A bone marrow transplant, also known as a stem cell transplant, is a medical procedure that replaces damaged or diseased bone marrow with healthy blood-forming stem cells. This procedure is often used to treat various types of blood cancers, immune disorders, and genetic diseases.

Overview

Bone marrow is the soft, spongy tissue inside bones responsible for producing blood cells. In a healthy individual, stem cells in the bone marrow give rise to three main types of blood cells:

• Red blood cells (erythrocytes) – Responsible for carrying oxygen throughout the body.
• White blood cells (leukocytes) – Help the body fight against infections and diseases.
• Platelets play a vital role in blood clotting, helping to prevent excessive bleeding.

When a person’s bone marrow is damaged or not functioning properly, due to conditions like leukemia, lymphoma, or aplastic anemia, a bone marrow transplant may be recommended. The transplant procedure aims to restore the patient’s ability to produce healthy blood cells.

Types of Bone Marrow Transplants

Here are three primary types of bone marrow transplants:

Autologous Bone Marrow Transplant:

1. In this procedure, the patient’s own stem cells are collected and stored before high-dose chemotherapy or radiation treatment.
2. After the intensive treatment, the stored stem cells are infused back into the patient’s body to help restore normal blood cell production.
3. This is also known as a “rescue” transplant, as it helps the patient recover from the damaging effects of the cancer treatment.

Allogeneic Bone Marrow Transplant:

• In this case, the stem cells come from a donor, who may be a sibling, a relative, or an unrelated individual found through a bone marrow registry.
• The donor’s cells must be a close genetic match to the patient’s cells to reduce the risk of rejection or complications.
• This type of transplant can be used to treat various blood cancers, immune disorders, and genetic diseases.
  Umbilical Cord Blood Transplant:
• This is a type of allogeneic transplant where the stem cells are obtained from the umbilical cord and placenta of a newborn baby.
• Umbilical cord blood contains a high concentration of stem cells and is less mature, which means there is a lower risk of rejection.
• However, the recovery of blood cell counts is generally slower compared to other types of transplants.

Best Bone Marrow Transplant Hospitals in India

Metro Hospitals are recognized as one of the leading centers for bone marrow transplants in India. The hospital’s dedicated team of specialists, advanced facilities, and comprehensive care make it a preferred choice for patients seeking bone marrow transplant treatment.

At Metro Hospitals, patients can expect personalized care, state-of-the-art treatment techniques, and a commitment to providing the best possible outcomes.

Bone Marrow Transplant Cost in India

The cost of a bone marrow transplant in India can fluctuate significantly depending on various factors. Here’s a detailed breakdown of typical costs:

Autologous Bone Marrow Transplant Cost

The cost of an autologous bone marrow transplant, where the patient’s own stem cells are used, typically ranges from ₹15,00,000 to ₹30,00,000. This procedure is often used to treat blood disorders like thalassemia.

Allogeneic Bone Marrow Transplant Cost

The cost of an allogeneic bone marrow transplant, where stem cells are obtained from a donor, can range from ₹20,00,000 to ₹40,00,000. This type of transplant is used to treat conditions like leukemia and lymphoma.

Additional Factors Affecting Cost

The actual cost of the bone marrow transplant may vary based on the following factors:

1. Hospital and Location: The cost can differ significantly depending on the hospital and the city where the procedure is performed. Hospitals in metro cities like Delhi, Mumbai, and Bangalore generally have higher costs compared to smaller cities.
2. Type of Transplant: The cost can vary based on the type of transplant, such as autologous, allogeneic, or syngeneic (using stem cells from an identical twin).
3. Complications and Additional Procedures: The cost may increase if there are any complications or the need for additional procedures, such as extended hospital stay, intensive care, or treatment for graft-versus-host disease.
4. Insurance Coverage: If the patient has health insurance coverage, the out-of-pocket expenses may be lower, as the insurance provider will cover a portion of the costs.

It’s essential to consult with the hospital and the transplant team to get a more accurate estimate of the total cost based on your specific medical condition and the recommended treatment plan.

Pre-Transplant Eligibility and Preparation

Before the bone marrow transplant, the patient will undergo a series of tests and evaluations to ensure they are eligible for the procedure. These may include:

• Blood work
• 24-hour urine specimen for kidney function evaluation
• Electrocardiogram (EKG)
• Chest X-ray
• CT scans (chest, sinus, abdomen, and pelvis)
• Bone marrow diagnostic test (if required)
• MUGA scan or echocardiogram to assess heart function
• Pulmonary function test to evaluate lung performance
• Consultation with the psychology department (if recommended)

The transplant team will work closely with the patient and their caregiver to guide them through the entire process, from pre-transplant preparation to post-transplant care and recovery.

