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Introduction

The Bone Marrow Transplant unit is dedicated to provide outstanding care and support to paediatric patients who can be helped by transplantation therapy. The program provides transplant as a treatment option for a variety of acquired and congenital disorders of children and young adults including acute and chronic blood conditions like haematopoietic malignancies, anaemias and bleeding disorders; and inherited immune deficiency syndromes and metabolic diseases. At Kokilaben Hospital the expert team specializes in performing allogeneic and autologous bone marrow, peripheral stem cell and umbilical cord blood transplants and provides best possible care to the patients.

The Bone Marrow Transplant unit has HEPA filters that provide air free of microorganisms within the unit. The plan of the unit is designed to provide the maximum care and prevention of infections.

Living life again

Bone Marrow Transplantation (BMT), also called haematopoietic stem cell transplant, is used to increase the chance of a cure or remission in certain blood cancers and some benign blood disorders. It usually involves intense chemotherapy followed by an infusion of stem cells. The treatment requires close nursing and medical care for a number of weeks.

What is a stem cell transplant?

A stem cell transplant may be used so that intensive high-dose chemotherapy (and sometimes radiotherapy) can be given to a patient to kill cancerous cells. The chemotherapy is higher than conventional chemotherapy and also kills the stem cells in the bone marrow that would normally make blood cells. Therefore, following the chemotherapy, the patient is given back (or transplanted) stem cells which can then make normal blood cells again.

Where do you get stem cells from?

Stem cells can be obtained from the blood, bone marrow, and increasingly, nowadays from the umbilical cord; therefore, it is also denoted as the term stem cell transplantation.

What is the bone marrow, and what are stem cells and blood cells?

Bone marrow

Blood cells are made in the bone marrow by stem cells. Bone marrow is the soft sponge like material in the centre of bones. Large flat bones such as the breastbone (sternum) and pelvis contain most of the bone marrow. To make blood cells constantly you need a healthy bone marrow. You also need nutrients from your diet, including iron and some vitamins.

Stem cells

Stem cells are primitive (immature) cells. There are two main types in the bone marrow - myeloid and lymphoid stem cells. These come from even more primitive cells called common pluripotent stem cells. So these cells are the one from which all other cells come from. Stem cells constantly divide and produce new cells. Some new cells remain as stem cells and others go through a series of maturing stages (precursor or blast cells) before forming into mature blood cells.

Blood cells

Mature blood cells are released from the bone marrow into the bloodstream. Mature blood cells are:

Red Cells:

These are responsible for the red colour of the blood. One drop of blood contains about five million red cells. Red cells contain chemical called haemoglobin. This binds to oxygen, and transports oxygen from the lungs to all parts of the body.

White cells:

The different types of white cells are called neutrophils, lymphocytes, eosinophils, monocytes, and basophils. They are part of the immune system. Their main role is to defend the body against infection.

Platelets:

These are tiny cells and help the blood to clot incase of an injury.

Stem cells rapidly multiply to make millions of blood cells each day. Because of this feature, they are more easily killed by chemotherapy than most other cells in the body. This is because chemotherapy drugs work by killing rapidly dividing cells (such as cancer cells).

When is a stem cell transplant used for treatment?

A stem cell transplant is an option which is considered for various cancer conditions. For some cancers such as multiple myeloma or acute myeloid leukaemia it can be considered as part of the initial therapy for the disease; whereas for other cancers such as lymphomas, it may be considered in cases of relapse. A stem cell transplant is also used for some rare non-cancerous blood disorders like aplastic anaemia, thalassemia major, etc.

What are types of stem cell transplant?

There are two main types of stem marrow transplantation: Autologous and Allogeneic.

Autologous transplant

Here, the patients own stem cells are removed and frozen for storage and later use. This is followed by high dose chemotherapy or radiation, after which the cells are thawed and transplanted back to the patient.

Allogeneic transplant

In this transplantation, the haematopoietic stem cells come from a donor, ideally a brother or sister with a similar genetic makeup. If the patient does not have a suitably matched sibling, an unrelated person with a similar genetic makeup can at times be used.

