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A bone marrow transplant is a procedure that infuses healthy blood-forming stem cells into your body to treat diseased bone marrow. It is also known as a stem cell transplant. You will need a bone marrow transplant if your bone marrow has stopped working and does not produce healthy blood cells.
Cross Border Care is here with you to give you all the details of bone marrow transplants in India and tell you about the best hospitals and doctors offering this service in India.
What is bone marrow?
A bone marrow is a spongy tissue that is found inside bones. It is where most of the blood cells are made. The blood cells that make other blood cells are called stem cells. The most primitive of the stem cells is called the pluripotent stem cell. This is different from other blood cells with regard to the following properties:
Renewal. It is able to reproduce another cell identical to itself.
Differentiation. It is able to generate one or more subsets of more mature cells.It is the stem cells that are needed in bone marrow transplants.
What is Bone Marrow Transplant?
Bone marrow contains stem cells. In healthy individuals, stem cells help in the creation of :
- Red blood cells that carry oxygen in our body
- White blood cells that help our body fight infection
- Platelets that help to stop bleeding in our body
If a bone marrow stops performing the above functions, then a person needs a bone marrow transplant.
What can a bone marrow transplant do?
The primary goal of bone marrow transplant is to cure different types of cancer. There are times when a person requires high doses of chemotherapy and radiation therapy. These doses are so high that the bone marrow stem cells get destroyed. You will need a bone marrow transplant in the following cases:
- Replaced diseased and non-functioning bone marrow with a healthy one
- Regenerate a new immune system that will fight the cancer cells; chemotherapy can’t kill
- Replace bone marrow to restore its normal function after a high dose of chemo and radiation therapy
What diseases can be treated by Bone Marrow Transplant?
- Aplastic Anemia,
- Sickle cell disorders
- Marrow failure syndromes
- Coagulative disorders
- Acute and chronic Leukemia
- Myelomas, lymphomas
- Multiple myeloma
- And other pediatric disorders.
Understanding Types of Bone Marrow Transplant
Type 1: Autologous Stem Cell Transplant
In this type of bone marrow transplant in India, your stem cells are harvested. They are removed from your bone marrow or your blood and then they are frozen. After you get high doses of chemo, your stem cells are given back to you. It is used in the treatment of:
- Leukaemia
- Lymphoma
- Multiple myeloma
- Multiple sclerosis
- Crohn’s disease
- Lupus
Advantage: In this type of transplant, since you get your stem cells back, there are no chances of reaction or rejection. This is also known as graft versus host disease.
Type 2: Allogenic Stem Cell Transplant
This type of bone marrow transplant uses donor stem cells. The best kind of donor is your close family member, your brother or sister. If you do not get a good match in your family, then you can find a donor in the general public via the national registry.
It works the same way. The stem cells are collected from the donor, stored, and frozen. After you get high doses of chemo or radiation therapy, the donor stem cells are given to you. It is used to treat:
- Leukaemia
- Lymphoma
- Multiple Myeloma
- Aplastic Anemia, a type of bone marrow disorder
Type 3: Umbilical Cord Transplant
It is a type of allogeneic bone marrow transplant. In this, stem cells are detached from a newborn baby’s umbilical cord just after the broth of the baby. The stem cells are frozen and stored until they are required for transplant. Umbilical cord blood cells have not matured enough, so blood count takes a long time to recover.
Advantage of Allogenic Stem Cell Transplant: A very major benefit of an allogenic transplant is that donor stem cells can make their open immune cells which could kill any cancer cells that remain even after chemo and radiation therapy. This is called the graft vs cancer effect.
Donors can also be asked to donate more stem cells if needed in the future.
Type 4: Half Matched Transplants
It is also known as a haploidentical transplant. It uses the stem cells of the donor, who shares half the genetic markers with the recipient. It can be a child, parent, or sibling. In this type of transplant, the donor and the recipient share the same genes, so the chances of a successful transplant increase.
Advantage: The half-matched transplants reduce the chances of graft rejection. Graft rejection typically happens when the recipient’s immune system fails to recognize the donor cells and tries to kill them as a virus or bacteria. That is why it is vital to find the closest match possible.
Understanding HLA Match
Many factors decide how the immune system plays a role in determining the difference between self and non-self. Human Leukocyte Antigen Systems are proteins that are found on the surface of most cells. Each person has a certain number of pairs of HLA antigens. We inherit it from our parents, and then our children get it from us. Doctors try to match these antigens while finding a donor for a bone marrow transplant.
A match occurs when 6 of the known pairs of HLA antigens match. This reduces the chances of graft versus host disease, as mentioned above.
Finding The Right Match
As already told, HLA antigens are inherited from both the parents. The search for the donor starts with siblings who have the same parent as you. The chance that any one sibling would be a perfect match is 1 on 4.
If the sibling does not match, then the search moves to relatives, half siblings or aunts, uncles, and cousins. If they also do not match, then the doctors extend their search to the general public.
Understanding the Process of Bone Marrow Transplant in India
Preparation of Recipient:
- Before the transplant, an extensive evaluation is carried out by the BMT team.
- A complete medical history and physical examination are performed to evaluate the working of the vital organs.
- A patient has to come 10 days before the transplant for placement of the central venous line and other preparations as well.
Preparation for Donor
- Donor sources can be the self, a sibling, a parent, a relative, or anyone from the general public.
- Once the donor is identified, they have to undergo specific tests to determine their overall health.
- The stem cells are collected by bone marrow harvest.
How are stem cells collected?
The stem cells are collected in two ways:
Peripheral Blood Stem Cells: In this process, blood is taken from one vein and circulated through a machine that removes the stem cells and returns the remaining blood and plasma to the donor through a needle inserted in the other arm. Several sessions are needed to collect the stem cells.
