Bone marrow transplant : Finding bone marrow transplant specialists for bone marrow transplant

Some of our bones are solid plates of calcium. Some of the other bones like the thigh and hip bone however consist of solid plates and inner spongy bone marrow. Bone marrow is a specialized kind of connective tissue, found filling up the central cavity of bones. The bones such as the hips (the iliac crests) and the breastbone (the sternum) have bone marrow in abundance. Bone marrow has a major job to do – it produces blood and blood cells, on a regular periodic basis. Blood cells have a cyclical production, because like all other cells of the body, they have a limited life span too.

What are the blood cells produced by the bone marrow ?
Bone marrow produces blood cells. These include white blood cells, red blood cells and platelets. There is a cell population called the “STEM CELLS” which are the immature blood cells or “parent” cells also found in the bone marrow. These give rise to the three above- mentioned mature blood cells. The white cells are the infection fighters of the body, the red cells are the oxygen carrying delivery system of the body and the platelets are responsible for the clotting mechanism of the body. All the three types of cells are crucial for the functioning of the human body in the normal state as well as in infections, injuries and wound repair.

What is a bone marrow transplant procedure ?
In a nutshell, bone marrow transplant is a procedure wherein old bone marrow cells are replaced by new cells. A bone marrow transplant, essentially, restores and resuscitates the older marrow to generate new and healthy blood cells. In the 1970s, bone marrow transplantation (BMT) was still very much an experimental procedure, but now it has become an established procedure.

When is a bone marrow transplant needed ?
A bone marrow transplant is needed if your existing bone marrow gets so badly damaged that it is unable to carry out its functions.

• If your existing bone marrow is diseased, it would have to obliterated or removed, if it is seen containing either cancer cells or other kinds of pathological/ diseased blood cells (such as sickle cells in sickle cell anaemia). The new marrow is then brought in to replace the old marrow.
• If your existing bone marrow becomes deficient, then also a bone marrow transplant is needed.
• If you need to undergo strong chemotherapy, for treatment of cancers. The tumour cells get targeted and destroyed by high dose chemotherapy. But then again, this same chemotherapy destroys even your normal bone marrow and blood cells. The existing bone marrow is not sufficiently strong to endure high dose chemotherapy. The bone marrow transplant is then given as a way for the old marrow to regenerate, allowing for growth of new bone marrow and emergence of new blood cells.

Bone marrow transplant has now become the treatment of choice for an extensive spectrum of diseases. These include haematological disorders and cancers, which need chemotherapy and/or radiotherapy for their treatment.

Bone marrow and stem cell transplants are the choice of treatment for many diseases. Among these are certain blood cancers like leukemia and lymphoma; tumours like neuroblastoma; blood diseases like aplastic anaemia and sickle cell disease; and immune and genetic diseases. The bones such as the hips (the iliac crests) and the breastbone (the sternum) have bone marrow in abundance. Hence, these sites become representative sites for bone marrow harvesting or bone marrow testing.

One of the most common causes of an acquired bone marrow deficiency is aplastic anemia. Aplastic anemia is a relatively rare hereditary or immune disease in which our bone marrow and the hematopoietic stem cells that reside therein are damaged. This results in an ensuing deficiency of the three blood cell types: red blood cells (the deficiency is known as anemia), white blood cells (the deficiency is known as leukopenia), and platelets (the deficiency is known as thrombocytopenia. Other diseases that show all the signs and symptoms of bone marrow failure are myelodysplastic syndromes (myelo is defined as spinal cord or bone marrow) and variants of leukemias.

Aplastic anemia, myelodysplastic syndromes, sickle cell anemias, thalassemias, or any bone and blood cancers can cause damage of bone marrow. To name the cancers, these can include multiple myeloma, lymphomas and leukemias.

Is there a difference between bone marrow transplant and a stem cell transplant ?
When the bone marrow acts as the source for stem cells in a patient, it becomes a bone marrow transplant. When the bloodstream, acts as the source for stem cells in a patient, it becomes a blood stem cell transplant also otherwise known as a stem cell transplant. Whether the terms “stem cell transplant” or “bone marrow transplant,” is used, they mean the same transplantation procedure. The only thing that varies is the source of the stem cells.

