What is Bone Marrow?
A part of our bones called bone marrow makes blood cells. Marrow is the soft spongy tissue inside the bones. It contains cells called hematopoietic stem cells. These cells can turn into several other types of cells. They can turn into more bone marrow cells or they can turn into any type of blood cell.
Certain cancers and other diseases keep hematopoietic stem cells from developing normally. If they are not normal then the blood cells that they make are not normal. A stem cell transplant gives you new stem cells. The new stem cells can make new, healthy blood cells.
What are the advantages of a Bone Marrow Transplantation (BMT)?
A bone marrow transplant can be used to:
- Replace diseased bone marrow with healthy, functioning marrow.
- Treat certain diseases that affect the production of bone marrow cells or severe immune system illness.
- Regenerate a new immune system that will fight existing or residual leukemia or other cancers not killed by the chemotherapy or radiation used in the transplant.
- Replace the bone marrow and restore its normal function after high doses of chemotherapy and/or radiation are given to treat a malignancy. This surgical procedure is often called rescue (for diseases such as lymphoma and neuroblastoma).
- Replace bone marrow with genetically healthy functioning bone marrow to prevent further damage.
A bone marrow transplant procedure involves the replacement of unhealthy marrow with healthy bone marrow stem cells. The goal of BMT is to transfuse healthy stem cells into a person after his or her own unhealthy bone marrow has been treated to kill the abnormal cells.
What are the diseases cured by bone marrow transplant?
Bone marrow transplants have been used for the treatment and cure of blood diseases, cancers, and immune diseases for many years.
- Aplastic Anemia: In this disorder, the patient’s marrow usually loses its ability to create blood cells.
- Bone marrow damage: The Patient who goes through chemotherapy would suffer from bone marrow damage. Such patients receive treatment using a bone marrow transplant.
- Sickle cell anemia: This is a blood disorder, which patients inherit from their family. This disorder causes the problem of deformed red blood cell type.
- Thalassemia: This is another blood disorder, which patients inherit from their family. This condition interrupts the formations of hemoglobin.
Bone marrow transplantations have also proved to be a life-saving treatment option for certain malignant conditions and blood-related diseases like:
- Hodgkin’s lymphoma
- Non-Hodgkin’s Lymphoma
- Multiple Myeloma (MM)
- Acute Myeloid Leukemia (AML)
- Chronic Myeloid Leukemia (CML)
- Acute Lymphoblastic Leukemia (ALL)
Who can be a suitable bone marrow donor?
A suitable (HLA matched) donor may be:
- Matched related donor (MRD) is where a donor is an HLA matched, relative. Brothers/sisters are the best choices for genetic match donors.
- Matched unrelated donor (MUD): The HLA matched marrow is from an unrelated donor usually found through bone marrow registries.
- Partially matched related – The Donor is from the patient’s family but partially matched.
- A suitable donor may also be a Parent / Child. (Haploidentical stem cell transplant)
What is the process for the selection of the best type of bone marrow transplant?
A BMT specialist can recommend between an Autologous transplant and an Allogeneic transplant. This selection would depend on the type of disease and would depend upon the patient’s health, the quality of bone marrow and age. For instance, a patient with bone marrow cancer is most likely to require the Allogeneic (donor marrow) type of stem cell transplant, because their own bone marrow cells might be severely damaged by cancer cells.
This is why the Allogeneic transplant is preferred over self or Autologous transplants.
There are 2 types of Allogeneic transplants.
The best type for each person depends on his or her age, health, and the type of disease being treated.
- Ablative, which uses high-dose chemotherapy
- Reduced-intensity, which uses milder doses of chemotherapy
What are the types of Bone Marrow Transplantation?
- Autologous BMT is done by using the patient’s own stem cells.
In an autologous transplant, the patient gets their own stem cells after doctors treat cancer. Initially, the health care team collects stem cells from the patient’s blood and freezes them. Next, the patient has powerful chemotherapy, and radiation therapy rarely. Then the health care team thaws the frozen stem cells. They put them back in the patient’s blood through a tube placed in a vein (IV). It takes about 24 hours for your stem cells to reach the bone marrow. Then they start to grow, multiply, and help the marrow make healthy blood cells again.
