Blood and Bone Marrow Transplant
A bone marrow transplant is a procedure that replaces damaged or diseased bone marrow cells with healthy blood-forming stem cells. A bone marrow transplant is also called a stem cell transplant or more specifically, haematopoietic stem cell transplantation (HSCT). It is performed when the bone marrow stops working and does not produce healthy blood cells.
Fortis Hospitals Mumbai, Bone Marrow Department provides comprehensive care for patients of all age-groups requiring bone marrow transplantation to treat a variety of blood disorders including cancers. Our transplant team comprises of experts with extensive experience in performing modern transplantation techniques for adults and children, such as autologous transplant (with patient’s own cells), allogeneic transplant (with donor cells) and/or cord blood transplant (with umbilical cord cells). Centre’s state-of-the-art bone marrow transplant facility utilises a collaborative approach, working across departments like haematology, infectious diseases, oncology and paediatrics, to provide customised care to patients based on the clinical condition, for example, a bone marrow transplant can also be performed as an outpatient procedure at the hospital.
The 6-bedded unit, is the largest such unit in the eastern suburbs of the city. The infrastructure in this wing has been planned and executed, keeping the patient at the centre of care. The design is of international standards incorporating world-class, robust infection control practices.
Each room has its own Air Handling Unit (AHU) with an automatic and selective control system that creates positive air pressure inside the room. Thus, no outside air is allowed to enter the patient’s room, ensuring infection prevention. The HEPA (High Efficiency Particulate Air) filters installed can absorb the minutest of particles like pollen, dust, moisture, bacteria, virus etc. helping to maintain a purified environment.
Every room functions like an independent intensive care unit, fully equipped with centralized oxygen and suction system, six parameter monitors for monitoring heart rate, breathing rate, blood pressure, oxygen saturation, central venous pressure and ECG, infusion and syringe pumps.
We are leading in the city for the best surgical outcomes, at par with international standards. Pivotal to our bone marrow transplant program is the psychosocial and mental wellbeing support, health education and advanced care accessible to the patient and the family throughout the clinical journey. Patient is actively involved in understanding the risks and benefits of the care plan, to enable a smooth transition post-transplant, to lead a longer, better quality of life.
Our multi-disciplinary bone marrow transplant team ensuring personalised care:
- Bone marrow transplant surgeons
- Infectious diseases specialists
- Well-trained transplant nurses, transplant coordinators, social workers, psychologists and clinical nutritionists
Our Blood Bank has leading Transfusion Medicine experts taking care of the stem cell collection (apheresis method), cryopreservation and 24x7 services related to blood platelet and blood products.
The team is well supported by intensive care specialists, radiologists and clinical pharmacologists.
Our team has performed more than 50+ bone marrow transplants.
What are stem cells?
Stem cells are special cells with the ability to make copies of themselves and change into different kinds of cells that the body needs. They can be found in different parts of the body at different times. Haematopoietic stem cells are stem cells that turn into blood cells. The bone marrow is a soft, spongy tissue found in most bones of the body and it contains hematopoietic stem cells. These cells are also found in the blood that is moving throughout the body. Cancer and cancer treatment can damage hematopoietic stem cells; this means they may not turn into red blood cells, white blood cells and platelets.
Blood cells are crucial and they perform the following functions in our body:
- Red blood cells - transport oxygen throughout the body. They also carry carbon dioxide to the lungs so it can be exhaled.
- White blood cells - are a part of the immune system and fight the disease-causing viruses and bacteria.
- Platelets - help in forming clots to stop bleeding.
The bone marrow transplant procedure replaces healthy stem cells in the blood, thereby restoring the body’s ability to create red blood cells, white blood cells and platelets, that it requires.
When is a bone marrow transplant needed?
Cancer and treatment for cancer can damage stem cells in the body. A bone marrow transplant is used to:
- Safely continue treatment for clinical conditions requiring high doses of chemotherapy or radiation, by replacing the damaged bone marrow.
