What is a Bone Marrow Transplant?

A bone marrow transplant involves transplanting blood stem cells into the bone marrow so that these healthy stem cells can replace damaged or destroyed cells.

When healthy blood stem cells are transplanted, they go to the bone marrow and help a new bone marrow grow so cell production can begin again. Red blood cells, platelets, and white blood cells are produced again to defend the body from infections and problems like anaemia.

Stem cells can come from your body or a donor. The bone marrow transplantation procedure is also known as a Stem cell transplant.

The rapid innovation in medical science over the past few years has increased the success rate of bone marrow transplants and the survival rates for different types of blood cancers.

Why is a bone marrow transplantation done?

Bone marrow is a crucial part of your body because it is essential for adequately functioning your immune system. If your bone marrow is diseased and there aren't enough white blood cells, red blood cells, or platelets, your body's immune system becomes weak, and you become prone to infections, disorders, and diseases.

It can cause extensive damage to your body and potentially lead to fatal infections. A bone marrow transplant is done when the bone marrow is not functioning optimally, such as when you have bone marrow disease or dysfunction. The cause of bone marrow destruction or damage varies from person to person, and sometimes, it is difficult to figure out the symptoms of bone marrow disease.

Your bone marrow transplant surgeon could recommend a bone marrow transplant if your bone marrow shows an inability to produce stem cells. Bone marrow transplant helps people suffering from cancer-related diseases and in the case of bone marrow damage due to prolonged chemotherapy and radiation exposure.

A bone marrow transplant can rescue damaged bone marrow as new stem cells expedite production.

Diseases and Conditions

Here are some of the most common problems that cause the need for a bone marrow transplant. If you suffer from any of these diseases, you need to consult with a bone marrow transplant specialist to understand your suitability for bone marrow transplantation.

Immune deficiencies
Congenital neutropenia: An inherited disorder that causes recurring infections
POEMS syndrome: A rare blood disorder that damages the nerves and may affect many other body parts.
Aplastic anaemia: A disorder in which the marrow stops making new blood cells
Neuroblastoma: A form of cancer caused by immature nerve cells found in the body
Sickle cell anaemia: An inherited blood disorder that causes misshapen red blood cells
Adrenoleukodystrophy
Plasma cell disorder: A spectrum of progressively more severe monoclonal gammopathies in which a clone or multiple clones of premalignant or malignant plasma cells over-produce and secrete myeloma protein into the bloodstream.
Thalassemia: an inherited blood disorder where the body makes an abnormal form of haemoglobin, an integral part of red blood cells.
Inborn errors of metabolism
Bone marrow cancers such as leukaemia, myeloma, or lymphoma

Understanding the Risks

Many factors determine the risk factors of a bone marrow transplant for any individual, such as age, general health, and the condition for which you are being treated.

Other factors that influence the outcome are the transplant type and how suitable a match the donor marrow is. Another critical factor is how a bone marrow transplant is done, whether you went through a radiation or chemotherapy procedure before your bone marrow transplant, and the dosage of these procedures matters to the outcome of your transplant.

The risk of complications can vary from person to person. In rare cases, those undergoing a transplant may have to be hospitalised and treated for complications that arise; some may even be life-threatening.

Minor complications that may arise due to bone marrow transplant include:

Impaired taste
A prolonged headache.
Drop in your blood pressure
Chances of contracting high ever.
Chest pain.
Nausea
Hives
Breathing difficulties
Chills

Serious risks that are associated with bone marrow procedures include:

Graft-versus-host disease (GVHD) can be a complication. In this, the donor cells transplanted through the bone marrow transplant procedure start to harm your body.
You may contract infections easily, and severe infections can be challenging to treat.
There may be clotting in your liver, especially the smaller veins.
You might get anaemia.
Graft failure can occur whereby cell production doesn't start as it should.
Your vital organs, such as your brain and lungs, may start to bleed.
You may contract a cataract (cloudiness in your eyes).
Nausea and vomiting.
You might develop new cancers as a result of the transplant.
You might have an early menopause.
You might get mucositis, where there is soreness in your throat, stomach, and mouth.
Infertility is another complication that can arise from getting a bone marrow transplant.

Understanding the Bone Marrow Transplant Procedure

Pre-transplant

Before your bone marrow transplantation starts, a bone marrow examination is to be performed. The bone marrow test is used to determine the types of bone marrow cells that you require. Your bone marrow doctor will decide which bone marrow test procedure to follow.

