Bone Marrow Transplantation (BMT) or Stem Cell Transplantation (SCT)

By Dr. Balkrishna Padate in Nanavati Max Institute of Cancer Care

Apr 24 , 2023 | 3 min read

Bone Marrow

Bone marrow is the soft spongy tissue that lies within the hollow interior of long bones. Bone marrow in large bones produce new blood cells. The bone marrow contains stem cells. These are cells at a very early stage of development that develop into the three different types of blood cells. When cells are fully mature, they are released into the bloodstream. Hence bone marrow works as a factory for blood. In the bone marrow when things go wrong it leads to Blood Cancer (Leukaemia) or Aplastic Anaemia (Empty Bone Marrow). Hence, bone marrow transplantation or stem cell transplantation can be a curative treatment for such conditions.

Bone Marrow Transplant

Bone Marrow Transplant procedure is performed not only for cancerous conditions like blood cancer but also for genetic condition like Thalassemia. Here, the cancerous or genetically abnormal stem cells are eradicated by Chemotherapy and Immuno suppressive medicines and new functionally normal stem cells are given which later populate the bone marrow and blood with normal non cancerous cells and genetically normal cells.

The two terms "bone marrow" and "stem cell" transplantation are sometimes used interchangeably. In pediatric age group and in olden days, in adult age group, bone marrow acquired by aspiration served as the source of stem cells and hence the terminology of BMT was used. Now in adults we use stem cells extracted from the blood, on a machine.

Conditions that can be treated with BMT/SCT

Leukaemia (Blood Cancer)
Lymphoma (Lymph gland cancer)
Myeloma (Bone Marrow Cancer)
Aplastic Anaemia
Germ Cell Cancers
Thalassemia
Sickle Cell Disease
Gaucher's Disease
Immunodeficiency conditions

Bone Marrow Transplant Unit (BMT)

A bone marrow transplantation programme is established at Nanavati Max Hospital by Dr. Balkrishna Padate in 2021. It is a state-of-the-art transplantation unit, in that has 6 cubicles for transplant patients. It has Hepa filtration system and en-suite facilities. The team is committed to providing a quality service to all needing this procedure.

Procedure of Stem Cell Transplant

Before stem cell transplant, stem cells are collected from either the bone marrow or the blood. Patient is given high doses of Chemotherapy, usually over a few days. Sometimes, Radiotherapy is also given to the whole body, known as Total Body Irradiation (TBI). After chemotherapy, patient is given stem cells that were collected before the treatment. These stem cells start producing mature blood cells again.

3 Main types of Transplant

Autologous

This uses patient's own stem cells and those stem cells are used after the high-dose treatment.

Allogeneic

This uses stem cells from other donor and is also known as an Allograft. An Allogeneic Transplant is a more complicated procedure than an autologous one and is only carried out in specialist hospitals like Nanavati Max Super Speciality Hospital. Recovery may take several months or longer. The donor is another person whose tissue has the same genetic type (HLA type) as the person needing the transplant (recipient). Because tissue types are inherited, similar to hair or eye color, it is more likely that the recipient will find a suitable donor in a brother or sister. This, however, happens only 25 to 30 percent of the time.

If a family member does not match the recipient, the request is sent to the unrelated bone marrow transplant registry database to look for a suitable unrelated individual who is a close match. It is more likely that a donor who comes from the same racial or ethnic group as the recipient will have the same HLA type.

Haploidentical Bone Marrow Transplantation

Many times, patients do not get a full match donor siblings or unrelated donor registry. In such circumstances, half match donor from siblings or parents is used as a source of stem cells. Large number of such transplant procedures are successfully conducted all over the world.

Umbilical Cord Blood Stem Cell Transplant

Very rarely umbilical cord stem cells are also used for bone marrow transplant.

Preparing yourself for Transplant

You will have a number of tests before the treatment. A specialist nurse will explain what they are and why they are needed. Some of the tests you have may depend on the type of cancer or leukaemia you have and the stage of your disease. Once you understand what the treatment involves, you can take time to think over and start to make practical arrangements. You will be admitted for the transplant in a room for a while, possibly several weeks. After the Chemotherapy, there is a period of low blood counts during which patients can be very unwell requiring several medicines to prevent and treat infections and nutritional supplements etc.