Bone Marrow Harvest: It involves collecting stem cells via a needle placed in the soft center of the bone. Most sites for bone marrow harvesting are located in hip bones, and the donor will be under anesthesia during harvest.
Note: If the donor is the person, it is called an autologous bone marrow transplant. If an autologous transplant is planned, previously collected stem cells from either peripheral (apheresis) or harvest are counted, screened, and ready to infuse.
Bone Marrow Transplant Procedure
- The treatment starts with high doses of chemo or radiation therapy. The bone marrow makes blood cells in our body. Ablative therapy prevents the production of blood cells and makes bone marrow empty. Empty bone marrow makes room for new stem cells to grow.
- After chemo, a bone marrow transplant is given via a central venous catheter. The process is the same as blood transfusion. The stem cells will find their way to the bone marrow and begin producing new cells.
- After the transplant, supportive care is given, like frequent blood tests, monitoring vitals, and providing a rigorous and clean environment to avoid any infection.
What will happen after the transplant?
- You will spend several weeks in the hospital.
- You have to protect yourself from infection.
- You can experience excessive bleeding.
- You will need blood transfusions.
- You will have to take medicines to prevent graft vs host disease.
After leaving the hospital, the recovery process continues for several months. You must attend regular follow up visits with your doctor to track your process.
What is engraftment after a bone marrow transplant in India?
Engraftment happens when the donated cells start making new cells in the body. Depending on the type of transplant and the type of disease being treated, the engraftment happens on the 15th or 30th day. Blood counts will be checked at regular intervals. Blood counts will be regularly checked post-transplant.
New bone marrow takes 30 days to start making new cells, and it can take years for the immune system to recover fully.
Prognosis
The prognosis of a bone marrow transplant depends on the following:
- Type of transplant
- Type of disease being treated
- Response to the treatment
- Genetics
- Your age
- Your overall health
- Complications
When it comes to any surgery, the outcome, as well as the survival rates in the future, also vary depending on the patient in bone marrow transplant. Aids that are now being carried out for the rise in several diseases have enhanced the facet of bone marrow transplants in children and adults. Another requirement for the patient is the continual follow-up care after a bone marrow transplant. Better ways of handling the transplant and, therefore, reducing the effects of the treatment and complications arising from it are being invented.
FAQs
How are Patients and Donors matched?
- A simple blood test is needed to determine HLA typing of patient and donor.
What are the side effects?
- Common side effects are Infections due to low immunity and bleeding due to diminish platelet count.
Will bone marrow transplant reduce the immunity of donors?
- No, since because only 1%-5% bone marrow is required for donation hence immunity isn’t affected.
How long will donor recovery take place?
- It varies from person to person and type of donation. Generally, it takes a week time to resume normal daily activities.
Does donor need follow up like patient?
- Yes, until he or she resumes normal activities.
Reduced Intensity Transplantation?
- This is often the only option for older and patients with multiple medical issues where small doses of chemotherapy or radiotherapy are used as this patient can’t tolerate full intensity Allogenic transplantation.
What is success rate?
- Success rate depends on type of transplant, patient’s general condition and severity of the disease. Generally, it ranges from 90 – 95% in case of autologous transplant and 70 – 90% in case of allogenic transplantation. Success rate of half matched transplant is around 70%.
What is hospital stay in isolation room?
- Autologous BMT (3 weeks )
- Allogenic BMT (4-6 weeks)
What is average stay of the patient in India during such procedure?
- Autologous BMT – One week post-transplant, the patient will be followed-up in OPD
- Allogenic BMT – Patient needs Four weeks of follow up in OPD Post-transplant.
What is the cost of bone marrow transplant in India?
Autologous BMT 15000 USD
Allogenic BMT 24000 USD (HLA Matched Donor)
35000 USD (Half Matched Donor)
60000 USD Matched Unrelated donor)
Pediatric BMT 25000USD
Chemo if needed 10000 USD
Top doctors in India offering Bone Marrow Transplant
- Dr Dharma Choudhary: Consultant & HOD, Max BLK centre for bone marrow transplant, Delhi, India.
- Dr Shishir Seth: Sr. Consultant, bone marrow transplant unit at Indrapratha Apollo Hospital, New Delhi., India.
- Dr Ashok Kumar Vaid : Chairman, Medical and Haemato Oncology, Cancer Institute at Medanta, The Medicity Hospital, Gurugram, India.
- Prof Vinod Raina: Chairman Institute of Oncosciences at Fortis Memorial Research Institute, Gurugram, India.
- Dr Rahul Bhargava: Principal Director Hemato-Oncology at Fortis Memorial Research Institute
- Dr Satya Prakash Yadav: Director Paediatric Hematology & Bone Marrow Transplant Institute at Medanta, The Medicity Hospital, Gurugram, India.
- Dr Rahul Naithani : Director , Cancer care , oncology, Bone Marrow Transplant , Hematology and medical oncology at Max Super Specialty Hospital Saket, India.
- Dr Nandini C Hazarika : Director, pediatric bone marrow transplant unit at Rainbow Children’s Hospital, India.
- Dr Vikas Duaa : Director Pediatric bone marrow transplant & Hematology unit
- Dr. Rakesh Chopra : HOD, Medical & Hematological Oncology at Artmemis Hospital, Gurgram, India.
Top hospitals in India Offering Bone Marrow Transplant
- Indraprastha Apollo Hospital
- Medanta The Medicity
- Artemis Hospital
- Max Super Speciality Hospital
- Fortis Memorial Research Institute, Gurugram
Need assistance with advanced treatment for bone marrow transplant to be performed in India? Contact us today!