If you are getting treated for cancer, then you might get bone marrow aspiration and bone marrow biopsy done, too. Usually, they will ask you for your medical history and conduct a physical exam. It is an essential step because the doctor needs to be sure that you are a suitable candidate for the transplant procedure. This testing phase can take several days.

Conditioning process

You might be given radiation, chemotherapy, or both by the bone marrow specialist. It is done before the bone marrow transplant procedure. There are two ways in which this is done.

Mini transplant or reduced-intensity treatment is when radiation and chemotherapy are given to you in smaller doses. It is generally for older people and those already suffering from health complications.
Myeloablative or ablative treatment is a process in which either radiation, chemotherapy, or a combination of both treatments is given to you in high doses. It is used to kill cancer cells in the body. Note that even the healthy cells in the bone marrow that are present are killed in this process.

The conditioning process suppresses your immune system, destroys cancer cells (if you are suffering from a type of cancer), and prepares your bone marrow for the new healthy stem cells that will be transplanted. The conditioning process can have one or more side effects, such as organ complications, fatigue, hair loss, vomiting, cataracts, infertility, mouth ulcers, and diarrhoea.

Typesof Bone Marrow or Stem Cell Transplants

Allogeneic bone marrow transplant

In this type of transplant, healthy stem cells are drawn from someone else (a donor). This donor can be someone from your family or someone who is not related to you. The donor marrow tissue is checked for compatibility; the transplant only occurs when the tissues match. The stem cells are taken from the donor through bone marrow or stem cell harvest. The stem cells can be removed from the donor's bone marrow or blood.One type of allogeneic bone marrow transplant is the umbilical cord blood transplant. In this, the stem cells in the umbilical cord of a newborn baby are removed as soon as the baby is born. These removed stem cells are frozen and kept. These can be used for the transplant. Since these cells are immature, they will likely be a close match. However, since the stem cells from the umbilical cord are lesser, it might take longer for the production of cells to start after the transplant.

Autologous bone marrow transplant

It is also known as a rescue transplant. It is a bone marrow transplant in which healthy stem cells are taken from your body through apheresis. Before apheresis is performed, the number of stem cells needs to be increased.

How to increase bone marrow count?

It is done with injections that stimulate the production of stem cells. These injections help move the stem cells into the blood, making collecting them easier.

Once this is done, a machine circulates the blood drawn from a vein. The machine separates blood and various parts of the blood, including stem cells. Once the stem cells are extracted, they are usually kept in a freezer. When the radiation and chemotherapy treatments are completed, the stem cells that were removed are again injected inside your body.

How is bone marrow transplantation done?

A central venous catheter, essentially a tube, helps inject healthy stem cells into the blood. This catheter is installed on the upper right part of your chest, neck, or arm. The tube enables the healthy stem cells in the fluid to go directly to the heart.

These healthy stem cells spread throughout your body and eventually form into the bone marrow. This is where the marrow starts to grow and produce stem cells. Usually, surgery is not required.

Bone Marrow Transplant Criteria and Requirements

A bone marrow transplant can take up to an entire week, and the cost can vary depending on the individual situation. This is why you need to make the necessary arrangements before your first bone marrow transplant session begins. The following are some of the things that you should keep in mind.

You need to inform your place of work about your absence for an entire week. Applying for medical leave is a good idea, so your workplace is aware beforehand.
You might want to arrange for your family to stay near where you are being treated. Looking for a hotel or housing near the hospital is an excellent way to prepare.
If you have pets, you must ensure they are cared for the entire week. You might want to start the search early.
You must consider how you will travel during this time and arrange for a helper, friend, or family member to support you.
If any bills are to be paid during that time, set up autopay or pay your bills in advance if possible. You also want to make sure that your insurance provider is informed.

Finding a Donor

If you require an allogeneic bone marrow transplant, also known as an allogeneic stem cell transplant, to be performed, you must find a donor. This donor's healthy blood stem cells will be required so that they can replace your destroyed bone marrow.

When it comes to finding a donor, there are a few options. A donor can be your family member, friend or even someone you don't know. However, doctors usually look for a donor's genetic makeup that matches yours, even if partly. The reason is that the success of an allogeneic bone marrow transplant depends on how good the donor match is.

A test will be performed to determine whether the donor is right for you and whether you need to find another donor or whether the current donor is a match. Usually, the closest family members, such as your siblings, are great matches.

However, that doesn't mean that people not related to you won't make a match. The national bone marrow registries are helpful when finding a matching donor unrelated to you.