- Allogeneic BMT involves using the stem cells of a donor: In an allogeneic transplant type, you get another person’s stem cells whose bone marrow matches the patient. This is because you have certain proteins on your white blood cells called human leukocyte antigens (HLA). The best donor has HLA proteins and matching proteins make a serious condition called graft-versus-host disease (GVHD) less likely. In GVHD, healthy cells from the transplant attack your cells. Once you find a donor, you receive chemotherapy with or without radiation therapy. Next, you get the other person’s stem cells through a tube placed in a vein (IV). The cells in an Allogeneic transplants are not typically frozen. This way, your doctor can give you the cells as soon as possible after chemotherapy or radiation therapy.
What are the medical procedures and recovery periods for bone-marrow transplant patients?
Operational procedures before the bone marrow transplant:
Collecting the donor’s stem cells: The donor receives injections that increase the count of white cells in his or her blood. An injection is given to increase the stem cell count in your blood. The stem cells are collected afterward. In some cases, donors would also go through bone marrow extraction, which takes a few hours. The stem cells are collected from the blood through a vein running in the patient’s chest. The overall process can take several days in the hospital.
- Before the blood is drawn out, you or your donor will be injected with medicines to transfer blood-forming stem cells from your bone marrow to your bloodstream.
- The stem cells from you or your donor’s blood will be collected, separated from the bloodstream and kept in a frozen state.
Transplant treatment: A patient would receive intense chemotherapy. Some cases can include radiation therapy as well. The whole process takes about 5-10 days in total.
- The patient can go through a conditioning treatment which involves high or low dose chemotherapy or radiation to kill the cancer cells and your own stem cells so as to replace them with new stem cells.
Operational procedures during the bone marrow transplant:
Infusing donor’s stem cells: The collected stem cells are inserted into the bloodstream of the patient again. Infusing the donor’s stem cells into a patient’s blood is a process of 30 – 60 minutes. The transplant is divided into several infusions. Each infusion requires about 30 minutes or less. The process takes about a whole day.
- The infusion procedure begins with you sitting in a chair and the infusion passing through a surgical line attached to your neck.
- The patient would be monitored for any fall in blood pressure and the development of fever.
- The patient may experience some side effects such as headache, nausea, and shortness of breath.
Operational procedures after the bone marrow transplant:
- After the transplant is complete the stem cells will start grafting to the bone marrow in a period of two to four weeks. Thereafter, they will also start producing white blood cells, platelets, and red blood cells.
- In case the stem cells are from a donor, the patient will need to take antibiotics and anti-rejection medicines to help your body accept the transfused cells. The patient may also need transfused red blood cells, platelets, and nutrition.
- The patient may need to stay in a hospital for a month until their immune function stabilizes. It’s important to stay in a germ-free environment.
- The patient will need to visit the outpatient section so that the doctors can check your blood and bone marrow for any complications.
Expert doctors monitor engraftment every day. The completion of engraftment can take 10-28 days beyond the procedure of transplantation. The white blood cells increase in your body, which says that the blood is getting new cells.
Recovery: The healthcare team assists in the recovery with antibiotics, blood transfusions, and other required care. Experts keep an eye on the side effects if any. Antibiotics and other medications are utilized to prevent GVHD. The catheter remains in the cell transplant location to provide blood transfusions. The minimum recovery takes about 2 weeks in the hospital. The side-effects are monitored and gradual recovery takes about 12 weeks, depending on the intensity of a transplant.
Overall recovery will depend on:
- The disease.
- The intensity of chemotherapy.
- The use of radiation therapy.
- The accuracy with which the donor matches the patient in Allogeneic transplant.
- The expertise and the facilities available in the hospital or the clinic.
What are the risks associated with a bone marrow transplant?
The risks and benefits must be weighed in a thorough discussion with the doctors and the specialists in bone marrow transplants, prior to the procedure.
