Aster's Oncology Centre has a dedicated comprehensive Bone Marrow Transplantation service. Autologus Stem Cell Transplant for patients with hematological & solid malignancies.
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What are bone marrow transplant and peripheral blood stem cell transplant?
Bone Marrow Transplant and Haematopoietic Stem cell Transplant are non-surgical modes of treatment to cure advanced stages of malignancies as well as non-malignant haematological diseases and multiple other disorders.
As the name suggests, bone marrow transplant and peripheral blood stem cell transplant mean replacing or restoring dysfunctional cells with healthy cells.The diseased cells in your body are first destroyed completely through conditioning therapy, which is inducing high doses of chemotherapy or irradiation.You’ll be then infused with healthy cells that will start multiplying on their own in about 2 to 3 weeks.
What are bone marrow and hematopoietic cells?
Bone marrow is the soft, sponge-like material found inside your bones and contains immature cells known as hematopoietic or blood-forming cells. The Hematopoietic cells keep dividing into more blood-forming cells; and mature into one of three types of blood cells: infection-fighting white blood cells, oxygen-carrying red blood cells and clot-forming platelets.
Though most hematopoietic stem cells are found in the bone marrow, some cells called peripheral blood stem cells are found in your bloodstream. Blood in the umbilical cord also contains hematopoietic cells. Cells from any of these sources can also be used in transplant.
What is Donor- Recipient Matching?
Your body is unique and has a set of proteins called human leukocyte-associated (HLA) antigens, on the surface of your body cells. We identify this set of proteins from samples drawn from your blood or buccal swab smears.
We have the expertise and facilities to evaluate bone marrow morphology and immunohistochemistry at our state-of-the-art lab. The other relevant specialised tests include flowcytometry, cytogenetics and molecular genetics.
In most cases, the success of allogeneic transplantation depends on how well the HLA antigens of the donor and recipient’s stem cells. Higher the number of matching HLA antigens, greater are chances of your body accepting the donor’s stem cells.
You are less likely to develop graft-versus-host disease graft-versus-tumour effect post allogeneic transplant: when white blood cells from the donor attack the cells in the patient’s body after the chemotherapy and/or radiation therapy, if the stem cells are closely matched. It is estimated that only 25 to 35 percent of patients have a HLA-matching sibling. The chances of obtaining matching stem cells from an unrelated donor too vary, so finding the right donor is the key to a successful BMT or PBSCT.
Donating Cells: What’s the risk?
If you are a bone marrow donor, you might feel tired and lethargic after donating the cells. However, you will return to normalcy in a few days or sometimes, in a few weeks. As it is a procedure done under anesthesia, you might need to do all relevant health checks before donating.
Apheresis, however, is easier, except for occasional giddiness, headache, and some discomfort caused mainly due to the medicines given for increasing stem cells.
What happens after the transplant?
The post-conditioning period and 3-4 weeks post-infusion are the most crucial for BMT and PBSCT patients as the chances of infection are at an all-time high.
Our entire medical team is trained to observe international standards when it comes to hygiene and infection control so that you are ensured a safe, sterile environment to recuperate.
The stem cells, after entering your bloodstream, travel to the bone marrow and begin to produce new white blood cells, red blood cells, and platelets in a process known as “engraftment.” This usually occurs within about 2 to 4 weeks after the transplantation. Complete recovery of your immune function will take longer - up to several months for autologous transplant and 1 - 2 years for allogeneic or syngeneic transplants. We will evaluate your blood health through various tests including bone marrow aspiration to confirm whether new blood cells are being produced and there’s no relapse.
What is Mini Transplant?
Called a non-myeloablative or reduced-intensity transplant, a mini uses lower, less toxic doses of chemotherapy and/or radiation to prepare you for an allogeneic transplant.
Called a non-myeloablative or reduced-intensity transplant, a mini uses lower, less toxic doses of chemotherapy and/or radiation to prepare you for an allogeneic transplant.
What are the different types of Bone Marrow Transplants?
There are three types of Bone Marrow Transplants based on from who the donor cells are harvested
Autologous transplant is when you are receive your own stem cells.
Allogeneic transplants in when you receive cells donated by your sibling or parent. However, an unrelated donor or a person who is not related to you can also give you stem cells for transplant.
Syngeneic transplant is when you are infused with stem cells donated by your identical twin.
What is conditioning/ Chemotherapy and radiation therapy before bone Marrow Transplant and Peripheral Blood Stem Cell Transplant?
The first step to BMT and PBSCT is destroying the diseased cells from your body through high doses of chemotherapy or radiation called conditioning. At Aster Medcity, we have the most advanced technology for these procedures, including Kerala’s first True Beam Linear Accelerator and dedicated radiotherapy rooms to ensure maximum patient safety. All radiotherapy treatments we provide are based on NCCN (USA) and ESMO (Europe) guidelines.
As cancerous cells divide faster than healthier cells, we can, through conditioning destroy the existing bone marrow cells so that we can infuse healthy, transplanted cells into your body effectively.
How is bone marrow obtained for transplant?
With advances in technology, obtaining cells from a donor or harvesting has become relatively simple. Bone marrow is harvested using a needle from the hip or at times breastbone area, after inducing general or local anesthesia.
The harvested bone marrow is processed to remove blood and bone fragments, combined with a preservative, and frozen at sub-zero temperatures to keep the stem cells alive but dormant until required. This technique is known as cryopreservation. We have a cryopreservation unit where we can cryopreserve stem cells for many years.
In order to harvest PBSCs, the donor is given medications to produce and release excess stem cells into the bloodstream.
Called apheresis, blood is drawn from the donor and subject to a process that removes only the stem cells. The blood is then returned to the donor and the collected cells, stored in the cryopreservation unit. This usually takes 4 to 6 hours.
We also obtain stem cells from the umbilical cord on consent, to treat children and adults. We can cryopreserve these cells or even the entire cord for years.
How are healthy, transplanted cells infused?
You will be infused with healthy, transplanted cells in the BMT unit through an IV line – just like you’d be on drips. As there will be no disease -fighting white blood cells and blood-clotting platelets after the conditioning, your susceptibility to infections will be extremely high. You’ll need to be extremely careful so that you don’t contract any infection and follow the doctor’s advise meticulously to avoid any complications.
Since the stem cells used for autologous transplantation should relatively be free of cancer cells, the harvested cells can sometimes be treated before transplantation in a process known as “purging”. This process removes maximum cancer cells from the harvested cells and minimise the chance of reoccurrence.
What are the possible post-transplant complications?
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