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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.

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

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.

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.

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.

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.

8. What are the different types of bone marrow transplant?

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 as normal cells. This procedure is also known as a rescue transplant.
• Allogeneic bone marrow transplant - In this case, the stem cells are removed from another person or a donor. It’s important for the cells to partly match for the process to work. A special test is done to confirm the match. Mostly family members like a brother or sister are 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 where 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 matching is not required. Smaller number of stem cells mean that the blood counts may take longer to recover.

9. How do I know which type of bone marrow transplant is right for me?

It’s best to discuss with your transplant physician as to which treatment option will best suit your specific diagnosis. In case you have any doubts about which transplant type your physician has recommended, you can contact your transplant coordinator. The coordinator can help in determining the type of transplant you’ll receive and can even schedule an appointment with your designated physician to review your treatment option.

10. Do I need to carry anything to the hospital for my bone marrow transplant procedure?

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

11. Will my blood count matter during the bone marrow transplant procedure?

While the transplant is happening, there can be a dip in your blood cells (WBCs, RBCs, PLTs). This is why 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 it can cause complications. The measurement values for RBCs are hemoglobin (Hgb) and hematocrit (Hct). Hgb should be somewhere between 14 and 18 and Hct should be somewhere between 37 and 52. In case of platelets, the count should be between 150,000 and 400,000.

12. What are the risks of infection from an unrelated bone marrow transplant?

It’s best to match the stem cells of the donor before a transplant is done. 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 transplant 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.

13. What are the precautions I should take post-treatment?

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 6 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. You should visit your doctor immediately in case you have the following symptoms:

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

14. Is it possible to lead a normal life after a bone marrow transplant?

One of the things you have to keep in mind 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 in mind so that you can take care of 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, it may take some time for you to get back to your normal activities.