Narayana Health Care

What is Haploidentical Bone Marrow Transplant?

Haploidentical Bone Marrow Transplantation (BMT) is a method of stem cell transplantation where stem cells are collected from a half HLA matched parent or sibling instead of fully HLA matched donor like an identical sibling.

Indications of Haploidentical Bone Marrow Transplantation:

It is recommended in all types of blood cancer and genetic anomalies like:

• Leukemia
• Lymphoma
• Sickle cell anemia
• Severe aplastic anemia
• Thalassemia
• Types of myeloproliferative disorders
• Types of plasma cell disorders

Sickle cell anemia is a genetic disorder of the blood caused by abnormal hemoglobin (the oxygen-carrying protein within the red blood cells). The abnormal hemoglobin causes distorted sickled shaped red blood cells. It reduces their oxygen-carrying capacity and quantity of blood flow. This leads to a deficiency of blood, causing anemia.

When is the procedure recommended?

• Absence of identical sibling
• Delay in finding the exact match
• Patient with high-risk disease progression
• Young patients

Preparing for the Procedure?

It depends on the following factors:

• The condition of the patient
• Previous treatment
• Patient Age

The procedure is absolutely novel therefore it is extremely difficult to locate a center who does it. Therefore the first step will be to locate one. Make sure to look into the number of successful procedures performed.

How is Haploidentical Bone Marrow Transplantation performed?

Various approaches like:

• Myeloablative regimens with ex vivo T-cell
• Myeloablative regimens with in vivo T-cell depletion
• Total body irradiation (TBI) based myeloablative regimens are used

In a Haploidentical procedure, the donor is usually your parents or your child. Parents are always a half-match for their children. Siblings have a 50% probability of being a half-match for one another.

Haploidentical Bone marrow transplantation is carried out is assistance with high-dose chemotherapy.

While collecting donor stem cells, they are injected with medications so that stem cells move from bone marrow to blood from where they are collected through a drip to a machine. This machine separates white blood (containing stem cells) cells from the rest of the blood.

When the patient is transfused, a central line is introduced through the chest directly into the heart so that the stem cell goes to the heart and to the entire body including bone marrows. Here they establish and begin to propagate. Similar sessions are carried out another couple of times to ensure success. The central line stays intact until all sessions are complete.

Risks and Complications involved with the procedure:

1. Graft-versus-host disease (GVHD) – Extremely likely in Haploidentical procedure:

• Donor cells attack your body tissues and organs.
• It can happen anytime post-procedure.
• Acute or immediate GVHD affects the skin, digestive tract, or liver.
• Chronic or delayed GVHD affects multiple organs. Symptoms include –

i. Joint or muscle pain

ii. Diarrhea

iii. Nausea

iv. Vomiting

v. Breathlessness

vi. Cough

vii. Dryness of eyes

viii. Scarring Skin changes

ix. Rashes

x. Yellow tint to your skin and eyes (jaundice)

xi. Dryness of mouth

xii. Sore Mouth

2. Graft failure – when transplanted cells don’t produce new cells
3. Bleeding in lungs, brain
4. Clouding in the lens of the eye
5. Damage to vital organs
6. Early menopause
7. Anemia – when the body doesn’t produce enough red blood cells
8. Infections
9. Nausea, diarrhea, or vomiting
10. Mucositis – inflammation, and soreness in the mouth, throat, and stomach

What to Expect After a Haploidentical Bone Marrow Transplant:

Results of a large number of clinical trials have shown major improvements in transplanted cases than all cases managed medically. Not only the quality of life improves, but it is also by far the only curative approach to Sickle Cell Disease.

Post-procedure care:

• Avoid excess iron
• Eat a healthy diet
• Avoid infections

With Sickle Cell Anemia, the problems faced by your children are so massive that there is no time for their social life. Haploidentical Bone Marrow Transplant is their chance to get their lives back. Our team here is committed to ensuring the same.

Dr. Suparno Chakrabarti, Senior Consultant & HOD – Bone Marrow Transplant, Haemato Oncology, Oncology, Dharamshila Narayana Superspeciality Hospital, Delhi