Bone Marrow Harvesting

In this procedure, the doctor uses a needle to extract bone marrow from specific parts of the patient’s hipbone. The process typically takes 1-2 hours, and the patient is given medication to help them sleep through the procedure. Afterward, the patient will have large bandages over their hips that need to remain in place for 24 hours. The patient may also experience some soreness for a few days.

During the procedure, the doctor will also collect some of the patient’s red blood cells, which will be returned to the patient through an intravenous line as they recover.

For a donor, the process is similar, but the collected stem cells are then immediately transplanted into the recipient patient.

Cord Blood Collection

In some cases, stem cells can be obtained from the placenta and umbilical cord of a newborn baby. The mother decides beforehand if she wants to donate these cells, and the process does not affect the baby. The collected cells are then frozen until they are needed for a transplant.

Conditioning

Before the transplant, the patient will undergo a process called conditioning. This typically involves chemotherapy, and sometimes radiation therapy, to:

• Prepare the bone marrow to accommodate the new stem cells.
• Suppress the patient’s immune system to lower the risk of rejection.
• Kill any remaining cancer cells
• The conditioning process can take up to a week to complete.

Transplant

A few days after conditioning, the patient will receive the new stem cells through a central line in their chest. This process takes a few hours, and the patient remains awake and pain-free. The new stem cells will then make their way into the patient’s bone marrow.

It may take a few weeks for the patient’s blood cell counts to return to normal levels. If the stem cells were frozen, the patient may experience side effects from the preservative used, and will be given medication and additional fluids to help manage these.

Overall, the side effects of the transplant procedure are usually minor and may include chest pain, fever, headaches, nausea, and a metallic taste in the mouth.

Donor Process

If a donor is identified as a match for a patient, they will go through the following steps:

1. Information session: The donor will receive detailed information about the donation process, recovery, and any risks or side effects.
2. Physical exam and testing: The donor will undergo a physical exam and provide blood samples to confirm they are a suitable match and the donation is safe.
3. PBSC or bone marrow donation: The donor will either undergo a non-surgical PBSC donation or a surgical bone marrow donation, depending on which is most appropriate for the patient.
4. Recovery and follow-up: Most donors are able to return to their normal activities within 1-7 days after the donation process.

The time and effort required from donors is an essential part of the bone marrow transplant process, and their contribution can be life-saving for the recipient patient.

When a Bone Marrow Aspiration and Biopsy Are Recommended

Your healthcare provider may recommend a bone marrow aspiration and biopsy if blood tests reveal abnormal levels of red blood cells, white blood cells, or platelets. Abnormally high or low levels of these cells can indicate underlying medical conditions, such as blood disorders or cancers originating in the bone marrow. For patients undergoing cancer treatment, these tests help determine if the cancer has affected the bone marrow. Bone marrow tests are performed to:

• Investigate issues related to abnormal blood cell levels
• Diagnose and monitor blood disorders like anemia, Polycythemia Vera, and thrombocytopenia
• Diagnose and assess bone marrow disorders
• Diagnose and track specific cancers, including leukemia, multiple myeloma, and lymphoma
• Identify infections originating from or affecting the bone marrow
• You will be asked to sign a consent form authorizing these tests. If you have any questions about the procedure, consult your healthcare provider.
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Understanding Bone Marrow Test Results

Results from bone marrow tests may take days or weeks to finalize. They can reveal whether you have a bone marrow disease, blood disorder, or cancer. For those already undergoing cancer treatment, results can indicate:

• The effectiveness of current treatments
• The progression of the disease
• If results are abnormal, your healthcare provider may recommend additional tests or discuss further treatment options. For clarification on your results, consult with your healthcare provider.

Benefits of Bone Marrow Transplants

Bone marrow transplants involve replacing damaged or nonfunctional bone marrow with healthy marrow. This procedure can restore the immune system to combat residual cancer or other diseases that were not eradicated by previous treatments. Common conditions treated with bone marrow transplants include:

• Leukemias
• Severe aplastic anemia
• Lymphomas
• Multiple myeloma
• Immune deficiency disorders
• Certain solid-tumor cancers (rarely)

However, not all patients with these conditions are suitable candidates for bone marrow transplants.

