Bone Marrow Transplant

Certain types of blood cancers and some blood disorders may affect the body's ability to produce healthy blood cells. While medicines and other types of treatment, such as chemotherapy, assist most patients, there are conditions when an advanced form of treatment is necessary to replace the unhealthy bone marrow. In such cases, a Bone Marrow Transplant (BMT) may be the only option for managing the disease and restoring health.

Bone Marrow Transplant (BMT) is a rather complicated treatment procedure in which stem cells that produce healthy blood cells are infused into the patient's body. Depending on the patient's condition, cells can be taken from the patient or a matched donor.

At Gleneagles Hospitals, prior to bone marrow transplantation, each patient undergoes thorough testing. The team of doctors at Gleneagles, which includes haematologists, transplant physicians, oncologists, infectious diseases specialists, transfusion medicine doctors, and critical care specialists, develops an appropriate individual treatment plan.

Bone Marrow Transplantation (BMT), also known as Haematopoietic Stem Cell Transplantation (HSCT), is the process of replacing faulty or damaged bone marrow with healthy stem cells that produce new blood cells.

Bone marrow refers to the soft substance inside bones, which contains stem cells responsible for producing:

• Red blood cells, which transport oxygen throughout the body
• White blood cells, which help fight infections
• Platelets, which assist in stopping any bleeding

Once the bone marrow is damaged by an illness or aggressive cancer treatments, it becomes difficult to produce healthy blood cells. In this case, a bone marrow transplant can restore the ability to manufacture healthy blood cells.

The transplanted stem cells migrate from the bloodstream into the bone marrow and begin producing new blood cells. Engraftment occurs within weeks, depending on each patient's recovery.

A bone marrow transplant is not needed by all individuals suffering from any blood condition or cancer. The procedure is considered only if the disease and past medical history have been properly assessed.

A transplant may be recommended for conditions such as:

• Acute leukaemia
• Chronic leukaemia
• Multiple myeloma
• Lymphoma
• Aplastic anaemia
• Myelodysplastic syndromes (MDS)
• Certain inherited blood disorders, such as thalassaemia and sickle cell disease
• Some immune deficiency disorders

In many patients, transplantation is considered when:

• The disease has returned after treatment.
• Chemotherapy alone is unlikely to provide long-term disease control.
• The patient is at high risk of disease recurrence.
• Bone marrow function has been severely damaged.
• Standard treatment options have been exhausted.

The decision is always individualised. At Gleneagles Hospitals, each case is discussed by an experienced multidisciplinary transplant team before a bone marrow transplant is recommended.

The transplant type depends on the patient's condition, overall health, and the availability of a donor.

1. Autologous Bone Marrow Transplant

In an autologous transplant procedure, the patient’s own stem cells are harvested before high-dose chemotherapy and reinfused after it to regenerate the bone marrow.

This technique is often used for:

• Multiple myeloma
• Certain types of lymphoma

As the patient’s own stem cells are transplanted, there is no risk of graft-versus-host disease and no need for donor matching.

2. Allogeneic Bone Marrow Transplant

In the allogeneic bone marrow transplant, the stem cells are taken from a donor who can be:

• Siblings or other family members
• Unrelated matched donor
• Half-matched donor (haploidentical)
• Umbilical cord blood transplantation (in selected cases)

In addition to regenerating diseased bone marrow, the donor’s immune cells can help eliminate residual cancer cells.

Before proceeding with transplantation, patients undergo a comprehensive medical assessment to determine whether the procedure is appropriate and safe.

This evaluation typically includes:

• Complete blood investigations
• Bone marrow examination
• CT scan, PET-CT, or MRI, when required
• Heart function assessment (ECG and echocardiogram)
• Lung function tests
• Kidney and liver function tests
• Infectious disease screening
• Human Leukocyte Antigen (HLA) typing for donor matching
• General physical examination and nutritional assessment

Doctors also evaluate previous treatments, current disease status, existing medical conditions, and the patient's ability to tolerate intensive therapy.

Such evaluations help identify risk factors, optimise the patient’s condition before transplantation, and improve treatment effectiveness.

Although bone marrow transplantation is now considered relatively safe compared with previous years, this method may not be suitable for all patients.

Bone marrow transplantation may not be suitable in cases of:

• Severe infection that cannot be controlled
• Organ failure involving the heart, lungs, liver, or kidneys
• Weaknesses of the general health state
• Uncontrolled medical conditions
• Conditions which cannot be treated with transplantation

In some instances, the potential dangers of transplantation might exceed its benefits.

