Bone Marrow Transplant

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Bone Marrow Transplant

What Is A Stem Cell (Bone Marrow) Transplant? A stem cell transplant is more commonly known as a bone marrow transplant (BMT). The reason we use different terms is that in the past the stem cells were obtained just from the bone marrow. We can now obtain the stem cells from three different sources.

  • From the bone marrow:
    Stem cells can be found in the bone marrow, which is present in all large bones. Stem cells can be taken from the bone marrow with a large needle – usually from the back of the hip bones – while the patient is asleep under a general anaesthetic. This is called a ‘bone marrow harvest’.
  • From the peripheral (or circulating) blood:
    The bone marrow is stimulated into producing extra stem cells by a growth factor – usually G-CSF. The G-CSF is usually given as an injection just under the skin, once a day for four to six days before the harvest. The stem cells move from the bone marrow into the circulating blood where they are collected. The donor has a special cannula inserted and is attached to a stem cell collecting machine. This is called a Peripheral Blood Stem Cell Harvest (PBSC Harvest).
  • Umbilical cord stem cells:
    Stem cells can be collected from umbilical cords at the time of delivery of a baby. This requires good organisation and can only be done where the patient has time to wait for the baby to be born. Also a special Human Tissue Authority (HTA) licence is now required by the maternity unit collecting the stem cells. Only a limited amount of stem cells can be collected using this procedure.

All stem cells can last for up to approximately 72 hours if they are to be given fresh, or they can be frozen and used at a later date.

Why Transplant?

In patients with leukemia, Aplastic anemia, and some immune deficiency diseases, the stem cells in the bone marrow malfunction, producing an excessive number of defective or immature blood cells (in the case of leukemia) or low blood cell counts (in the case of Aplastic anemia). The immature or defective blood cells interfere with the production of normal blood cells, accumulate in the bloodstream and may invade other tissues.

Large doses of chemotherapy and/or radiation are required to destroy the abnormal stem cells and abnormal blood cells. These therapies, however, not only kill the abnormal cells but can destroy normal cells found in the bone marrow as well. Similarly, aggressive chemotherapy used to treat some lymphomas and other cancers can destroy healthy bone marrow. A bone marrow transplant enables physicians to treat these diseases with aggressive chemotherapy and/or radiation by allowing replacement of the diseased or damaged bone marrow after the chemotherapy/radiation treatment.

While bone marrow transplants do not provide 100 percent assurance that the disease will not recur, a transplant can increase the likelihood of a cure or at least prolong the period of disease-free survival for many patients.

What are the different types of bone marrow or stem cell transplantation?

There are two main types of transplants – Autologous and Allogenic.

  • Autologous Transplants
    This means that the bone marrow or stem cells used for the transplant are one’s own. A little bit of the patient’s bone marrow or stem cells is taken and stored before high dose treatment. When the treatment is over, the bone marrow or stem cells are given back through a vein.
  • Allogeneic Transplants
    In this type of transplant, bone marrow or peripheral blood stem cells donated by someone else is used. It is essential that the donor’s tissue matches. The most suitable donor is usually a close relative, most commonly a brother or sister (MRD). It is possible to get a good match from an unrelated donor (MUD).

Dr. Vipin Khandelwal

Dr. Vipin Khandelwal is a highly acclaimed clinician in the field of Paediatric Oncology, Paediatric Hematology and Bone Marrow Transplant (BMT). With more than 10 years of experience, he has helped in accomplishment of more than 1000 bone marrow transplants, predominantly in paediatric patients suffering from various hematological disorders.

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