Conditions Treated by Metro Hospital’s Bone Marrow Program

Metro Hospital’s Marrow Transplant Program addresses a variety of conditions, including:

• Acute Myeloid Leukemia (AML): A rapid-progressing blood cancer with elevated granulocyte levels.
• Acute Lymphoblastic Leukemia: Cancer characterized by excessive production of lymphocytes by the bone marrow and lymphatic organs.
• Amyloidosis: A condition marked by abnormal protein buildup in organs.
• Aplastic Anemia: A rare disorder where the bone marrow fails to produce sufficient blood cells.
• Chronic Myelogenous Leukemia: A slow-progressing cancer affecting blood-forming cells in the bone marrow.
• Chronic Lymphocytic Leukemia (CLL): A slowly progressing blood cancer with excessive lymphocyte production.
• Acute Renal Failure (ARF): A serious complication that can arise post-transplant, sometimes due to veno-occlusive disease.

Planning for Bone Marrow Transplant Surgery

• Matching Donor Cells
• To donate stem cells, the donor must have compatible HLA markers with the recipient. Blood tests for HLA typing determine how well the donor’s cells match the recipient’s. The match is assessed based on 10 HLA markers.
• Stem Cell Donation to a Relative: Siblings have a higher likelihood of being a match, known as a Matched Related Donor (MRD) transplant. A 50% match is termed Haploidentical Transplant.
• If Not a Match: Non-relatives can be matched through extensive searching in national and international registries for a matched unrelated donor.

Complications

For Autologous Bone Marrow Transplants

Pre-transplant chemotherapy and radiation can cause side effects similar to those treatments, including:

• Increased infection risk due to low white blood cell counts
• Immediate side effects: nausea, vomiting, mouth sores, fatigue, anemia, and diarrhea
• Long-term side effects: infertility, cataracts, early menopause, thyroid issues, lung or bone damage, and increased cancer risk

For Allogeneic Bone Marrow Transplants

Complications include:

Infections: Higher risk of infections due to a weakened immune system.

Graft-Versus-Host Disease (GVHD): Occurs when the donor’s cells attack the recipient’s body. GVHD can be mild to severe and may require medication.

• Immediate side effects similar to autologous transplants
• Long-term side effects similar to autologous transplants

Cost of Allogeneic Bone Marrow Transplant

The cost of an allogeneic bone marrow transplant in India typically ranges from ₹20 lakhs to ₹35 lakhs.

Pediatric Bone Marrow Transplants

Bone marrow transplants in children come with specific risks, which should be discussed with the healthcare provider and BMT team. Risks and complications include:

• Infections: Resulting from significant suppression of bone marrow function.
• Low Platelet Levels: May require multiple transfusions.
• Pain: Often from oral sores and gastrointestinal irritation.
• Diarrhea, Nausea, and Vomiting: Common from chemotherapy and radiation.
• Fluid Overload: Monitored closely to avoid complications.
• Breathing Problems: Managed with supplemental oxygen if needed.
• Organ Damage: Potential short-term or long-term damage to the liver or heart.

Post-Operative Recovery

• Balanced Diet: Vital for regaining strength, despite potential side effects.
• Avoid Certain Foods: Unpasteurized milk, raw or undercooked eggs and meats, and food from bulk bins should be avoided.
• Exercise: Helps manage weight and boost stamina. Consult your doctor about suitable exercise.
• Avoid Alcohol: To protect liver function.
• Medication: To prevent rejection if the marrow is from a donor.
• Sun Protection: Use SPF 50 sunscreen and wear protective clothing.
• Mouth Care: Important to manage soreness or dryness.
• Emotional Support: Crucial for coping with the physical and emotional impact of the transplant.

Bone Marrow Transplant FAQs

What is the difference between bone marrow & bone marrow transplant?

Bone marrow is the soft, spongy tissue within bones responsible for producing blood cells. A bone marrow transplant replaces damaged or diseased marrow with healthy stem cells through an IV.

How are bone marrow and stem cell transplants different?

The difference lies in the source of stem cells. Bone marrow transplants use stem cells from the marrow, while peripheral blood stem cell transplants use stem cells from the bloodstream.

Are there different types of bone marrow transplants?

Yes, there are two main types:

Autologous: Involves utilizing the patient’s own stem cells.

Allogeneic: Uses stem cells from a donor, who must match the patient’s blood.

How do I know if a bone marrow transplant is right for me?

Consult your doctor to evaluate your disease and overall health. Discuss all treatment options to determine the best approach.

How long will I be hospitalized after the bone marrow transplant?

Hospital stays typically range from 30 to 100 days, depending on factors like the type of transplant and individual response.

How can I find out if I am a match for a relative’s transplant?

Undergo blood tests for HLA typing. Discuss with your family and doctor about the testing process.