Hematopoietic Stem Cell Transplantation

Hematopoietic (blood transfusion) stem cell transplantation uses stem cells to treat blood cancers like leukaemias, autoimmune disorders like sickle cell anaemia, thalassemia, and some neurological disorders. Stem cells are immature cells that can take up the function of any targeted cells or tissues and help regrow. Stem cells are acquired from a related or blood-matched donor or the same person who needs treatment. It can be performed on individuals of all age groups.

Alternate Name:

Bone marrow transplant, stem cell therapy

Body Location:

Blood, the bone marrow of the hip bone, and umbilical cord blood

Procedure of Hematopoietic Stem Cell Transplantation :

The blood type and group are matched with a donor whose blood is further tested for the number of stem cells present. This is known as allogeneic stem cell transplantation. Stem cells may be obtained from circulating blood, the bone marrow of the hip bone, and/or blood from the umbilical cord of a growing fetus. The bone marrow is taken out through a small incision made around the hip bone. Bone marrow cells are collected and processed for stem cell therapy. The stem cells obtained are transferred to the recipient through blood transfusion for a duration of 1-2 hours.

When stem cells are obtained from the same individual undergoing treatment, it is known as autologous stem cell transplantation. Blood from one arm is drawn and transferred back into the body through the other arm after being processed for stem cells.

Preparation:

• The individual undergoing stem cell transplantation needs to take medicines for treating his existing conditions like chemotherapy for cancer, antibiotics for infection, and supplements to boost immunity.
• The individual needs to get admitted 2-5 days in advance to be monitored for any adverse reactions and fitness for stem cell transplantation.
• Fitness tests like screening for haemoglobin levels, sugar levels, and other comorbidities are performed to ensure fitness for stem cell therapy.
• No fasting is required for the procedure, but a strict diet is maintained to prevent adverse reactions. Hydration is to be maintained.
• The procedure takes around 1-2 hours, and the extraction of the bone marrow may take 1-2 hours.

Procedure Type:

Surgical invasive and blood transfusion

Follow Up:

After discharge from the hospital, one needs to have regular follow-up consultations with their oncologist, surgeon, and dietician to monitor progress and complete the treatment protocol. The donor may need to have a follow-up for stitch removal in case of bone marrow extraction.

Supervised rehabilitation sessions with a physiotherapist may be indicated in most cancer cases. Individuals with cancer may need to continue with their existing treatment protocol like radiation and chemotherapy as per the doctor.

Risks:

• Graft versus host reaction: The stem cells obtained from a donor may provoke the patient’s immune system and may start killing the stem cells. This may be harmful to the patient. It is usually controlled with appropriate medications and specific blood matching between the donor and recipient.
• Infection: The host’s body may not tolerate the blood transfusion, and/or the donor site may react abnormally, causing infection and is treatable with antibiotics.
• The donor may feel lethargic and have difficulty with daily activities but will recover within 2 weeks.

Recovery:

Bone marrow donors and their recipients may need to stay in hospital for 3-5 days. The donors may experience discomfort, pain, and tenderness around the operated site for a couple of weeks, and these signs usually resolve spontaneously.

Stem cell recipients need to undergo a strict routine of nutrition, exercise, and monitoring the symptoms of distress and infection because of the body’s reaction to the stem cells received. The entire process of hematopoietic stem cell transplantation takes anywhere between 6-12 months for the stem cells to take over the function of host tissues and produce healthy blood.