Types of bone marrow transplant / Stem cell Transplant
Autologous transplant - When the stem cells come from your own blood or bone marrow, it is called an autologous transplant
Allogenic transplant - When the stem cells come from another person, it is called an allogeneic transplant. The donor's immune system markers are closely matched to recipient. The donor may be a relative or a complete stranger.
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Bone marrow transplant can be used in :
In diseases such as leukaemia , aplastic anaemia , sickle cell anaemia , non-Hodgkin's lymphoma and Hodgkin's lymphoma, multiple myeloma, and aplastic anemia etc
Restore bone marrow that has been damaged after cancer treatment by total body radiation and high doses of chemotherapy .
Regenerate a new immune system that will fight existing cancers not killed by chemotherapy or radiation
As the treatment of immune system and genetic defects, diabetes, sickle cell disease, and thalassemia, autism etc
Stem cells Collection Procedure
Stem cells for transplantation are collected from either :
For peripheral blood stem cell transplantation (PBSCT), stem cells are taken from blood.
The growth factor G-CSF is used to stimulate the growth of new stem cells
The blood is removed and passed through a machine that takes out the stem Cells and circulates the remaining blood back to the donor . This way of collecting stem cells is called apheresis.
Bone marrow :
Stem cells can be retrieved directly from the bone marrow.
This requires the donor to undergo a minor surgical procedure.
The surgeon inserts a hollow needle into the donor's pelvic bones and removes liquid marrow. This is done many times to collect enough stem cells for the person receiving the donated bone marrow, is called harvesting the bone marrow .
The marrow that's removed (harvested) passes through a series of filters to remove bone or tissue fragments and is then placed in a blood bag from which it can be infused into the recipient.
You may be interested in: Allogeneic bone marrow transplantation
Placental and cord blood :
Stem cells may also be taken from umbilical cord blood.
Before Transplant :- Before you have a transplant, you physician will discuss the transplant process and all its effects with you.
You will first be evaluated to find out if you are eligible for a transplant.
Many different medical tests will be performed , these might include:
HLA tissue typing
A complete health history and physical exam
Bone marrow biopsy
CT (computed tomography) scan or MRI (magnetic resonance imaging)
Lung function tests, such as a chest x-ray and PFTs
Blood tests, such as a complete blood count, blood chemistry , hepatitis B, CMV, and HIV
Conditioning treatment (chemo and/or radiation therapy)
It’s the first step in the transplant process and typically takes a week or two.
Conditioning is treatment with high-dose chemo and/or radiation therapy.
Doctors use chemotherapy and radiation to destroy bone marrow. This also gets rid of the cancer cells-along with the normal cells-in your bone marrow and the rest of your body. Later, when healthy stem cells are infused from a donor, those new cells will go to the marrow and be able to take over the job of making new blood cells
This phase of the transplant can be very uncomfortable because very high treatment doses are used. Chemo and radiation have many side effects .
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Infusion of stem cells
A central venous catheter (CVC) is inserted , the CVC will stay in during your treatment and for some time afterward until your blood counts are normal.
After few days after conditioning treatment, you will be transfused stem cells. They will be given through your central venous catheter, much like a blood transfusion.
For allogeneic transplants, the donor cells may be removed and then processed in the lab right away and transfused to recipient – they’re not frozen.
It is a painless process and no anesthesia required.
Side effects from the infusion are rare and usually mild, If they do happen, they are treated as needed. The stem cell infusion must always be completed.
Some side effects may be
The recovery stage begins after the stem cell infusion.
The time taken for normal blood counts is usually about 2 to 6 weeks but varies from individual patient
Right after transplant,the blood counts are the lowest, prophylactic antibiotics are given to prevent from getting infections.
Still, many patients have high fevers due to very few white blood cells (neutropenia), or bleeding from too few platelets (thrombocytopenia).
Transfusions of RBCs and platelets are often needed until the bone marrow starts working and new blood cells are being made by the infused stem cells
Risks Of Transplant
Graft failure. The new stem cells do not work,
Graft-versus-host disease- The new stem cells attack other cells in your body.
Veno-occlusive disease- liver pathology caused by the high dose of chemotherapy or radiation given before a transplant.
Factors Affecting Cost Of Transplant
The cost to the patient depends on a variety of factors like
The hospital, the patient chooses.
Room –Standard single room, deluxe room, super deluxe room for the number of nights specified (including nursing fee, meals, room rate, and room service).
Fee for the team of doctors
cost of medications, immunosuppressant drugs , chemo/ radiotherapy
cost for stem cell collection process n donor testing
Standard tests and procedure for the recipient
Cost of the follow –up care required after the procedure