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 hematopoietic stem cell transplantation (HSCT). It is performed when the bone marrow stops working and does not produce healthy blood cells.
Fortis Hospitals Mumbai, India, 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 experts with extensive experience in performing modern transplantation techniques for adults and children, such as autologous transplant (with the patient’s cells), allogeneic transplant (with donor cells), and cord blood transplant (with umbilical cord cells). Centre’s state-of-the-art bone marrow transplant facility utilizes a collaborative approach, working across departments like hematology, infectious diseases, oncology, and pediatrics, to provide customized care to patients based on their 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 center of care. The design is of international standards incorporating world-class, robust infection control practices.
Best Hospital for Blood and Bone Marrow Transplantation in India
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, and six parameter monitors for monitoring heart rate, breathing rate, blood pressure, oxygen saturation, central venous pressure, ECG, infusion, and syringe pumps.
We are one of the leading hospitals in India for the best surgical outcomes, at par with international standards. Pivotal to our bone marrow transplant program is the psychosocial and mental well-being support, health education, and advanced care accessible to the patient and the family throughout the clinical journey. The 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.
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. Hematopoietic 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 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 the 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 hematopoietic stem cell 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:
Leukemias
Severe aplastic anemia
Lymphomas
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 depend on who serves as the donor.
1. Autologous transplant
Uses an infusion of the patient’s 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.
Autologous transplant is used to treat:
Multiple myeloma
Relapse lymphoma
2. 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
the bone marrow of the donor's hipbone
blood of a donated umbilical cord
Allogenic transplant is used to treat:
Acute Leukaemia
Aplastic Anaemia
Bone marrow failure disease
Thalassemia
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 tests (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 a 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 the patient’s stem cells are to be infused, the stem cells are frozen and stored until needed. In the case of donor-donated stem cells, infusion happens on the day they are collected.
The conditioning and transplant may be done as an outpatient or inpatient procedure. Periodic transfusions of red blood cells and platelets may also be needed until the 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, the 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 the side effects of chemotherapy and radiation, such as nausea. Some of the dietary recommendations may include:
Avoid food and drinks that carry the risk of foodborne infections
Avoid alcohol
Eating a wide variety of healthy food gives 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 may be more sensitive
Regular physical activity to control weight, slowly increase physical activity as recovery happens
Range of Hematology Services
Allogeneic stem cell transplant
Autologous stem cell transplant
Blood transfusion
Cord blood transplant
Day-care chemotherapy
Myeloablative conditioning
Outpatient transplant
Reduced-intensity conditioning
How to get to us and find the hospital
At Fortis Hospitals Mumbai, India we have access to modern equipment and the best healthcare facilities for Bone Marrow Transplant(BMT) patients across the globe.
How successful is bone marrow transplant in India?
Bone Marrow Transplant in India has a phenomenal success rate ranging from 60 to 90%. More than 19000 transplants have been completed in India till date (Source: ICMR, January 2021)
BMT is the standard of care for many benign and malignant diseases. It is an integral part of several cancer treatment protocols. For a successful BMT, a close match of the donor's bone marrow stem cells and that of the recipient is essential. Fortis Hospital Mumbai has a high success rate of bone marrow transplant in India with over 100+ BMTs in Indian and international patients across all age groups.
What is the cut-off age (eligibility) for a bone marrow transplant?
Bone marrow cell donors and recipients of all ages who meet strict health criteria are eligible for bone marrow transplant. This means both, the donor and the patient who is to receive the donor bone marrow cells, will undergo stringent tests to check for underlying risks and heath issues that could restrict the treatment.
While younger donors under the age of 65 years are preferred for BMT, transplant recipients age can be extended upto 75 years if they are otherwise fit and without accompanying severe illness.
How long can a person live after bone marrow transplant?
The encouraging news is that the risks or complications following bone marrow transplant are decreasing according to medical research. This is making it possible for more people to live longer after a successful BMT.
The general estimated survival rate following BMT is 80%; this means that the person can live a healthy life for many years after a BMT. If the BMT is done when the cancer is in its first remission, the long-term disease-free survival rate (> 5 years) is more than 50%. In fact, 25 - 40% of the individuals over 60 years who receive BMT are estimated to survive for three years or more.
The success rate of BMT varies from person to person, depending on the stage and type of cancer, general health condition according to age, and the source of the stem cells.
In autologous BMT, the success rate is greater than 95%.
Can leukemia be cured after bone marrow transplant?
There are four common types of leukemia. Of these, Acute Leukemia is the highly curable form of adult leukemia. This is attributed to the advances in the diagnosis and high-precision treatment of this type of blood cancer. Cure rates of 80-90 percent following bone marrow transplant have been reported from centers specializing in acute leukemia treatment, including Fortis Hospital in Mumbai, India.
Which family members can donate bone marrow?
Seeking a bone marrow donor within the family is the first option. A brother or sister is most likely to be a perfect match as a donor. This is called a matched sibling donor transplant. There’s a 1 in 4 chance of the bone marrow cells matching among siblings. One’s parents, own children, and other relatives can sometimes be good matches. Only about 30% of those who need a bone marrow transplant can find a matching donor in their own family.
Is bone marrow transplant painful?
The transplant procedure is not painful because it is not surgery. In fact, it is similar to a blood transfusion. The bone marrow cells are infused into the vein directly through a thin catheter or intravenous tube. This process could take a couple of hours and the recipient is awake throughout.
Can you walk after a bone marrow transplant?
Recovery after a bone marrow transplant is gradual but most patients can walk throughout the transplant period barring a few days time when they have low blood counts. It could take several weeks for the new bone marrow cells which were infused into the blood to travel to the bone marrow to begin to make healthy new cells. In some, it could take longer. This is why doctors will keep a steady watch on the recipients to monitor their progress.
Depending on the type of transplant, and the risks of complications, doctors could recommend light forms of exercising like walking for short periods within the transplant unit itself.
How long is recovery after bone marrow transplant?
Recovery after a bone marrow transplant is gradual. It takes up to 2 weeks for the newly infused cells to reach the bone marrow to begin to make healthy new cells. This process is called engraftment. In some recipients, it could take longer. During this time the immunity system can be weak.
To prevent infections or the risk of complications, doctors recommend hospitalization for a few weeks to around 90 days to monitor the progress.
Even after being discharged from the hospital, the bone marrow transplant recipients will have to visit the hospital for routine follow-ups with the doctors to check the response to the transplant.
Which is the best hospital for Bone Marrow Transplant?
Fortis Hospital Mumbai is the best hospital for Bone Marrow transplants in India. Our team of India's top transplant specialists has rich expertise in the complete range of bone marrow transplants (BMT) in all age groups. Our hematologists have pioneering experience in delicate BMTs. We have a dedicated organ transplant unit equipped with the latest technology in BMT.
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