Are there any new types of transplant?

Non-Myeloablative (Mini) Transplant allows the patient to have less intensive chemotherapy before transplantation with the stem cells. This approach may be recommended if the patient cannot undergo standard bone marrow transplantation because of older age or any other coexisting illnesses.

Which type of transplant is the best?

The treating doctor will determine whether allogeneic or autologous transplantation is best, based on many factors including the type of cancer, age and overall health, and the availability of a suitable donor.

As a general rule, autologous transplantation is associated with fewer serious side effects, since the patient is transplanted with their own cells. However, an autologous transplant may be less effective than an allogeneic transplant in treating certain kinds of cancers.

In an allogeneic transplant, a major component of the overall benefits of a stem cell transplant is an immunological phenomenon called graft versus tumour effect. This happens because the transplanted donor cells fight against the patient’s tumour cells and kill them. In many cancers, the immune response caused by the transplanted cells improves the overall effectiveness of the treatment. This immune response helps kill off any residual cancer cells that remain in the patient’s body. However, a major concern is that at times, the transplanted cells may fight against the patient’s own cells as well, which is called graft versus host disease.

Where are stem cells obtained from?

Stem cells can be collected:

Bone marrow

This involves a small operation to collect some marrow from the pelvic bone.

Peripheral blood

Some stem cells occur in the blood (most are in the bone marrow). The stem cells in the blood can be collected (harvested) by a machine called a cell separator. The blood flow is diverted from a vein in the arm to pass through the machine which separates out the stem cells. The procedure takes about 4-6 hours. Drugs are given for a few days before this procedure to stimulate the body to make more stem cells in the bone marrow which spill out into the blood.

Umbilical cord of a newborn baby.

How is a stem cell transplant given?

It is very similar to a blood transfusion. Following the intense course of chemotherapy (and sometimes radiotherapy), the solution containing stem cells is given into a vein via a drip. The stem cells travel through the bloodstream and end up in the bone marrow. Here they start to make blood cells. It can take several weeks for the bone marrow to recover, to take up the transplanted stem cells, and to make enough new blood cells. During this time the patient will need to be in hospital and be closely monitored.

The patient may need several blood transfusions during this time until they are making enough blood cells. Antibiotics are given to minimise the risk of infection. Also, drugs are given to help stimulate the stem cells to multiply as quickly as possible.

What are the main risks of having a stem cell transplant?

There is a risk of serious problems with a stem cell transplant. For example:

  • Infectionis the main risk. Following the intense chemotherapy, and before the time the bone marrow is working again, the patient will have a very low immunity. During this time they are at risk of serious and life-threatening infections. This is why antibiotics are given and they will be nursed away from other people until the bone marrow recovers. This can take several weeks.
  • Bleedingproblems from the low level of platelets after the chemotherapy.
  • If the transplantation is from a donor, there is some risk that the match will not be perfect, and the donor cells may react with the patient's body cells. This is called graft versus host disease. This is not always serious but sometimes it can be.
  • Rarely, the transplanted stem cells may fail to work (Graft Failure).
  • There is a risk of short-term and long-term side-effects from intense chemotherapy (and/or radiotherapy).

Why Kokilaben Hospital?

The Bone Marrow Transplant unit is dedicated to provide outstanding care and support to paediatric and adult patients who can be helped by transplantation therapy. The program provides transplant as a treatment option for a variety of acquired and congenital disorders of children and young adults including acute and chronic blood conditions like blood cancers, anaemias and bleeding disorders, and inherited immune deficiency syndromes and metabolic diseases. At Kokilaben Hospital, the expert team specialises in performing allogeneic and autologous bone marrow, peripheral stem cell and umbilical cord blood transplants and provides best possible care to the patients.

The Bone Marrow Transplant unit has HEPA filters that provide air free of microorganisms within the unit. The plan of the unit is designed to provide the maximum care and prevention of infections.

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