- Graft versus host disease (GvHD)
This often occurs after stem cell transplantation. This may happen when the immune cells of the donor sense that the patient’s transplanted cells (graft cells) are different and attack them. This can be a serious side effect of the transplant.
- GvHD is the most common complication seen in Allogeneic BMT and occurs in up to one in 10 patients who have transplants from related donors. It can be higher in transplants from other donors.
About 40% of patients develop GvHD. There are two types of GvHD:
- This condition can be acute (occurring less than 100 days from the transplant) or chronic (occurring more than 100 days after the transplant)
- Acute GvHD usually occurs during the first three months following the transplant. It may involve the skin (generalized rash or itching), Gut (diarrhea or abdominal pain), liver (jaundice)
- Chronic GvHD can develop at any time between three months and two years after the transplant. The symptoms can persist or may come and go for many years. They can range in severity from mild to life-threatening. The Patient can have dry eyes, joint pain, skin changes, breathing difficulty, difficulty in swallowing. It develops from acute GvHD and can cause symptoms for many years.
After having a bone marrow transplant the risk of developing an infection will increase. This is because the conditioning received before the transplant will weaken the immune system. Chemotherapy temporarily lowers the number of white blood cells, which normally fight and prevent infections. This puts the patient at a high risk of infections which can be caused by bacteria, fungi or viruses. If the patient gets an infection it could quickly develop into a more serious condition, such as lung infection (pneumonia). The risk of infection may be increased further if you need to take Immunosuppressants. It’s very important to prevent infections from developing. It may affect the skin, liver, lungs or intestinal tract of the patient. Medicines are given to prevent and fight these infections however some of these infections may not respond to the medications.
Generally, the risks are reduced if:
- The patient is young – studies have shown the younger the patient is the more likely the treatment is to succeed.
- The patient receives stem cell donation from a sibling (brother or sister)
- The patient has no serious health conditions (apart from the condition being treated for)
- Graft failure
There is a one in twenty chance that the new bone marrow from the family members will fail to take. The chance of this is higher with other types of donors. This means that the patient will not be able to make white cells, red cells or platelets. In this case, the transplant will need to be repeated or stem cells collected from the patient prior to the transplant can be given back to the patient. This will restore the original bone marrow, which means that the sickle cell disease will come back.
- Nutrition problems
The stomach and intestines are sensitive to chemotherapy. Nausea, vomiting, mouth sores, diarrhoea and loss of appetite may occur. The patient will be given nutrition through a nasal tube or through the veins until they are able to eat.
- Low blood counts
The patient may require transfusions with platelets and red blood cells, after receiving chemotherapy while waiting for the new stem cells to make normal blood cells.
Most patients who receive a transplant will not be able to have their own children in the future. This is a possible side effect of chemotherapy however, there have been patients who were able to conceive children after having a transplant. If the patient has gone through puberty before having a transplant it may be possible to collect and store sperm/ovarian tissue prior to the transplant.
How do you ensure the lowest possible bone marrow transplantation cost?
Treatment Possible ensures high-quality surgery is provided while we guarantee the lowest median cost. Our understanding of the Indian Healthcare market and our valued relation with surgeons enables us to ensure transplant treatment at a cost that is reasonable, affordable and flexible. You first get a free consultation with chosen Top BMT specialists in India with the hassle-free setup of post-operative recovery care, travel and stay.
A BMT specialist associated with Treatment Possible would ensure the highest quality of the transplant at an affordable price. So, instead of looking for general Bone marrow transplant cost, a patient can also specifically search for the cost of a bone marrow transplant for thalassemia through Treatment Possible ensuring that you get the correct cost details prior to the treatment.
The bone marrow transplantation cost is very high in advanced countries. The average cost of a Bone Marrow transplant in the United States is between USD 360,000 USD 800,000 for autologous or allogeneic but Treatment Possible through its association with Hospitals in India ensures that the same bone marrow transplantation cost ranges only from USD 25,000 to USD 40,000.
Treatment Possible through its expert transplant treatment services team and medical tourism professionals has flexible payment options besides offering the best bone marrow transplant cost package with customized treatment plans.
