To understand BMT, we have to first know what is bone marrow. Bone marrow is the spongy tissue inside few bones of the body, such as hip and thigh bones. This spongy tissue creates the parts of the blood- namely Red Blood Corpuscles (RBC), White Blood Corpuscles (RBC) and Blood Platelets. When these get diseased thereby unable to produce healthy blood cells, then the only way to cure it is by infusing it with healthy blood stem cells. The marrow transplant is also called Bone Marrow Transplant (BMT). Autologous bone marrow transplant is also known as autologous stem cell transplant, it is also commonly called auto BMT. The treatment aims to treat damaged bone marrow by replacing it with a healthy stem cell from the body. This process is applicable if the body generates enough healthy cells.
Why is Auto BMT needed?
Autologous bone marrow transplant is required in patients with damaged bone marrow due to other therapies like radiation therapy and chemotherapy. It replaces the bone marrow with a healthy one. It also treats problems of plasma cell disorders, myeloma, Hodgkin’s lymphoma, and non-Hodgkin’s lymphoma.
- Hodgkin’s lymphoma– it is the cancer of a specific part of the immune system that is the lymphatic system. This is a common problem among middle-aged people, though it can occur to anyone. In Hodgkin’s disease, growth of cells occurs abnormally. The symptoms of this disease involve pain and swelling of lymph nodes, fever, fatigue, itching, extreme weight loss, sweating, and sensitive skin. The various types of Hodgkin’s lymphoma are nodular sclerosis Hodgkin’s lymphoma, lymphocyte-depleted Hodgkin’s lymphoma, mixed cellularity Hodgkin’s lymphoma, and lymphocyte-rich Hodgkin’s lymphoma.
- Plasma cell disorders- Plasma cells are cancerous in this case and cause potential damage to organs such as heart, liver, kidney, bones, immune system, and bone marrow resulting in extreme sickness. It is caused by the multiplication of identical cells. Such cloning leads to a large amount of immunoglobulin. Symptoms of plasma cell disorders are nausea, vomiting, chest pain, constipation, fatigue, and loss of appetite.
- Myeloma– it is often known by the name Kahler’s disease. Myeloma is the cancer of white blood cells. It is the occurrence and multiplication of cancerous cells which destroy the functioning of various body parts including bone marrow. Chest and spine pain, excessive fatigue, frequently occurring infections and a sense of thirst are common symptoms of myeloma. Women are less likely to get this disease as compared to men. Anemia occurs as a result of myeloma.
Autologous Bone Marrow Transplant procedure
Several tests are done before employing a transplant as it is necessary for the general health to be stable in order to continue the transplant. These tests take many days depending on the condition of health. After this, a long thin tube is inserted in the vein of the chest to be placed during the surgery. Apheresis is conducted to accumulate blood cells for which a drug is injected to increase the output of blood cells. This results in its circulation in the blood to be retrieved. The blood retreats from the veins into a device that separates the blood stem cell from the blood. These healthy stem cells are preserved for further use in frozen form while the blood is poured back into the body. Before the transplant, conditioning is done to stifle the immune system, prepare the body for new blood stem cells and destroy the cancerous cells. Normal side effects of the conditioning process are diarrhea, infection, bleeding, loss of hair, Anaemia, fatigue, cataract, infertility, and organ failure. Through the central line, stem cells are fused in the body for transplantation. After transplantation, engraftment occurs when new and healthy cells travel to the bone marrow to multiply themselves. Blood cells return to their accurate quantity after some time. For regular functioning, red blood cell transfusion is necessary to meet the requirements, until it can efficiently release blood cells itself.
Recovery from autologous bone marrow transplant
A healthy lifestyle and light exercises can help immensely. The doctors often recommend the consumption of vegetables, fruits, poultry, meat, whole grain, fish, legumes, and olive oil. Alcohol consumption and smoking are prohibited. Grapefruit juice should be avoided too. Salt intake should be checked.
Autologous Bone Marrow Transplant risks
Some potential risks are the damage of organs, certain new cancers, infertility, mild or severe infection, extreme pain, failure of stem cells, cataracts, and though it is highly rare death can occur.
Autologous Bone Marrow Transplant benefits
It is very beneficial in improving the damaged bone marrow caused by radiation therapy and chemotherapy. It has long-lasting effects, it is easily available and it is not painful at all. The most important is that it provides greater relief.
Allogeneic vs Autologous Bone Marrow Transplant
In an allogeneic transplant, the donor is someone else and after regular check-ups, he may provide the required amount of blood stem cells to the patient. Though the procedure for both processes is similar. Frozen cells are extracted from the donor’s blood to provide it to the patient. There are certain ways to do allogeneic transplants like if blood cells are extracted from the umbilical cord of a baby or placenta then it is a form of allogeneic transplant. This process can be done in any child and adult. The tendency of multiplication among blood cells of the umbilical cord is much higher as compared to any other body part. It is researched that the risk of getting new cancer or the return of treated cancer is least if the cells are taken from the umbilical cord. The risk of developing cancer is much higher if the cells are taken from an unrelated donor.
