Hemato-Oncology & Bone Marrow Transplant

Bone marrow is the soft spongy tissue that lies within the hollow interior of long bones. Bone marrow in large bones produces 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 cell. When the cells are fully mature, they are released into the blood stream. Hence, bone marrow works as a factory for blood. When things go wrong in the blood e.g. blood cancer (leukaemia), aplastic anaemia (empty bone marrow) its origin is in the stem cells in the 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.

Bone Marrow and Stem Cell Transplantation

The two terms "bone marrow" and "stem cell” transplants are sometimes used interchangeably. Previously, in paediatric and 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. All bone marrow transplants are stem cell transplants but not all stem cell transplants are bone marrow transplants

Conditions that can be treated with BMT/SCT

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

Bone Marrow Transplant Unit (BMT)

A bone marrow transplantation programme at Nanavati Max Institute of Cancer Care is a state-of-the-art transplantation unit in the country. All cubicles have a HEPA filtration system and en-suite facilities. The team is committed to providing a quality service to all children and adult 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 very high doses of chemotherapy, usually over a few days. Sometimes, radiotherapy is also given to the whole body, known as total body irradiation (TBI). As well as destroying any remaining cancer cells, the high doses of chemotherapy also destroy the stem cells in the bone marrow. After the chemotherapy, patient is given the stem cells that were collected before the treatment. These stem cells start producing mature blood cells again.

Types of Bone Marrow Transplant

There are three main types of transplant

1. Autologous Transplant

In this procedure patient's own stem cells are used after the high-dose treatment.

2. Allogeneic Transplant

This uses stem cells from a 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 super speciality 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 in only 25 - 30 percent of the time.

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

3. Umbilical cord blood stem cell transplant

Stem cells are filtered from blood in the umbilical cord after a baby is born and those cells are used for transplant if they are a match. Matching is attempted as for other stem cell transplant. This is a good source of stem cells when related or unrelated matched donor is unavailable.

Preparing yourself for Transplant

There will be a number of tests to be conducted before the treatment. Our specialist nurse will explain what they are and why they are needed. Some of the tests may depend on the stage of your disease and type of cancer or leukaemia. Once the treatment is explained the patient can take time to think things over and start to make practical arrangements. The patient may be required to stay for several weeks. After the chemotherapy, there is a period of neutropenia during which patients can be very unwell, requiring several medicines to prevent and treat infections and nutritional supplements.

Post-Transplant Care

After the transplant is completed and the patient is discharged, patients needs to continue some medicines to keep the transplant working.

Frequently Asked Questions

1. What is the life expectancy after a bone marrow transplant? 

The life expectancy after a bone marrow transplant (BMT) can vary depending on several factors, including the patient's underlying condition, age, overall health, the type of transplant performed (autologous or allogeneic), donor compatibility and the presence of any complications like infections or graft-versus-host disease (GVHD) or relapse. Survival rates and life expectancy are continuously in patients is continuously improving due to advancements in medical technology, post-transplant care, treatment protocols, and supportive care. 

2. What is a bone marrow transplant? 

A bone marrow transplant, also known as a hematopoietic stem cell transplant (HSCT), is a specialized medical procedure in which damaged or diseased bone marrow is replaced with healthy stem cells. These stem cells harvested either from the patient (autologous transplant) or from a donor (allogeneic transplant), regenerate healthy blood cells and rebuild the immune system. Highly specialised, quarternary care hospitals use BMT to treat leukemia, lymphoma, multiple myeloma, aplastic anemia, and other serious blood or immune disorders 

3. Does the Centre for Haematology & Bone Marrow Transplant has a dedicated transplant unit in Mumbai? 

Yes, the Centre for Haematology & Bone Marrow Transplant is one of India’s largest, quaternary care department, providing easy access to Bone Marrow transplants as a possible cure for patients with complex blood disorders.

The centre is equipped with ultra-modern infrastructure and a team of highly experienced, internationally trained specialists. It is supported by state-of-the-art transfusion services and advanced laboratories, along with a fully-equipped Radiation Oncology unit. the Centre for Haematology & Bone Marrow Transplant is also an authorised stem cell collection centre for DATRI Blood Stem Cell Donors' Registry. 

4. How serious is a bone marrow transplant? 

A bone marrow transplant is a complex and serious medical procedure. It carries potential risks and complications, including infections, graft-versus-host disease (GVHD), organ damage, and side effects from the conditioning regimen. It is important to thoroughly research about the experience and success rate of the clinical team, hospital’s infrastructure & infection control protocols and support services such as advanced laboratory and radiation oncology units. Patients should also confirm if the centre is a part of an authorised stem cell collection registry before choosing a treatment centre.   

5. How long do you stay in the hospital after a bone marrow transplant in Mumbai?

The length of hospital stay after a bone marrow transplant in Mumbai can vary depending on several factors, including the type of transplant, the patient's response to treatment, and the occurrence of complications. Typically, patients may need to stay in the hospital for several weeks to months for close monitoring, supportive care, and management of potential complications.