Allogeneic Bone Marrow Transplant in Delhi, India

An allogeneic bone marrow transplant is a medical procedure in which a patient receives healthy blood-forming stem cells from a genetically compatible donor to replace their own diseased or damaged bone marrow. This type of transplant is commonly used to treat various hematologic conditions, including certain cancers and non-cancerous blood disorders.

• Leukemia: Both acute and chronic forms, where the bone marrow produces abnormal white blood cells.
• Lymphomas: Including Hodgkin's and non-Hodgkin's lymphoma, cancers originating in the lymphatic system.
• Aplastic Anemia: A condition where the bone marrow fails to produce sufficient blood cells.
• Inherited Blood Disorders: Such as sickle cell anemia and thalassemia, which affect the production or function of hemoglobin.
• Immune Deficiencies: Conditions where the immune system is compromised.
• Myelodysplastic Syndromes: Disorders caused by poorly formed or dysfunctional blood cells.
• Multiple Myeloma: A cancer of plasma cells in the bone marrow.
• Neuroblastoma: A cancer that develops from immature nerve cells, often affecting children.

The decision to proceed with an allogeneic bone marrow transplant depends on various factors, including the specific disease, its stage, the patient's overall health, and the availability of a suitable donor. This procedure offers the potential for a curative treatment by restoring normal hematopoiesis and immune function in patients with otherwise life-threatening conditions.

Allogeneic bone marrow transplants can be categorised based on donor compatibility and the source of the stem cells. Understanding these types helps in determining the most suitable approach for each patient.

Based on Donor Compatibility

• Matched Related Donor (MRD) Transplant: The donor is a close family member, typically a sibling, whose human leukocyte antigen (HLA) markers closely match those of the patient. This type of transplant often has a higher success rate due to better compatibility.
• Matched Unrelated Donor (MUD) Transplant: The donor is not related to the patient but has compatible HLA markers. Such donors are usually identified through national or international bone marrow registries. While the compatibility is not as ideal as with related donors, MUD transplants provide viable options for patients without a suitable family donor.
• Haploidentical Transplant: The donor is a partially matched family member, sharing at least half of the HLA markers with the patient. Parents or children often serve as haploidentical donors. Advancements in transplant techniques have made haploidentical transplants more successful, expanding donor options.

Based on Stem Cell Source

• Bone Marrow Transplant: Stem cells are harvested directly from the donor's bone marrow, typically from the pelvic bones, through a surgical procedure under anesthesia. This traditional method is still preferred in certain cases.
• Peripheral Blood Stem Cell Transplant (PBSCT): Stem cells are collected from the donor's bloodstream after mobilizing them from the bone marrow using growth factors. The collection process, known as apheresis, is less invasive and has become more common due to faster engraftment times.
• Umbilical Cord Blood Transplant: Stem cells are obtained from the umbilical cord blood of newborns, which is rich in hematopoietic stem cells. Although the cell count is lower, cord blood transplants are advantageous due to the reduced risk of graft-versus-host disease and the less stringent HLA matching requirements.

Each type of allogeneic bone marrow transplant has its advantages and considerations. The choice depends on various factors, including the patient's condition, availability of donors, and specific medical circumstances. At Max Healthcare, our specialists conduct thorough evaluations to determine the most appropriate transplant strategy for each patient.

Before undergoing an allogeneic bone marrow transplant, patients undergo a thorough evaluation to assess their overall health and ensure they are fit for the procedure. This includes blood tests, imaging scans, and a bone marrow biopsy to determine the extent of the disease. One of the most critical steps is HLA typing, which helps identify a compatible donor, either from a sibling or an unrelated donor registry.

Once a donor is identified, the patient undergoes conditioning therapy, which involves high-dose chemotherapy and, in some cases, radiation therapy. This is done to destroy diseased bone marrow, suppress the immune system to prevent rejection, and create space for the new stem cells to engraft. Meanwhile, the donor undergoes medical screening, and stem cells are collected either from the bone marrow or peripheral blood. Before the transplant, the patient is admitted to a specialised bone marrow transplant unit, where strict infection control measures are followed to reduce the risk of complications.

