Loss of appetite
• Pain in the back
• Tenderness of the bones
• Swelling of the bones
• Increased susceptibility to fractures of the bone
• Recurrent infections
• Shortness of the breath
There are certain other diseases affecting the bone marrow that could warrant bone marrow transplantation. Some of them are:
• Aplastic anaemia
• Sickle cell anaemia
• Bone Marrow depression resulting from radiation or chemotherapy treatments
All these situations are dire and the patients require transplantation of the bone marrow at the earliest. Bone marrow transplantation procedure is undertaken in all major medical institutions around the world but the cost of the procedure varies significantly from country to country. Bone Marrow transplant cost in India is one of the lowest among medically advanced countries where the facilities are available. There are many super speciality hospitals that offer bone marrow transplant in India with a very high degree of success.
Types of bone marrow/Stem cell transplant and bone marrow transplant procedure:
There are various methods of bone marrow transplant depending on the source of the bone marrow:
• Autologous transplant: In an autologous transplant, the bone marrow is sourced from one’s own body and is ideal for situations where the patient may suffer from bone marrow depression because of radiation or chemotherapy. Functional stem cells are sourced from the large bones prior to the treatment and reintroduced into the body after the treatment is over.
• Allogeneic transplant: In an allogeneic transplant, bone marrow donation is done by another person who is genetically similar to the person who needs the transplant. Usually, close relatives like siblings, parents etc are the ideal donors but in certain cases, non-relatives may also qualify as potential donors. The bone marrow is harvested from the donor by using special syringes and needles from the hip bones under general anaesthesia. It is then transplanted to the recipient.
• Cord blood transplant: Placental cord blood is harvested and stored for potential use in the future. These placental stem cells are then used if any necessities arise in the future.
• Peripheral blood stem cell transplant: done by a process called Apheresis where blood is taken out from the donor to extract the stem cells by passing it through special apparatus through an IV line starting from one arm and reintroduced into the body through an IV line in the other arm. The procedure is repeated until an adequate amount of stem cells are harvested. These stem cells are transplanted to the recipients for the regeneration of a healthy bone marrow.
Prior to transplantation procedure, radiation or chemotherapy is performed with the aim of destroying the diseased bone marrow and other cancer cells to make space for the transplanted bone marrow. Immuno-suppressants are also administered to reduce the immunity of the body to prevent the rejection of the bone marrow graft.
Risks and complications:
• Graft Versus Host Disease (GVHD) where donor cells attack the recipient's body cells
• Graft failure
• Occurrence of internal Bleeding problems
• Development of cataracts
• Side effects like decreased blood pressure, headaches, nausea, pain, shortness of breath, chills, fever might occur frequently
Dos and Don’ts:
• Take medicines as prescribed
• Follow guidelines prescribed for healthy diet and food handling
• Give enough rest to the body
• Don’t expose yourself to situations that can cause an infection
• Don’t ignore the mildest of infections
• Don’t ignore symptoms of GVHD like skin blisters, rashes, nausea, jaundice etc.