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Your guide to understanding
Bone Marrow Transplants

(Procedure, Risks, Aftercare)

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1.What is bone marrow?

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Bone marrow is the spongy, fatty tissue that is found in the centre of your bones. Bone marrow contains hematopoietic stem cells which are commonly known as HSCs. These HSCs are unspecialized cells that have the ability to either divide and differentiate to form different types of blood cells, else they can remain stem cells. The function of Bone marrow in the body is to produce platelets, red blood cells, and white blood cells.

In certain cases, bone marrow’s function can be impaired due to diseases such as leukemia, aplastic anaemia, and lymphoma. In such cases, a bone marrow transplant is done to replace the damaged or diseased marrow and restore function.

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2.What is a bone marrow transplant?

A bone marrow transplant procedure is a process through which blood stem cells are transplanted in the bone marrow so that these healthy stem cells replace the cells that have been either damaged or destroyed in the bone marrow.

When the healthy blood stem cells are transplanted, these cells go to the bone marrow and start to help a new bone marrow grow so that cell production can start again. That is, red blood cells, platelets, and white blood cells are produced again so that your body can defend itself from infections and problems like anemia.

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

The rapid innovation in medical science over the past few years have led to an increase in the bone marrow transplant success rate and an increase in the survival rates for different types of blood cancers.

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3.Why is a bone marrow transplant done?

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

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

A bone marrow transplant could be recommended by your bone marrow transplant surgeon 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.

With the help of a bone marrow transplant, your bone marrow can be rescued after it has been damaged as new stem cells will expedite the process of stem cell production.

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4.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 parts of the body.
  • Aplastic anemia: A disorder in which the marrow stops making new blood cells
  • Neuroblastoma: Form of cancer caused due to immature nerve cells found in the body
  • Sickle cell anemia: 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 blood stream.
  • Thalassemia: an inherited blood disorder where the body makes an abnormal form of hemoglobin, an integral part of red blood cells.
  • Inborn errors of metabolism
  • Bone marrow cancers such as leukemia, myeloma, or lymphoma

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5.Understanding the risks

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

Other factors that influence the outcome are the transplant type and how good of match the donor marrow is. Another important factor is how bone marrow transplant is done. Whether you went through radiation procedure 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 hospitalized 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 procedure 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 pretty easily and serious infections can be difficult to treat.
  • There may be clotting in your liver especially the smaller veins.
  • You might get anemia.
  • Graft failure can occur whereby cell production doesn’t start as it should.
  • Your vital organs may start to bleed such as your brain and lungs.
  • 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.

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6.Understanding the bone marrow transplant procedure

Pre-transplant

Before the start of your bone marrow transplantation, 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 determine which bone marrow test procedure to go for.

If you are getting treated for cancer then you might get bone marrow aspiration and bone marrow biopsy done too. Usually, he will ask you for your medical history and conduct a physical exam. This is an important 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 or chemotherapy or both by the bone marrow specialist. This is done before the bone marrow transplant procedure. There are two ways in which this is done.

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

The reason conditioning process is done is to suppress your immune system, destroy cancer cells (if you are suffering from a type of cancer) and allow your bone marrow to be ready for the new healthy stem cells that are going to 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 diarrhea.

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7.Types of 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 and the transplant is carried out only when the tissues are a match. The stem cells are taken from the donor with the process of bone marrow harvest or stem cell harvest. The stem cells can be removed from the donor’s bone marrow or the donor’s blood.

One type of allogeneic bone marrow transplant is the umbilical cord blood transplant. In this, the stem cells that are 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 quite immature, it is highly likely that they will be a close match. But since the stem cells from the umbilical cord are lesser, it might take longer for the production of cells to start after the transplant.

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Autologous bone marrow transplant

This is also known as rescue transplant. This is the bone marrow transplant in which the healthy stem cells are taken from your body through a process called apheresis. Before apheresis is performed, the numbers of stem cells need to be increased.

How to increase bone marrow count?

This is done with the help of injections that stimulate the production of stem cells. These injections help to move the stem cells into the blood which will make collecting them easier.

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

How is bone marrow transplantation done?

With the help of a central venous catheter, which is essentially a tube, the healthy stem cells are injected into your blood. This is installed on your chest’s upper right part, your neck or your arm. The tube enables the healthy stem cells which are contained in the fluid to go directly to the heart.

These healthy stem cells then spread in your body and then eventually form into the bone marrow. This is where growth and production of stem cells by the marrow will start. Usually, there is no requirement for surgery to be performed.

