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What You Need To Know About Bone Marrow Transplantation .pdf



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What You Need To Know About Bone Marrow
Transplantation

Bone marrow is the soft, spongy tissue located inside the bones which produces the
blood cells: red and white blood cells and platelets. The marrow also contains
unspecialized Hematopoietic Stem Cells. These cells can turn into many other types of cells such
as bone marrow cells or any type of blood cells. Some cancers can prevent these stem cells
from developing normally.
Bone Marrow Transplantation (BMT) is one of the complex medical procedures that
are performed to treat both the benign and malignant disorders of the blood, when the
marrow is incapable of functioning properly. This can be due to chronic infections
or cancer treatments like chemotherapy. Cancers are broadly divided into liquid cancers which
affect the blood, and solid tumours. Liquid cancers are again categorized into leukaemia
and lymphomas. Bone Marrow Transplantation is used to treat some common blood cancers such
as acute marrow leukaemia, Lymphomas which have relapsed and Multiple Myelomas.

Historically, the stem cells used in this process was collected from the bone marrow.
But, now they are collected from the peripheral blood. So, BMT is more aptly referred to
as Hematopoietic Stem Cell Transplantation. Contrary to popular perception, there is no
painful surgery involved. Basically, the doctors collect the stem cells from donor and
after conditioning chemotherapy, where the diseased bone marrow cells are destroyed, they
are transfused back into the recipient. The stem cells are mainly collected in two ways. One way
is by collecting the peripherally mobilized stem cells after administering the growth factor,
which brings the stem cells from the bone marrow to the periphery. These are then collected
using an apheresis machine. By and large, this is a safe procedure and the donor experiences
little or no pain during the collection process and there are no short-term or long-term sideeffects resulting from it. In some disorders like bone marrow failures such as primary
immunodeficiency disorders and aplastic anaemia, it is preferable to collect the stem cells from
the bone marrow. In such cases, the donor is taken to an Operation Theatre and the stem cells are
collected from the marrow after administering general anaesthesia.
There are mainly two types of BMT:
1.Autologous Bone Marrow Transplant: The source of the stem cells is the patient
themselves. The stem cells are harvested, or removed, before the patient receives high-dose
chemotherapy or radiation treatment which will destroy the bone marrow. After the treatment,
the cells are returned to the body to make normal blood cells. The advantage of this method is
that there are no adverse effects on immunity since the person’s own cells are returned and there
are no foreign agents involved. However, this method can be used only if the person has a
healthy bone marrow.
2. Allogeneic Bone Marrow Transplant: In this case, the stem cells are collected from
another person called the donor. The donor must be a close genetic match. This is further divided
into Matched Sibling Donor Stem Cell Transplantation wherein the patient’s own sibling gives
the stem cells. Another way is Unrelated Stem Cell Transplantation, where the donor is an
unrelated person. Since our country does not have a robust donor registry, sometimes a HalfMatch or Haploidentical transplant is also carried out where the HLA is not identical, but halfmatched.

Some basic questions and answers about BMT are as follows:
1.What happens after the stem cells have been transplanted to the patient?
BMT is a very complicated and intensive treatment. The doctor briefs the patient and the
caregivers thoroughly regarding this procedure. The patient is given treatment to control the
disease which may be refractory or relapsed as much as possible. This is called Salvage Therapy
in Lymphomas. After this the patient is taken to a highly sterile ward where they will be given
conditioning chemotherapy to destroy the abnormalities in the bone marrow. The stem cells are
then collected from a healthy related or an unrelated donor and are infused back into the patient.
It may take about 3-4 weeks for those stem cells to go into the bone marrow and start making
blood cells. During this period, the patient is kept under strict surveillance for any infections or
complications. Once the patient is stable, walking around and orally consuming food, he/she is
discharged from the ward. The doctor maintains a close watch on the patient for about 60-90
days after the patient is discharged. This is because, the first hundred days after the transplant are
very critical.
2. What are the possible side-effects of BMT?
BMT toxicities can be classified into short-term and long-term toxicities. Short-term
toxicities can be a result of the chemotherapy and include nausea, vomiting, ulcers in the mouth,
severe pain, inability to taste food, loss of appetite, weight loss, diarrhoea and other fungal and
viral infections. But then, there are adequate medications to take the patients safely through the
critical period.
In the long-term, in allogeneic transplantation, the stem cells can mount an immune
attack in some cases. This is called Graft-versus- host disease (GVHD). In rare cases, it
may affect their lungs, heart etc. But with each passing year, the Transplant-Related
Mortality (TRM) has decreased from 30%-40% historically to 10%-20% in recent
years.
3. What diseases are treated most often using BMT?
Globally, the most common diseases treated using Bone Marrow Transplantation are Multiple
Myeloma which is a common indicator for autologous transplantation,Acute leukaemia, which is

a common indication for allogeneic transplantation,Aplastic Anaemia and Relapsed and
Refractory Lymphomas. In Asia, Thalassemia accounts for a large number of transplants. There
are certain rare immune disorders such as primary immunodeficiency disorders which can be
cured using BMT.


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