- Replace the damaged/diseased bone marrow with new stem cells.
- Supply new stem cells, which can help kill cancer cells directly.
Bone marrow transplantation technique can benefit patients with a variety of benign and malignant cancers, including:
- Severe aplastic anemia
- Multiple myeloma
- Immune deficiency disorders
What are the different types of bone marrow transplants?
There are different types of bone marrow transplants. The two main types of transplants depends on who serves as the donor.
Autologous transplant - uses an infusion of the patient’s own stem cells to restore the body’s ability to make healthy blood cells. In this procedure there is no need to check for compatibility unlike the donor transplant. This option is used when the body is producing enough healthy bone marrow cells, which can be collected, frozen and stored for later use.
Allogeneic transplant - uses donor cells to provide patients with new blood cells after cancer treatment. Finding a donor match is a necessary step for an allogeneic transplant. A healthy donor’s blood proteins called human leukocyte antigens (HLA) should closely match with the patient. Siblings from the same parents are often the best match, but another family member or an unrelated person can be a match too.
The blood stem cells used in an allogeneic stem cell transplant can be collected from the:
- donor's blood
- bone marrow of the donor's hipbone
- blood of a donated umbilical cord
Preparation for a bone marrow transplant
If the preferred mode of treatment for the patient is a bone marrow transplant, a series of tests are conducted to evaluate the patient’s clinical condition such as:
- Blood tests (including exposure to Hepatitis and HIV)
- Bone marrow biopsy
- Heart test (ECG)
- Lung test (pulmonary function tests)
- Chest x-ray
- Dental x-ray
Also, a surgeon or a radiologist implants a long thin tube (intravenous catheter) into a large vein in the patient’s chest or neck. The catheter (often called a central line) usually remains in place for the duration of the entire treatment and is used by the transplant team to infuse transplanted stem cells, medications and blood products into the patient’s body.
Bone marrow transplant techniques
The bone marrow transplant begins with a preparation therapy called conditioning that includes chemotherapy, with or without radiation. This is done to destroy cancer cells, suppress the immune system and prepare the body for new bone marrow cells. The stem cells are collected for the transplant before the conditioning process begins:
- Stem cells are collected from patient or donor’s blood in a procedure that’s similar to blood donation. This process is called apheresis. The blood is collected from the vein through the earlier placed catheter.
- The blood spins through the apheresis machine that selects the stem cells, rest of the blood is returned to the patient or the donor through the catheter.
- In case patient’s own stem cells are to be infused, the stem cells are frozen and stored until needed. In case of donor donated stem cells, infusion happens on the day they are collected.
The conditioning and transplant maybe done as an outpatient or inpatient procedure. Periodic transfusions of red blood cells and platelets may also be needed until patient’s bone marrow starts producing enough of those cells on its own. In time, the new stem cells begin producing healthy blood cells. This process is called engraftment. It may take several weeks for the number of blood cells to return to normal.
Post the transplant, patient is closely monitored by the care team for any infections, side-effects etc. In case of an allogeneic transplant, doctors may prescribe medications to help prevent graft-versus-host disease (donor stem cells that now make up the new immune system see the body’s tissues and organs as foreign and attack them).
After the bone marrow transplant
After the bone marrow transplant, the care team may recommend a clinical nutritionist to help create a healthy-eating plan that meets the patient’s needs and lifestyle. The nutritionist can also give dietary suggestions to control side effects of chemotherapy and radiation, such as nausea. Some of the dietary recommendations may include:
- Avoid food and drinks that carry risk of foodborne infections
- Avoid alcohol
- Eating a wide variety of healthy food to give the body nutrition it needs
- Limiting salt and sodium intake
The doctor may even recommend lifestyle changes, which may include:
- Avoid tobacco
- Keep the home clean and free of mold
- Limit time in sunlight because the skin maybe more sensitive
- Regular physical activity to control weight, slowly increase physical activity as recovery happens