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8.Bone marrow transplant criteria and requirements

A bone marrow transplant can take up to an entire week and the cost of bone marrow transplant can vary depending on 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 in advance is a good idea so that your workplace is aware beforehand.
  • You might want to arrange your family to stay near where you are being treated. For this, looking for a hotel or housing near the hospital is a good way to prepare.
  • If you have pets then you need to ensure that they are taken care of for the entire week. You might want to start the search on this early.
  • You need to think about how you are going to travel during this time and arrange for a helper, friend or family member to support you at the time.
  • If there are any bills to be paid during that time, then set up autopay or pay your bills in advance if possible. You want to make sure that your insurance provider is intimated as well.

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9.Finding a donor

If you require an allogeneic bone marrow transplant, also known as an allogeneic stem cell transplant, to be performed, then you need to 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 genetic makeup that matches yours, even if partly. The reason is that the success of allogeneic bone marrow transplant depends on how good the donor match is.

A test will be performed to see if the donor is right for you or not. This test will determine whether you need to find another donor or the current donor is a match. Usually, the closest of the family, such as your siblings, turn out to be great matches.

However, that doesn’t mean that people who are not related to you won’t make a match. The national bone marrow registries are helpful when you are trying to find a matching donor not related to you.

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10.Road to recovery and aftercare

The engraftment state is what doctors will monitor because this is what tells them that the transplant has been a success. It can take up to about a month for the engraftment to be completed successfully.

Engraftment is when the cells you received from the transplant start to produce healthy cells. Usually, it is the number of white blood cells that starts to increase which points to the successful completion of engraftment.

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

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11.Diet and nutrition

You need to ensure that you stay in peak health always, particularly after you get a bone marrow transplant. Health problems such as high blood pressure, high cholesterol, and other problems can further aggravate and delay your recovery.

One of the ways to ensure that you stay healthy is by maintaining a healthy body weight and ensuring you are making the best choices daily. To achieve this, adjustments to what you eat needs to be made. The key is to eat healthy foods so that you don’t gain any excess weight and maintain healthy overall BMI.

The best way to do this is to consult a dietician who will understand your lifestyle first. He will be able to 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 who will be able to suggest foods so you get all the nutrition you need to recover well 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 on 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.

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12.Bone marrow transplant FAQs: All your concerns addressed

1. I am hesitant about the bone marrow transplant procedure. What should I do?

You need to realize that having fears about bone marrow transplant is normal. You should jot down all the questions you have and speak to your doctor about them. The key is for you 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 is negatively impacting you and becoming unmanageable, then it is a good idea to speak to a counsellor. Speaking to your family about the procedure and preparing them is a good idea so they are aware of 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 transplant in India where you can receive the best medical care. This will go a long way in alleviating your concern.

2. Is it possible to not be eligible for a bone marrow transplant?

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 and hence general health should be maintained before attempting it. This is why doctors spend a good 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.

3. How long will it take for me to resume my normal activities after the transplant procedure?

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 lots of 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 deemed successful (Stem cells are being produced), then you can resume your normal daily activities.

4. What is the bone marrow transplantation cost in India?

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. This is why after the appropriate tests are done, your doctor can give you an estimate of the bone marrow transplantation cost. Rest assured that the cost of bone marrow transplant in India is lesser than if you get it done from other countries. The bone marrow transplant cost in India can vary from hospital to hospital, hence it’s necessary that you do your research online and take a quote from multiple hospitals before choosing to proceed. However, make sure that the quality of healthcare you receive is not compromised when looking for affordability.

5. Which is a safer alternative; allogeneic or autologous bone marrow transplant?

Getting any type of bone marrow transplant is risky. However, usually using autologous bone marrow transplant is more advantageous because you are using your own body’s stem cells inside of ones from a donor. The big risk with allogeneic bone marrow transplant is the incompatibility issue. Finding a perfect match can be tough and there is a higher risk of having complications such as GVHD among others. There might be a requirement for you to take medications so that your body cells don’t end up attacking the donor stem cells. This can make you more prone to health problems.

6. Is it okay for me to exercise after a bone marrow transplant?

Once your bone marrow transplant has been a success, you can start to exercise. However, it is a good idea to start slow and then as you get better you can increase the intensity of the exercise accordingly. Your doctor will help you create an exercise plan that is tailored to your needs and requirements.

7. How long am I supposed to stay at the hospital after the transplant procedure has completed?

This 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.

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