What are the types of bone marrow transplants ?

There are two categories of transplant.

1. An autologous bone marrow transplant : It is called so when the patient’s own bone marrow or stem cells will be used in the transplantation. It is in essence a self-donation.
2. An allogeneic bone marrow transplant : It is called so when the bone marrow or stem cells from a donor are used. The important thing is that the donor stem cells should have a compatible human leukocyte antigens (HLA) match to the patient’s.

The stem cell donor may be any of the following types.

• Allogeneic (Donor) Transplants Using Matched Sibling (done most commonly).
• Allogeneic Transplants Using Unrelated Donors.
• Allogeneic Transplants Using Haploidentical (or Half-Matched) Donors.

What is haploidentical donor bone marrow transplant ?
A haploidentical (Half Matched) bone marrow transplant is a type of allogeneic bone marrow transplant wherein healthy, blood-forming cells obtained from a half- matched donor is used to replace the unhealthy ones. The donor is usually a family member, even if not a sibling. For these allogeneic transplants as mentioned above, the human leukocyte antigen (HLA) type should match in both donor and recipient. In case you are wondering what is the human leukocyte antigen (or HLA) system is ?, it is a gene complex encoding the major histocompatibility complex (MHC) proteins in humans. These proteins are cell surface molecules responsible for making antigens that play a key role in acceptance or rejection of organ transplants.

What is umbilical cord blood transplant ?
This is again a type of allogeneic transplant. These days, stem cells are removed from a newborn baby’s umbilical cord or placenta right after birth. These stem cells are then frozen and stored until they are needed for a transplant. The unique feature is that umbilical cord blood cells are very immature so there is less of a need for perfect matching. Due to the smaller number of stem cells obtained from the umbilicus, blood counts take much longer to recover.

Who are the donors in bone marrow transplants ?
There are different types of donors as well.

• Related donor transplant: It could be a parent or a sibling.
• Unrelated donor transplant: It could be from an unrelated donor, but this donor has to be matched to the transplant recipient.
• Syngeneic transplant: From an identical twin.
• Cord blood transplant: The placenta, or the umbilical cord, which connects the mother and the baby is a rich source of stem cells. This serves as a source for the transplant.

What do you have to undergo prior to a bone marrow transplant ?

• Firstly, the transplant team decides the need for a bone marrow transplant for you. You will be educated about bone marrow transplants, what the procedure entails and what might be the complications and asked to sign consent forms. A donor search is started to get a matched donor.
• Secondly, you will be made to undergo several tests including organ function tests. Basically, your health status will be cross-checked with a complete medical examination to determine your eligibility for the marrow transplant. You should take care to secure your finances either through insurance or other caregiver plans.
• Thirdly, the disease for which you are getting a marrow transplant needs to be assessed. If you have either leukemia or cancer affecting the bone marrow, a spinal tap, a bone marrow biopsy or an aspirate of the bone marrow will have to be done. Other tests include MRIs, PET/CT Scans, Echocardiogram, Chest X-Ray, Blood Work-up and Urinalysis.
• Fourthly, you will have to visit other specialty departments as well. There is a possibility of infertility, not because of the marrow transplant but because of the chemotherapy or radiation therapy you receive prior to the transplant. Visit a fertility specialist and get your sperms/ eggs banked, if necessary. Get your dental work-up also done, prior to the transplant.

What are the steps of the bone marrow transplant procedure ?
To concise it, we have drawn up an overview of the main steps involved in bone marrow transplant procedure.

