Bone Marrow Transplant

Below are the conditions for which hematopoietic stem cell transplant is offered:

Non-Cancerous Conditions:
• Thalassemia, Sickle Cell Anaemia
• Transfusion Dependent Anaemia
• Aplastic Anaemia
• Fanconi Anaemia
• Pure Red Cell Aplasia
• Metabolic disorders
• Immunodeficiency States
Blood Cancers:
• Multiple Myeloma
• Hodgkin Lymphoma
• Non-Hodgkin Lymphoma
• Acute Lymphoblastic Leukemia (ALL)
• Acute Myeloid Leukemia (AML)
• Chronic Myeloid Leukemia (CML)
• Myelodysplastic Syndrome 

An interesting observation here is that the type of bone marrow used for transplant is different from the different types of BMT:
1. Allogenic BMT: Donor and Recipient are two separate individuals and BMT is done using the stem cells of donor. It may be:
1.1 Matched Related, where donor is HLA matched relative usually a sibling.
1.2 Matched Unrelated, where donor is not a relative of patient and usually found from one of the various national or international registries.
1.3 Partially Matched Related, where donor is from a patient’s family but partially matched (haploidentocal).
2. Autologous BMT: Donor and Recipient are same individuals. BMT is done using the patient’s own stem cells. The procedure involves giving high dose chemotherapy to patient in order to remove primary disease. Thereafter, an autologous transplant is conducted to rescue damaged bone marrow. This type of transplant has minimal complication and is preferred for diseases like multiple myeloma.  
Generally, the risks are reduced if:
• you are young – studies have shown the younger you are, the more likely the treatment is to succeed
• you receive stem cell donation from a sibling (brother or sister)
• you have no serious health conditions (apart from the condition you're being treated for) 
It is an extremely safe procedure for the donor and the patient can return to normalcy within 6 months- 1year post successful transplant. The modern day advancements are such that the risk to donor is nearly negligible. However, they may get fever and or body pain for 1 day or so whichever is manageable. The donor need not be admitted and does not require anesthesia.
No, Bone Marrow Transplant is a medical procedure. Mostly, stem cells are collected via peripheral vein and the whole procedure is like donating blood or platelet. In some patients Bone marrow harvest is done which involves general anesthesia to the donor. 
An ideal situation for the donor should be to stay near transplant center for a week or so after transplant as patient may require platelet support from his donor.
Post transplant, the patient should avoid crowded places and eat hygienic food. In case you tend to witness the symptoms of GVHD like diarrhea, skin rashes, and jaundice, consult the doctor immediately.
These days we can do unrelated donor search from international bone marrow donor registries. There are already several patients who have been benefitted from transplants with bone marrow or stem cells being donated at international centers and brought to India.
Bone marrow transplant involves giving high dose chemotherapy to the patient. Donor also receives some injections called growth called growth factors. Stem Cell collection requires apheresis which requires a dedicated blood bank support. However, the most part of BMT is management of post-transplant drop in blood counts which may require high grade antibiotics and antifungals. Therefore, BMT is usually done in HEPA filtered rooms to reduce incidence of infections.
Yes, patient can return to his normal routine in 6 months – 1 year post successful transplant. However, he needs to follow up with transplant centre as advised.
You can experience:
• Graft versus host disease- Is a life threatening condition that can develop after stem cell transplant. GVHD occurs the new cells are not able to recognize the organs and tissues of recipient’s body. It may cause a skin rash, itching, liver or gastro intestinal system (loose stool or pain abdomen).
• Bacterial Infections that can cause a permanent organ damage
• Respiratory problems -Causes inflammation of the airway and serious problems of the pulmonary system.
• Low blood cells and low platelets, which can cause excessive bleeding in the brain, lungs, and gastrointestinal tract.
There can be complications from the conditioning regimen after transplant when bone marrow is severely depleted. To prevent these complications, patient needs to be monitored in special HEPA filter rooms.  
It depends upon the disease and type of transplant whether autologous or allogenic. In case of autologous transplant, patient needs to follow up for around 1-2 months, whereas in Allogenic transplant at least 3 months follow up is necessary. In case patient develops any complications a longer follow up is required. 
If the patient does not have a matched sibling, the other options available are matched unrelated donor and partially matched sibling donor transplant. However, cost can significantly go up in matched unrelated donor transplant because of costs involved in procuring stem cells. Partially matched transplant is another option but it involves increased risk of GvHD and infections.
Success of bone marrow transplant usually depends on stage of disease, duration of disease and patient's condition at the time of transplantation. With modern day medicines and technological advances one expects a cure rate of 90% if BMT is performed at age of 3 years for thalassemia while it drops to 80% if done at the age of 7 years.

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