Autologous Bone Marrow Transplant is a medical procedure to replace damaged or destroyed bone marrow due to disease, infection, or chemotherapy. In this procedure, bone marrow stem cells are transplanted to the bone marrow where they produce new blood cells and grow.
Autologous refers to the removal of stem cells from the patient’s own before receiving high dosage treatment of chemotherapy, radiation or both. The stem cells are kept in a freezer and transplanted back to the patient after receiving the treatment. This will enable production of normal blood cells.
Bone marrow is a spongy substance found in the large bones such as the thighs, hips and ribs. Bone marrow is taken usually from the hip. They are made of haematopoietic stem cells which contains red blood cells, white blood cells and platelets. The bone marrow is a place for these cells to grow and be stored until they are released when needed such as:
- To fight infection – white blood cells
- To carry oxygen from the lungs and return carbon dioxide to the lungs – red blood cells
- To form blood clots to control bleeding – platelets
Indications for Autologous Bone Marrow Transplant
When bone marrow stem cells are not healthy enough to perform normal functions after treatment, a Bone marrow transplant is needed, as follows:
- Cancer affecting the marrow like lymphoma, multiple myeloma and leukaemia
- Damaged bone marrow due to chemotherapy or radiotherapy
- Aplastic anaemia, a disorder where the marrow stops making red blood cells
- Sickle cell anaemia, an inherited blood disorder causing red blood cells to misshapen
- Thalassemia, an inherited blood disorder that causes formation of abnormal haemoglobin, an integral part of red blood cells
- Congenital neutropenia, another inherited disorder causing recurring infections
Diagnosis and Tests
- An electrocardiogram (ECG)
- An echocardiogram
- An X-Ray
- An MRI Scan
- Blood tests
- Biopsy for cancer
Steps of Autologous Bone Marrow Transplant
- Tests and examination of your health
- Harvesting – obtaining the stem cells and storing
- Conditioning – a process of treatment to prepare your body through chemotherapy and/or radiotherapy to destroy existing bone marrow cells or any cancer cells
- Transplanting the stem cells
- The doctor will examine your overall health.
- Diagnostics tests should be done as suggested by your doctor.
- Inform your doctor of all your medical history including current medications and allergies.
- Through the tests, your doctor will determine whether you are fit for a transplant or not.
- You will be asked to stop certain medications like blood thinner or herbal supplements if you are currently doing so.
- If you have cancer, biopsy test will be taken to find out if the cancer is in remission or if there is any high risk of returning after the transplant.
- You will be given general anaesthetic to take about a litre of bone marrow using a needle and syringe before stem cells are taken from your hip bone.
- The stem cells are stored in a freezer and thawed for later use.
- Before the conditioning treatment is done, a central line will be inserted into a large vein near your heart.
- A range of medications like chemotherapy and/or radiotherapy will be passed on through this without the need for many injections.
- At this stage, you may suffer from temporary side effects of therapy such as hair loss, sickness and tiredness.
- Transplant will then be carried out a day or two after conditioning.
- The stem cells are thawed before being transplanted.
- The stem cells will be transplanted through the central line.
- This takes a couple of hours.
- This process is not painful and you will be awake.
- After a transplant, the stem cells take around 7 – 14 days to begin producing new blood cells and mature to start functioning
- This waiting period may be the most difficult time for you as your body’s blood count is low.
- You will be prone to infections, fatigue, bleeding, and fever so you will be given antibiotics and other medications.
- You may need red blood cells transfusion as well.
- You may also suffer from the side effects of chemotherapy like diarrhoea, vomiting, decreased appetite etc.
- However, all these symptoms vary from person to person.
- Blood tests will be done regularly to check if your blood cells start to come up.
- Full recovery can take 6 months to a year depending on the patient.
- Regular follow up may be recommended by your doctor.
Risks and Complications
Stem cell transplant is a complex treatment that could result in complications. In Autologous bone marrow transplant, complications are less serious than Allogenic bone marrow transplant or Umbilical blood transplant. Complications depend on your age, type of transplant, overall health and the diseases you are being treated for.
- Some of the possible complications are:
- Excessive bleeding or bruising
- Side effects of chemotherapy
- Infertility (high doses of chemotherapy)
- Early menopause
- Graft failure (rare)
- Damage of vital organs
Factors affecting the cost of Autologous Bone Marrow Transplant
The cost price may vary due to various factors like:
- Type of disease
- Type of treatment
- Location of the hospital
- Choice of hospital
- Cost of diagnostic tests
- Surgeon's fee
- Medical treatment
- Duration of hospital stay