Preparation

The transplant process begins a few days before stem cell infusion. Conditioning therapy is provided to patients, involving high-dose chemotherapy and sometimes also radiation therapy to:

• Eliminate residual cancer cells
• Suppress immunity to lower the risk of rejection
• Make the bone marrow ready for stem cells

Supportive drugs are administered to prevent infections and counter treatment complications. Patients are admitted to specialised transplant centres that practice strict infection control procedures.

During the Procedure

The infusion of stem cells is much like a blood transfusion and does not require surgical procedures or general anaesthesia. Healthy stem cells will be infused into the body via the central venous catheter and reach the bone marrow, where they begin forming healthy blood cells.

Immediately After the Procedure

Once the procedure is complete, the patient will be observed as the transplanted stem cells begin producing healthy blood cells. This usually takes from two to four weeks.

Monitoring during recovery includes:

• Blood cell counts
• Infection signs
• Bleeding or bruising
• Liver and kidney functions

Since immunity is compromised for some time, patients can be placed in protective isolation and receive supportive care, including blood transfusions and medications such as antibiotics, antiviral agents, antifungal drugs, and nutritional support.

Recovery following a bone marrow transplant is gradual and differs from one patient to another. The initial recovery stage generally takes some weeks, while recovery of the entire immune system can take months or longer, depending on whether an allogeneic transplant was performed.

Some of the signs that may be observed during the early stages include:

• Tiredness
• Poor appetite
• Mouth ulcers
• Temporary hair loss
• Nausea
• Vulnerability to infections

All these symptoms normally subside with time as more healthy blood cells develop in the body.

In case a patient is discharged from the hospital, it is important to ensure that they attend the recommended follow-up visits, where the doctor monitors the blood levels, organ functioning, immune system recovery, and also checks the status of the disease.

A bone marrow transplant is a complex process, and, like any medical procedure, it may involve certain risks. Monitoring a patient throughout the process ensures that complications are detected and treated early.

Complications Experienced During Early Stages Include:

• Infections
• Bleeding due to low levels of platelets
• Anaemia
• Nausea and vomiting
• Sore mouth (Mucositis)
• Liver or kidney dysfunction temporarily

These complications occur primarily during the initial recovery stages and can be treated with appropriate medical intervention.

Considerations for the long run include:

• Graft-versus-host disease (GVHD)
• Immune system problems
• Changes in hormones or fertility
• Formation of cataracts after some medical interventions
• Rare cases of secondary cancers

These complications do not occur in all patients, and advances in the science of transplantation have made it easier to prevent and treat them.

Over the past few decades, advances in stem cell transplantation, donor matching, supportive care, and infection prevention have made bone marrow transplantation safer and more successful for carefully selected patients.

Some of the reasons why this technique has become increasingly used include:

• Possibility of long-lasting remission in different forms of blood cancer
• Restoration of the normal functioning of bone marrow
• Access to other sources of donors when no matching sibling is available
• Improvement in the success rate due to better matching of donors
• Improve supportive care and infection control
• Personalised treatment depending on the features of the disease

Transplantation is not applicable to all patients, but it has become an essential treatment for many difficult blood diseases that may not be effectively treated by other techniques.

Comprehensive Multidisciplinary Care

Bone marrow transplantation requires the expertise of multiple specialists. At Gleneagles Hospitals, haematologists, oncologists, transplant physicians, infectious disease specialists, and specialist nurses coordinate efforts to provide comprehensive care to patients.

Advanced Evaluation

All patients receive a comprehensive assessment before the transplantation procedure, including lab tests, disease evaluation, imaging, and HLA matching to identify the optimal transplantation method.

Dedicated Transplant Unit

The transplantation procedures are conducted in specialised units with rigorous infection control measures, advanced monitoring and comprehensive supportive care.

Tailored Approach

We tailor each treatment program to the patient's condition, disease stage, overall health, and available donors to achieve the best possible outcome.

Follow-Up

Treatment does not end when the patient leaves the hospital. Follow-up appointments will allow for checking the patient's blood count, immune restoration, organ function, and overall progress.

A bone marrow transplant is one of the most advanced treatment options available for selected blood cancers, bone marrow disorders, and certain inherited blood diseases. Since the procedure involves replacing diseased bone marrow with healthy blood-producing stem cells, it can normalise blood cell production in patients, who may have the prospect of being disease-free or achieving remission.

However, the success of this procedure depends on proper patient selection, careful planning, medical expertise, and supportive care throughout all stages of the process. At Gleneagles Hospitals, all patients receive personalised treatment plans from expert transplant teams.