- Benefits of allogeneic transplant
Since in this case, the best donors are searched for better results it gives various options to the doctor to decide the best blood cells as per suitability. If advised by the doctor, the donor may be asked to donate white blood cells too as healthy donation of cells will be risk-free.
- Risks of allogeneic transplant
The highest risk is that the immune system can be affected adversely because in some cases new cells assault the existing cells. The chances of graft versus host disease are prevalent as well. Sometimes administration of certain drugs causes infection.
- What is graft versus host disease?
Another important factor is that if you have another host for the donation of cells then there is a high chance of getting graft versus host disease. This usually occurs when the new cells attack the tissues and organs of the patient’s body. It is very normal though. It can occur to anyone at any point in time after an allogeneic transplant. The severity of graft versus host disease range from chronic to acute. After the transplant, acute graft versus host disease generally occurs in earlier months of recovery.
It damages the functioning of the liver and heart, digestion problems can occur and dryness and sensitivity of skin are common symptoms. Acute GVHD can be treated easily. However, chronic graft versus host disease occurs in later months and injures many parts of the body. The indications of chronic graft versus host disease are shortness of breath, vision problems like irritation and dryness in the eyes, rashes, body pain, dryness of the mouth, pain in muscles and joints, severe cough, soreness of mouth, nausea, vomiting, diarrhea, and symptoms of jaundice.
- What is the process of Autologous Bone Marrow Transplant?
In autologous transplantation, doctors usually collect or harvest, stem cells that circulate in the bloodstream. These cells are called peripheral blood stem cells (PBSCs). PBSC harvesting is similar to giving blood. Over the course of one to five days, blood is taken out of a vein and put through the machine, which collects the stem cells. The other parts of the blood are then returned to your body. Most people don’t have side effects from blood collection and can go back to their regular activities. The stem cells are cryopreserved (frozen) until they are given back to you.
Preparing for a Transplant
Once your stem cells have been collected and you know the date of the transplant, you will go through a process called a preparation regimen. It is also sometimes called conditioning or cytotoxic treatment. In this step, doctors use chemotherapy with or without radiation to kill cancerous cells. Our doctors customize your treatment based on your disease and which therapy it is most likely to respond to. The preparative regimen may be given over several days. People usually have the transplant a day or two after their last chemotherapy or radiation dose.
Transplantation and Recovery
Doctors usually add the collected stem cells into the patient’s bloodstream in the same way they perform a blood transfusion. Over the following days and weeks, the transplanted stem cells move to the marrow space in the bones. There, they gradually begin to produce new blood cells. Between two and three weeks after the transplant, doctors usually start to find newly formed blood cells in the patient’s bloodstream. With time, a successful transplant graft will make red blood cells, white blood cells, and platelets. In the days right after a transplant, you need a lot of medical support. You may get transfusions of irradiated blood products, such as platelets and red blood cells. You may also get antibiotics to prevent and treat bacterial, viral, and fungal infections.
These infections are most likely to happen in the first three months after transplantation. People who have had Bone Marrow Transplants may also have complications because of the chemotherapy and radiation given before the transplant. Such complications may require more treatments. Most people stay in the hospital for two to three weeks after a transplant. During this time, you will need special protection from infections. Everyone who comes into the room has to wear protective gloves and masks and to wash their hands with antiseptic soap. Sometimes people entering the room need to cover their clothing with clean, disposable gowns. Fresh fruit, plants, and cut flowers are not allowed, because they can carry disease-causing mold and bacteria.
Who needs Bone Marrow Transplant?
• Those who suffer from Sickle cell anemia.
• A few types of cancer like Leukemia, Multiple Myeloma or Hodgins
• Non Hodgins Lymphoma
• aplastic anemia, which is a disorder in which the marrow stops
making new blood cells
• Due to chemotherapy the bone marrow is damaged.
• congenital neutropenia, which is a genetic disorder that causes
• thalassemia, which is another genetic blood disorder where the body makes an abnormal form of hemoglobin which is in RBC.
• Rare diseases like Krabbe disease, Hurler Syndrome, Adrenoleukodystrophy, and metachromatic Leukodystrophy
What is the cost of autologous bone marrow transplant?
The cost of autologous bone marrow transplant ranges around $100,000 and $350,000. It is highly expensive which makes it unaffordable by most. Other expenses like medications and injections can add for a hefty amount.
How long does it take to complete the procedure?
It is a long procedure. Preparation of the surgery takes almost 4-6 days. Transplantation takes 3-4 hours while recovery alone takes 2 to 7 weeks according to the pace of rest and medications.
How to prepare for autologous bone marrow transplant?
Preparation includes avoiding activities advised by the doctor, doing all the required medical tests beforehand, avoiding the previous medications and arranging the necessities for a few days.
Is autologous bone marrow transplant painful?
No, autologous bone marrow transplant is not painful. During transplant, the patient is under anaesthesia and it numbs the area for some time. The patient may not or may be asleep but he will not experience any pain.
What does it cure?
Congenital neutropenia, leukaemia, lymphoma, myeloma, thalassemia, anaemia and destruction due to chemotherapy and radiation therapy can be cured by autologous bone marrow transplant.