Bone marrow transplant (BMT) is a special therapy in which the healthy cells from the bone marrow taken from your child’s or another person is filtered and transfused, once the unhealthy cells in your child is eliminated. The purpose of this is to replace the diseased bone marrow of your child with healthy ones thereby curing your child of diseases or cancer.
Bone marrow is the soft, spongy material inside the bones that produce healthy blood cells including young cells called stem cells. The function of the bone marrow is to develop and store most of the body’s blood cells. There are three main types of blood cells namely,
- Red blood cells (erythrocytes) – They carry oxygen to the tissues in the body
- White blood cells (leukocytes) – They fight infections and aid the immune system
- Platelets – They help with blood clotting.
Indications for Bone Marrow Transplant
Paediatric Bone marrow transplant is needed when the child goes through conditions such as:
- When the child’s bone marrow has been damaged or destroyed due to intense treatments from radiation or chemotherapy
- Tumours like brain tumours, neuroblastoma
- Sickle-cell disease
- Immune deficiencies
- Diamond Blackfan anaemia
- Cancer of the kidneys
- Metabolic/storage disease
Types of Bone Marrow Transplant
There are different ways in which the stem cells are collected.
- Autologous bone marrow transplant – This is when your child becomes his or her own donor. This could be done in two ways:
- Peripheral blood stem cells (PBSCs) – Stem cells are taken by means of apheresis which is the process of collecting stem cells that float in the blood (PBSCs). The cells are then transplanted after an intensive treatment.
- Bone marrow harvest – Stem cells are collected by a needle from the soft centre of the bone, usually the hip bones where there is a large number of stem cells.
- Allogenic bone marrow transplant– A donor may be someone who has the same or similar genetic type as your child. Stem cells are taken by means of apheresis or bone marrow harvest. It could be a sister or a brother. Other donors could be a parent or unrelated donor but with a matching marrow of stem cells.
- Umbilical cord blood transplant – Stem cells are taken immediately after birth from the umbilical cord. These stem cells grow into maturity quicker and more effectively than stem cells taken from a child or donor. The stem cells are tested, typed, counted, and frozen until the need for a transplant arises.
Diagnosis and tests
- Chest X-Ray
- Dental checks
- Audiology tests
- Lung function
- GFR (Glomerular Filtration Rate)
- Chest CT Scan
- Blood tests
- Total Body Irradiation (TBI) planning
Tests for donors
- Medical examination for fitness
- Blood tests
- Chest X-Ray
- Genetic analysis
- Exposure to viruses
- A complete medical history examination is done on your child
- A through physical examination is also carried out
- Diagnostic tests are to be done
- The bone marrow transplant team will evaluate your child’s health and risks versus benefits
- You must get your child to the hospital several times for hydration, evaluation, and other preparations. This may take up to 10 days
- A catheter is surgically placed in a vein in the chest area where blood products and medications will be given through
- Once a match is found, the donor will have to go through several tests and a stem cell will then be collected by means of bone marrow harvesting or peripheral blood stem cells.
- General anaesthesia will be given so that the donor feels no pain during the procedure of collecting stem cells.
- Procedure for bone marrow transplant depends on the type of transplant, disease, and medical condition of your child
- An ablative therapy or myeloablative is performed wherein high doses of chemotherapy and/or radiation will be given to eliminate all unhealthy cells and make grow for the new cells to grow and function
- The next step is the transplant. The stem cells are intravenously transfused into the bloodstream through the catheter. The stem cells will find their way into the bone marrow and start reproducing and growing healthy blood cells
- The day of transplant is counted as day 0 while the days before transplant are counted as minus (-) and the days after transplant counted as plus (+)
- During the infusion, your child may experience pain, chills, fever, chest pain, and hives
- Your child will be vulnerable to infections, side-effects, and other complication and will be monitored closely.
- Engraftment of stem cells may take between 15 and 30 days after the transplant depending on the type of disease and transplant being done
- Blood tests will be taken daily to count the blood cells
- During this time, your child will be given several medicines and antibiotics
- Your child will need blood transfusions
- Engraftment can be delayed because of infections, graft failure, medications, and low donated stem cells count
- Experience temporary emotional or psychological distress
- It may take months to years for the entire immune system fully recover
- It may also take several months to stay in the hospital.
Risks and complications
- Each child may experience different symptoms and complications differ depending on factors like:
- Type of bone marrow transplant
- Type of disease
- Age and overall health of the child
- Preparative regimen
- Compatibility of tissue between donor and recipient
- Presence of severe complications.
Complications that could happen are:
- Low platelets and low red blood cells
- Respiratory problems
- Graft-versus-host-disease (GVHD)
- Graft failure
- Fluid overload
- Nausea, vomiting, and diarrhoea
- Organ damage
Factors affecting the cost of a Pediatric Bone Marrow Transplant
Prices may vary depending on:
- The type of disease
- The type of transplant
- Location of the hospital
- Choice of the hospital
- Diagnostic tests
- Medical care
- Duration of stay in the hospital