The transplant itself is a relatively straightforward process. The harvested stem cells are infused into the patient’s bloodstream through a central venous catheter, similar to a blood transfusion. This procedure is painless and typically takes a few hours. Once the stem cells enter the bloodstream, they travel to the bone marrow, where they begin the process of engraftment—the formation of new blood cells. Engraftment usually occurs within 10 to 21 days, during which the patient is closely monitored for any complications.

Since the immune system is temporarily weakened, there is a high risk of infections, organ complications, and Graft-versus-Host Disease (GvHD)—a condition where the donor cells attack the recipient’s body. To minimise these risks, medications, including immunosuppressants and antibiotics, are administered, and regular monitoring of blood counts and organ function is carried out.

The initial recovery phase requires close observation in a protective hospital environment to reduce infection risks. During this period, patients may experience side effects such as nausea, vomiting, fatigue, and loss of appetite. Blood transfusions and supportive care are often needed to manage these symptoms. The risk of infections remains high, so precautions such as maintaining hygiene, limiting exposure to crowds, and adhering to prescribed medications are essential.

One of the most significant post-transplant challenges is Graft-versus-Host Disease (GvHD), where the donor cells attack the recipient’s tissues, particularly affecting the skin, liver, and intestines. To manage this, immunosuppressive medications are given, and patients are closely monitored for symptoms. Long-term recovery requires frequent follow-up visits to assess blood counts and overall health. Since the immune system takes time to rebuild, patients may need vaccinations after six to twelve months. A healthy lifestyle, including a nutritious diet and regular medical check-ups, plays a crucial role in ensuring a successful recovery and long-term well-being.

While allogeneic bone marrow transplants offer significant benefits, they also carry potential risks and complications. Understanding these risks is crucial for patients and their healthcare teams to make informed decisions and prepare for possible challenges.

• Graft-Versus-Host Disease (GVHD): This condition occurs when the donor's immune cells (graft) recognise the recipient's body (host) as foreign and attack its tissues. GVHD can manifest as acute or chronic, affecting various organs such as the skin, liver, and gastrointestinal tract. Management often involves immunosuppressive medications to control the immune response. 
• Infections: The conditioning regimen and immunosuppressive therapy can weaken the immune system, making patients more susceptible to bacterial, viral, and fungal infections. Prophylactic antibiotics, antivirals, and antifungals are administered to prevent infections. Vigilant monitoring for signs of infection is essential. 
• Organ Damage: The conditioning regimen can lead to damage in organs such as the liver, lungs, heart, and kidneys. Regular assessments of organ function are conducted to detect and manage any complications promptly. 
• Infertility: The conditioning regimen, especially when it includes chemotherapy and radiation, can lead to infertility in both men and women. Patients are counseled about fertility preservation options before undergoing the transplant. 
• Secondary Cancers: There is an increased risk of developing secondary cancers, such as skin cancer, later in life due to the conditioning regimen. Regular screenings and protective measures, like sun protection, are recommended to mitigate this risk. 
• Long-Term Physiological Side Effects: Late complications can include bone loss and osteoporosis, cataract formation, kidney dysfunction, and cardiovascular health issues. Regular follow-up care is essential to monitor and manage these potential long-term effects. 
• Mortality: Despite advancements, the procedure carries a risk of mortality due to complications such as GVHD, infections, and organ failure. The decision to proceed with an allogeneic bone marrow transplant involves a thorough evaluation of the potential benefits and risks. 

It's important to note that while these risks are significant, many patients undergo successful transplants and achieve long-term remission. Advancements in medical care, early detection, and management strategies have improved outcomes. Patients are encouraged to discuss these risks with their healthcare team to make informed decisions and to develop personalised care plans.

1. How does an allogeneic bone marrow transplant differ from an autologous transplant?

An allogeneic bone marrow transplant uses stem cells from a compatible donor, while an autologous transplant uses the patient’s own stem cells. Allogeneic transplants are typically recommended for conditions where the patient’s bone marrow is diseased or dysfunctional.

2. How long does the entire allogeneic bone marrow transplant process take?

The entire process, from pre-transplant evaluation to post-transplant recovery, can take several months. Hospitalisation usually lasts 4-6 weeks, but full immune recovery may take a year or more.

