Definition:
Bone marrow transplantation is a surgical procedure performed to replace the diseased or destroyed bone marrow by a healthy bone marrow stem sells received from a donor. The process involves extracting bone marrow containing normal stem cells from a healthy donor and replacing it in to a recipient. The aim of the transplant is to reproduce the recipient’s blood cells to cure the disease and built the immunity.
The bone marrow is a sponge like tissue found in the central hollow of the long bones. It contains the stem cells that produce the new blood cells.
The types of bone marrow transplant
- Autologous bone marrow transplant- Stem cells are taken from the patient before chemotherapy or radiation treatment.
- Allogeneic bone marrow transplant- Stem cells received from a donor who is mostly a close family member of the patient, or some other person
- Umbilical cord blood transplant. Stem cells are taken from an umbilical cord immediately after the delivery of an infant.
Why it needed?
Bone marrow transplant is advised in conditions when the body is unable to produce the blood cells, that includes
- Cancerous conditions –leukemia, lymphoma and multiple myeloma
- Diseased condition in which bone marrow is not able to produce required amount of blood cells
- Sickle cell anemia
- Aplastic anemia
- Thalassemia
- Congenital neutropenia
- Severe immunodeficiency syndromes
- The bone marrow is destroyed, due to chemotherapy to treat certain cancers including Hodgkin’s disease, Breast and ovarian cancer renal cell carcinoma etc.
Facts and figures
- The theory of bone marrow transplant was given by E. Donnall Thomas who received the Nobel Prize in Physiology of Medicine for the same
- The first successful allogeneic bone marrow transplantation was performed by Robert A. Good at the University of Minnesota.
- The National Bone Marrow Donor Registry or National Marrow Donor Program was established in 1986. They have more than 4 million volunteer donors and are providing services in about 14 countries
Advantages
- After the successful bone marrow transplant the donor’s marrow reaches the recipient’s bone cavity and produces the normal quantity of healthy blood cell
- Thus it extends the patient’s life as well as improves the quality of life by curing the underlying disease.
Disadvantages
- Risk of developing Graft –Versus- host disease
- Children’s growth may delayed after receiving bone marrow transplant
Risk and complication and side effects associated with bone marrow transplants includes
- Serious infections
- Bleeding and anaemia
- Diarrhoea, nausea and vomiting
- Severe mucositis
- Damage to the kidney, liver ,lungs and heart
- Early menopause
- Cataracts
- Graft failure
- Headache
- Skin rashes
Risk to the donor is very less including Anaesthesia reaction. There could be stiffness or soreness at the area where the bone marrow was taken out. He may experience weakness or tiredness for 3-4 days.
Preoperative preparation
- Complete physical examination
- Blood and urinalysis
- Visit to mental health counsellor to be prepared emotionally to overcome post transplant stress
- Patient and relatives are informed about the procedure, follow up and risk involved
- Consultation with surgeon or doctor a week ago, and have a list of medicine which is to be taken or needed to be stopped
- Arrangement for blood transfusion
- Have an arrangements with family and/or friends to help during the post-operative rehabilitation
- Do not eat or drink anything after midnight the night before surgery
- The medical tourist is advised to plan a trip for staying maximum time
- One or two catheters will be inserted in to larger blood vessels before the transplant to receive treatments, fluids etc.
Post operative care
- Most people need to stay in hospital for 4-6 weeks after the surgery. During hospitalization special care will be taken to avoid infection. The vital signs will be monitored and medications will be given to prevent infection.
- Some patients needs blood transfusion
- Intravenous fluid will be continue until the diarrhoea, nausea and mouth sores are cleared up
Engraftment
- The stem cells travel to the bone marrow of the recipient, and there they begin to produce new blood cells, within about 2-4 weeks of transplantation, this process is known as Engraftment. To confirm the reproduction and successful transplantation regular blood counting is required.
- Full recovery can be expected about 3-6 months and patients needs to do regular follow up visit to the physician. Some patient may need a year to recover fully. One can return to work