Road to Recovery and Aftercare

Doctors monitor the engraftment state because it tells them the transplant has succeeded. Successful engraftment can take about a month.

Engraftment occurs when the cells received from the transplant start to produce healthy cells. Usually, the number of white blood cells starts to increase, which indicates the successful completion of engraftment.

Generally, it takes about three months to recover after a bone marrow transplant, but it may take an entire year. Various factors determine how long your recovery takes. These include the condition you are being treated for, how good a match your donor is, radiation, chemotherapy, and the transplant location.

Diet and Nutrition

You must always stay in peak health, particularly after a bone marrow transplant. Health problems such as high blood pressure, high cholesterol, and other issues can further aggravate and delay your recovery.

One way to stay healthy is to maintain a healthy body weight and make the best choices daily. To achieve this, adjustments to what you eat need to be made. The key is to eat nutritious foods so you don't gain excess weight and maintain a healthy overall BMI.

The best way to do this is to consult a dietician who will understand your lifestyle first. He can better guide you about how, when, and what to eat, depending on that. Making a healthy eating plan and ensuring you follow the plan is crucial.

Many people experience side effects due to radiation and chemotherapy. Your dietician will help suggest foods that will make you feel better if you suffer from nausea or other problems after the bone marrow transplant. Your dietician is the best person to ensure you get all the nutrition you need to recover after the transplant.

While the diet plan can be different from person to person, here are some of the recommendations that your dietician may make.

Stay hydrated at all times to avoid fatigue.
Avoid consuming alcohol because it can cause complications.
Opt for only whole-grain cereal and bread.
Ensure you eat a diet that is low in salt content.
Incorporate fruits into your diet. However, you should avoid having grapefruit juice or grapefruit.
Opt for low-fat dairy products such as low-fat milk.
Include green cruciferous vegetables in your diet.
Include fibre in your diet plan.
Eat lean meats as a source of protein.

Bone Marrow Transplant FAQs

Q1. I am hesitant about the bone marrow transplant procedure. What should I do?
A1. You need to realise that having fears about bone marrow transplants is normal. You should jot down your questions and speak to your doctor about them. The key is to be comfortable with the procedure before it begins. Don't hesitate to ask your doctor all the questions you have. If you think that stress negatively impacts you and becomes unmanageable, speaking to a counsellor is a good idea. Speaking to your family about the procedure and preparing them is a good idea so they know what to expect. Support groups are available to help you navigate through the stress and apprehensions of the procedure. These support groups can also help you conduct adequate research online about the best hospital for bone marrow transplants in India where you can receive the best medical care. It will go a long way in alleviating your concern.

Q2. Is it possible to not be eligible for a bone marrow transplant?
A2. Yes. Some people might not be eligible for a bone marrow transplant because they are not healthy enough to receive a transplant. The procedure is quite taxing on your body, so general health should be maintained before attempting it. Thus, doctors spend a reasonable amount of time to ensure you are physically ready for a bone marrow transplant. A bone marrow transplant is a serious medical procedure, and the doctors will only perform the procedure once they are sure that your body can handle it.

Q3. How long will it take for me to resume my normal activities after the transplant procedure?
Q3. After the bone marrow transplant, you will be closely monitored by the doctors as they will be on the lookout for an increase in blood cell count and any discomfort you might experience. The complete recovery might take a year, but it depends on many factors. These include your age, health, radiation, chemotherapy, the condition for which you are being treated, and the donor match if you had an allogeneic transplant. If the transplant is successful (Stem cells are being produced), you can resume your normal daily activities.

Q4. What is the bone marrow transplantation cost in India?
A4. The bone marrow transplant cost depends on many factors, such as the type of transplant and the location of where you are getting the transplant. Thus, after the appropriate tests are done, your doctor can give you an estimate of the bone marrow transplantation cost. Rest assured that the bone marrow transplant cost in India is less than if you get it done in other countries. The bone marrow transplant cost in India can vary from hospital to hospital. Hence, you must research online and get a quote from multiple hospitals before proceeding. However, ensure that the quality of healthcare you receive is maintained when looking for affordability.

Q5. Which alternative is safer: allogeneic or autologous bone marrow transplant?
A5. Getting any bone marrow transplant is risky. However, using an autologous bone marrow transplant is usually more advantageous because you use your own body's stem cells inside of one from a donor. The significant risk with an allogeneic bone marrow transplant is the incompatibility issue. Finding a perfect match can be challenging, and there is a higher risk of having complications such as GVHD, among others. You might be required to take medications so your body cells don't attack the donor stem cells. It can make you more prone to health problems

Q6. Is it okay for me to exercise after a bone marrow transplant?
A6. Once your bone marrow transplant has succeeded, you can start exercising. However, it is a good idea to start slow and increase the intensity of the exercise as you get better. Your doctor will help you create an exercise plan tailored to your needs and requirements.

