Bone marrow transplants are a critical therapy for many severe diseases such as some forms of cancer and blood diseases. This is a complicated process of transplanting healthy bone marrow in place of the unhealthy one which can assist the body to produce blood cells. In this guide, we will explain everything you need to know about bone marrow transplant, from the procedure to life after bone marrow transplant.
What is Bone Marrow Transplant?
A bone marrow transplant is a treatment process in which the damaged or diseased bone marrow is replaced with healthy bone marrow. Bone marrow is the soft, red tissue found in the cavities of bones and is responsible for the production of blood cells such as red blood cells, white blood cells and platelets. When bone marrow is diseased or destroyed by some treatment such as chemotherapy, it cannot produce these important blood cells as it used to.
A bone marrow transplant is a treatment process in which the damaged or diseased bone marrow is replaced with healthy bone marrow. The American Society of Clinical Oncology reports that survival rates for patients receiving a transplant can exceed 60-70%, depending on the disease type and stage at which the transplant is performed.
The procedure involves two main types of transplants:
- Autologous Transplant: In this type, the patient’s own bone marrow or stem cells are harvested, processed and then infused back into the patient.
- Allogeneic Transplant: This type employs the use of bone marrow or stem cells from a third party. The cells that are to be donated must be compatible with the patient’s tissue type to minimize the chances of rejection.
The Bone Marrow Transplant Procedure
The bone marrow transplant procedure involves several key stages:
Pre-Transplant Evaluation
- Assessment: The patient is first subjected to a medical check-up to determine his or her fitness for the procedure. This comprises laboratory investigations, radiological investigations and general clinical investigations.
- Donor Matching: In the case of allogeneic transplants, the donor is important and the search for a suitable donor is done. The patient’s tissue type (human leukocyte antigen (HLA) tissue) is matched against possible donors and a match is found. The donors can be related or unrelated but the tissue type of the donor and the recipient should be compatible to reduce rejection. A study published in NCBI emphasizes that HLA matching is crucial, as a higher degree of compatibility can lead to better transplant outcomes and lower rates of graft-versus-host disease.
Pre-Transplant Preparation
- Conditioning Regimen: Before the transplant, the patient receives a preparative regimen, which often includes high-dose chemotherapy and/or radiation. This treatment kills the affected bone marrow and weakens the immune system in order to receive the new one.
- Stem Cell Collection: In autologous transplants, stem cells are harvested from the patient’s blood or bone marrow before the start of conditioning. In allogeneic transplants, stem cells are harvested from the donor by a process known as apheresis or directly from the donor’s bone marrow.
The Transplant Procedure
- Infusion: The collected stem cells are then administered back into the patient’s body through a central line just like a blood transfusion. The new stem cells go to the bone marrow and start to make new blood cells.
Post-Transplant Care
- Recovery: The patient will then be transferred to a high dependency unit where he or she will be observed for any adverse effects of the transplant. The recovery period entails dealing with side effects and making sure that the new bone marrow is working as it should.
- Monitoring: It is therefore important to have follow up appointments to check on the patient and also check for any complications that may arise.
Bone Marrow Transplant Cost
The cost of this procedure is not negligible, and the cost may differ depending on the type of transplant, the patient’s condition, and the facility. The average cost is between 15,00,000 to 40,00,000/- rupees or more in India. This encompasses the pre-transplant assessment, the transplant surgery, the hospitalization, the drugs, and the follow-up care. There are insurance coverage and financial assistance programs that can assist in paying for some of these expenses. This means that one has to engage the healthcare providers and financial advisors to determine the expenses and options.
Bone Marrow Transplant Donor
The search for a compatible donor is one of the most important steps in the bone marrow transplant. In case of an allogeneic transplant, the donor has to be a match with the patient in terms of tissue type. The selection of donors is usually done according to the HLA typing, which should be as close to the patient’s as possible. Potential donors may include:
- Family Members: Siblings are usually the first to be tested since there are high chances that they will be a match. However, other family members may also be potential donors.
- Unrelated Donors: In case of non-availability of family donors, other sources of unrelated donors can be searched through national as well as international registries.
The process of becoming a donor is as easy as a blood test or a swab to check for HLA compatibility. Selected donors will be subjected to further tests and training in order to donate their stem cells.
Bone Marrow Transplant Side Effects
This treatment process is very effective but it comes with some aftereffects too. The side effects depend on the patient, the type of transplant, and the preparative regimen that is used. Common side effects include:
Graft-Versus-Host Disease (GVHD)
In allogeneic transplants, the donor’s immune cells can react against the patient’s tissues leading to GVHD. This condition may be mild or severe and may involve the skin, liver, and the digestive system.
Infections
The conditioning regimen also weakens the immune system of the patients and therefore they are prone to infections. The patients are observed and given antibiotics and antifungal drugs if necessary.
Fatigue and Nausea
Some of the side effects that patients are likely to develop during the recovery process include fatigue, nausea, and loss of appetite. These symptoms can be alleviated by supportive care and medications.
Organ Toxicity
Tumor related high dose chemotherapy and radiation therapy may have an impact on organs like heart, lungs and kidneys. These are some of the possible effects that need to be closely monitored and require supportive care.
Life After Bone Marrow Transplant
After this procedure, the patient has to undergo several follow-ups to check the functioning of the new marrow and to address the side effects. Patients will be seen in the clinic at regular intervals to check their blood counts, organ function and to look for any signs of complications.
Key aspects of life after a bone marrow transplant include:
Adherence to Medications
Patients will require immunosuppressive drugs to avoid GVHD and other related side effects. It is very important to take the prescribed medications as directed to ensure a good recovery.
Lifestyle Adjustments
Eating a proper diet and exercising can also help in the recovery process and improve the general health of the patient.
Emotional Support
It is important to know that the transplant journey can be emotionally demanding. Psychotherapy and support groups can be useful to the patient and the family in coping with the psychological issues of rehabilitation.
Conclusion
Bone marrow transplants are a complicated but possibly curative treatment for patients with certain blood diseases and malignancies. From the procedure to the costs and the side effects, it is crucial to go through the process with adequate knowledge and assistance. For anyone who is a candidate for bone marrow transplant or a family member of such a person, it is important to work with a committed medical team to get the best results and the highest quality of life.