1. Initial consultation: Your health care and transplant team will explain the transplant process in detail and clear all your doubts before your treatment begins. Most transplant teams offer classes and sessions to help patients and caregivers prepare for the necessary transplant and recovery.
2. Planning ahead: This involves preparation and conditioning financially, mentally and physically. Once you begin treatment, your transplant team will help you and your family navigate the entire process. You will have to regularly visit the hospital to get the necessary investigations and tests done.
3. Bone marrow transplant: The transplant procedure is described in detail below and involves the harvesting from donor and insertion into the recipient. The bone marrow or the blood flowing through your body, contains the progenitor cells or stem cells. Harvesting is nothing but the procedure to collect and gather stem cells. There are two different ways that bone marrow cells can be harvested – Bone marrow harvest and Peripheral blood stem cell harvest. In a bone marrow harvest, doctors obtain bone marrow cells (stem cells) from the hip bone of the donor. The donors will be put to sleep (under general anesthesia) for the procedure, so they do not feel the discomfort of the procedure. In peripheral blood stem cell harvest the stem cells are collected or harvested from the peripheral bloodstream. At any given moment, there are stem cells present in your blood stream, traveling from one bone marrow site to another. An apheresis machine is what it takes to filter and separate out the necessary stem cells from the bloodstream. The duration of collection could vary between 1-4 days to amass adequate stem cells for the transplant. This procedure does not require general anesthesia.
4. Recovery after engraftment: After your transplant, the long-term follow-up team will be there to provide you with care and support.
5. Long-term recovery

How does life change after bone marrow transplant ?

1. Physical health and recovery: It is important for you and your caregivers to be prepared for the recovery period after transplant as this takes time.
2. Follow-up appointments: Plan with your doctor for the follow-up appointments. You can consult with your doctor and hospital transplantation team about the care and precautions you will have to take.
3. Medication: The regimen will include immune-modulating drugs, to prevent Graft Vs. Host Disease as well as drugs to prevent or treat infections. These will include antibiotics, antifungals, and antiviral medicines. You will probably need many blood transfusions. An intravenous (IV) line will be inserted until you can eat by mouth and stomach.
4. Rejoining work after a bone marrow transplant: Doctors typically recommend allogeneic transplant recipients to wait at least 1 year after transplant before going back to work. The reason for that is that it takes 9 to 12 months for your immune system to recover. You should feel upto it physically as well as prevent yourself from risk of infections.

What are the complications of a bone marrow transplant ?

• There may be an increased chance of contracting infections as white blood cell counts are still recovering. As even the red cell and platelet counts are still recovering, there is a possibility of anaemia and bleeding.
• The most common complication is Graft-versus-host-disease (GvHD). It can occur as an immediate complication or as a delayed complication. Symptoms include feeling of sickness, dryness, fatigue, jaundice, diarrhoea and rashes over the skin.

What is the outlook (or prognosis) of a bone marrow transplant ?
The outcome of how well you do after the transplant depends on the following factors.

• The type of bone marrow transplant that you are getting.
• How well the donor’s cells match yours (HLA Matching) ?
• The type of cancer or illness that you are getting the transplant for.
• General factors like your age and overall health.
• The amount and type of chemotherapy or radiation therapy you had before your transplant.
• Any other complications or diseases you may have.

Bone marrow transplants may either completely or partially cure your illness. If the transplant is successful, you can return for the most part to your normal activities as soon as you feel recovered enough. Usually it takes upto about a year to recover fully. It is important to know that transplantation is a serious procedure, and that complications or failure of the transplant can lead to death.

How to find and reach bone marrow transplant specialists for bone marrow transplant procedure ?
Now you can find and reach bone marrow transplant specialists from different hospitals and destinations on a single platform, Hinfoways. You can avail opinions and information from multiple bone marrow transplant specialists, get cost estimates for bone marrow transplant from different hospitals, compare things and then choose a bone marrow transplant specialist or a bone marrow transplant hospital for bone marrow transplant procedure.

Find, reach and choose a bone marrow transplant specialist for bone marrow transplant procedure on Hinfoways. Make an informed choice.

Disclaimer: The content provided here is meant for general informational purposes only and hence SHOULD NOT be relied upon as a substitute for sound professional medical advice, care or evaluation by a qualified doctor/physician or other relevantly qualified healthcare provider.