Q7. How long am I supposed to stay at the hospital after the transplant procedure has been completed?
A7. It depends entirely on what you are being treated for and the location of the bone marrow transplant. Sometimes, people don't need to stay in the hospital overnight after the procedure, but others do. It depends on the individual situation. Sometimes, due to high doses of radiation therapy and chemotherapy, you might need to stay in the hospital for a much longer time. Your doctor will inform you about the length of your stay so that you can make arrangements accordingly.

Q8. What are the different types of bone marrow transplants?
A8. There are generally three types of bone marrow transplants:

Autologous bone marrow transplant - In this case, stem cells are removed before the chemotherapy or radiation treatment and kept in a freezer. After the treatment is over, they are transferred back to normal cells. This procedure is also known as a rescue transplant.
Allogeneic bone marrow transplant—In this case, stem cells are removed from another person or a donor. For the process to work, the cells must partly match. A special test is done to confirm the match. Family members, such as a brother or sister, are usually chosen as donors. Unrelated donors have to be found through bone marrow registries.
Umbilical cord blood transplant—This is a type of allogeneic bone marrow transplant in which the stem cells are removed from a baby's umbilical cord right after birth and stored in a freezer for future transplant. Since the blood cells are immature, a perfect match is not required. A smaller number of stem cells means that the blood counts may take longer to recover.

Q9. How do I know which type of bone marrow transplant is right for me?
A9. It's best to discuss with your transplant physician which treatment option will best suit your specific diagnosis. You can contact your transplant coordinator if you have any doubts about which transplant type your physician has recommended. The coordinator can help determine the type of transplant you'll receive and even schedule an appointment with your designated physician to review your treatment options.

Q10. Do I need to carry anything to the hospital for my bone marrow transplant procedure?
A10. You will be shifted to a separate cabin for your bone marrow transplant procedure. Some of the things you can carry to the hospital are:

Comfortable, clean and loose-fitting clothing
Loose slippers
Razor, toothbrush and other toiletries
Books, journals or magazines
Personal items such as blankets
Food items such as snacks and beverages

Q11. Will my blood count matter during the bone marrow transplant procedure?
A11. While the transplant is happening, there can be a dip in your blood cells (WBCs, RBCs, PLTs). Therefore, blood counts are monitored closely during the transplant. Before the transplant, your complete blood count or CBC is monitored for some weeks. The CBC gives information on the count of white blood cells (WBCs), red blood cells (RBCs), and platelets in your blood. The ideal WBC count should be between 4,000 and 10,000. If your WBCs fall below 1,000, then complications can occur. The measurement values for RBCs are hemoglobin (Hgb) and hematocrit (Hct). Hgb should be between 14 and 18, and Hct should be between 37 and 52. Regarding platelets, the count should be between 150,000 and 400,000.

Q12. What are the risks of infection from an unrelated bone marrow transplant?
A12. It's best to match the donor's stem cells before a transplant. You are at a lower risk of getting infections from an unrelated bone marrow transplant if:

Your age is less. Studies show that young people react better to transplants as compared to older people
You receive stem cells from someone in your family, can be a brother or sister
You don't suffer from any other health concerns.

Q13. What are the precautions I should take post-treatment?
A13. One of the most important factors to be careful about after a bone marrow transplant is the risk of infection. You're more susceptible to bacteria, viruses, and funguses during the first six weeks after the transplant. Your doctor may suggest antibiotics to reduce any risks of infection. You can also take steps such as washing hands with antibacterial soap or alcohol-based sanitiser, staying away from people who are sick, and wearing a mask and gloves in public. It would help if you visited your doctor immediately in case you have the following symptoms:

Higher temperature than 100.4 degrees F
Flushed face and sweating
Unusual pain or swelling in the body
Blurred vision

Q14. Is it possible to lead a normal life after a bone marrow transplant?
A14. One thing you must remember is that after a transplant, it takes a lot of time to recover. The transplant can take some weeks or months to be completed. After that, you're free to go home. It's best to have a medical plan to care for yourself better. You can also check with friends and family for help. During the first few months, you'll feel weak and more tired than usual. There can be a sharp change in your hunger and how you smell and taste food. Since all of your cells are growing, you may need some time to return to your normal activities.