3. Who can be a donor for an allogeneic bone marrow transplant?

A donor can be a matched sibling, an unrelated donor found through a registry, a partially matched family member (haploidentical donor), or an umbilical cord blood donor.

4. What conditions are treated with an allogeneic bone marrow transplant?

This procedure is used to treat conditions like leukaemia, lymphoma, aplastic anaemia, sickle cell disease, and certain genetic disorders affecting bone marrow function.

5. Is a perfect donor match necessary for a successful transplant?

A perfect match is ideal, but in some cases, a partial match (haploidentical transplant) can be used with additional treatments to reduce complications.

6. How is the donor’s bone marrow collected?

Bone marrow is typically collected either through a bone marrow harvest, which involves extracting marrow from the hip bone under anaesthesia, or through peripheral blood stem cell donation, where stem cells are collected from the bloodstream after receiving medication to increase their numbers.

7. What tests are required before undergoing an allogeneic bone marrow transplant?

Patients undergo several tests, including blood tests, imaging scans, organ function tests, and a bone marrow biopsy to assess their overall health and readiness for transplant.

8. What is conditioning therapy, and why is it needed?

Conditioning therapy involves chemotherapy and/or radiation before the transplant to destroy diseased bone marrow, suppress the immune system, and create space for new stem cells to engraft.

9. How are the donor stem cells administered to the patient?

The collected stem cells are infused into the patient’s bloodstream through an intravenous (IV) line, similar to a blood transfusion. The stem cells then travel to the bone marrow and begin producing new blood cells.

10. What are the possible complications of an allogeneic bone marrow transplant?

Potential complications include graft-versus-host disease (GVHD), infections, bleeding, organ damage, and delayed engraftment. Close medical monitoring helps manage these risks.

11. How long does it take for the transplanted stem cells to start working?

It typically takes 2-4 weeks for the new stem cells to engraft and start producing healthy blood cells, but full immune system recovery can take up to a year.

12. What is graft-versus-host disease (GVHD), and how is it treated?

GVHD occurs when the donor’s immune cells attack the recipient’s tissues. It can affect the skin, liver, and intestines. Treatment includes immunosuppressive medications to control the immune response.

13. What dietary precautions should be taken after an allogeneic bone marrow transplant?

Patients should follow a neutropenic diet, avoiding raw or undercooked foods, unpasteurised dairy, and foods that could carry bacteria. Hydration and a balanced diet are essential for recovery.

14. Can an allogeneic bone marrow transplant fail?

Yes, transplant failure can occur if the donor stem cells do not engraft properly. This may require a second transplant or alternative treatments.

15. How is the risk of infection managed after the transplant?

Since the immune system is weakened, patients receive preventive antibiotics, antifungals, and antiviral medications, along with regular monitoring for early signs of infection.

16. Long-Term Outcomes and Lifestyle

When can a patient return to normal activities after an allogeneic bone marrow transplant?

Recovery varies, but most patients can gradually return to normal activities within 6-12 months, depending on their overall health and immune system recovery.

17. Will the patient need lifelong medication after an allogeneic bone marrow transplant?

Immunosuppressive medications are typically required for several months to a year to prevent GVHD, but lifelong medication is not always necessary.

18. Can an allogeneic bone marrow transplant cure diseases like leukaemia?

For many blood cancers and disorders, an allogeneic transplant offers a potential cure. However, outcomes depend on factors such as the patient’s overall health, disease stage, and response to the transplant.

19. Is pregnancy possible after an allogeneic bone marrow transplant?

Fertility can be affected by the transplant, but some patients may still conceive naturally or with fertility treatments. It is advisable to discuss fertility preservation options before undergoing the procedure.

20. Can a patient receive vaccinations after an allogeneic bone marrow transplant?

Yes, but routine vaccinations are delayed until the immune system recovers. Patients usually start receiving re-vaccinations about a year after the transplant.

Reviewed by Dr. Nivedita Dhingra - Associate Director - Medical Oncology (Haematology, Hemato – Oncology, BMT), Bone Marrow Transplant, Cancer Care on 3 March 2025.