Call +91 9820327706 and get a free consulting session with top bone marrow transplant surgeons in India. Treatment Possible also offers a hassle-free arrangement for travel and stay in India during the treatment period.
Best Hospitals For Bone Marrow Transplant In India
Fortis Hospital - Mulund, Mumbai
Fortis Hospital Mulund is Maharashtra's largest multi-organ transplant hospital. It has completed the 100+ successful heart transplants in 4 years. Fortis hospital Mulund is equipped with the best surgical equipment and experienced surgeons that ensure a successive treatment in the best way possible. The facility now also has central Mumbai’s first advanced surgical robot.
- No. Of Beds: 315
- Speciality: Multi-Speciality
- Type of hospital: Tertiary care
- Accreditations: 5 times JCI accreditation (quality as per international standards), 5 times NABH accreditation (quality as per international standards)
- Location: Fortis Hospitals, Mulund Goregaon Link Road, Mulund-West, Mumbai, Maharashtra 400078
- Accommodation: Easily accessible hotels and service apartments nearby.
Medanta - The Medicity Hospital, Gurgaon
Medanta - The Medicity Hospital, Gurgaon is established in 2008 is one of the asia's first dedicated institute for liver transplant and other treatment for liver and biliary diseases. The Living Donor Liver Transplant program is the largest in India and second largest in the world consisting of a team of highly qualified experienced doctors who have conducted more than 2,500 Liver Transplants with a success rate of 95%.
- No. of beds: 1250
- Speciality: Super Speciality & Organ Transplant
- Type of hospital: Tertiary care
- Awards & Accreditations: 3 times NABH & JCL accreditated hospital
- Location: Medanta hospital, CH Baktawar Singh Road, Sector 38, Gurugram, Haryana 122001
Dharamshila Narayana Superspeciality Hospital - Delhi
Dharamshila Narayana Superspeciality Hospital was established in 1994 and is accredited by NABH and NABL. It is India’s first and world′s 11th hospital which has performed Haploidentical Bone Marrow Transplantation in an adult sickle cell disease patient. This is the Only hospital in Delhi that offers Third Generation Radiation Technology i.e. Elekta Synergy VMAT with IMRT, IGRT, SBRT and SRS / SRT and Respiratory Gating Capabilities and best Treatment Planning systems like Monaco, CMSxi0, ERGO++ and Plato.
- No. of beds: 300
- Speciality: Multi-speciality
- Type of hospital: Tertiary care
- Awards & Accreditations: NABH & JCL accreditated hospital
- Location: DHRC Hospital, Metro Station, Dharamshila marg, Vasundhara Enclave Near Ashok Nagar, Dallupura, New Delhi, Delhi 110096
Frequently Asked Questions (FAQ’s):
Q1. Can you walk after a bone marrow biopsy?
After the biopsy site will hurt for several days. Walking, taking pain killers and putting ice packs on the biopsy site can help. You will be able to return to normal activities after the procedure.
Q2. What is the most common site for bone marrow biopsy?
- The large pelvic bone near the hip (posterior iliac crest) is the most common site for a bone marrow biopsy but samples may also be taken from the sternum (breastbone).
- In case of infants, the shin bone (tibia) is the most common site for a bone marrow biopsy.
Q3. What will be the success rate of bone marrow transplant?
Bone marrow transplantation has nearly 85 percent survival rates for some blood cancers.
Q4. What will be the survival rate after a bone marrow transplant?
Survival rate of 22% at 3 years.
Q5. What are the symptoms of bone marrow disease?
- Weakness and fatigue due to shortage of red blood cells (anemia).
- Bleeding and bruising due to low blood platelets (thrombocytopenia).
- Infections due to shortage of normal white blood cells (leukopenia).
- Extreme thirst.
- Frequent urination.
- abdominal pain.
- Loss of appetite.
Q6. Can a blood test detect bone marrow cancer?
Blood cancers can be detected using Complete blood count blood test (CBC) but a bone marrow biopsy may help to confirm a diagnosis of a blood cancer.