Medical Facilitation

Sunday, 5 January 2014

Types of Bone Marrow Transplants - How the Bone Marrow Functions

How the Bone Marrow Functions

Bone marrow is the soft, spongy center of your bone where blood is produced. Marrow is filled with blood-producing cells, called stem cells, which develop into mature white blood cells, red blood cells or platelets.

White blood cells of various kinds make up part of your immune system for fighting infections.Red blood cells are responsible for carrying oxygen throughout your body.Platelets clot your blood to prevent bleeding. Stem cells are constantly being produced by your bone marrow, and will develop into the types of cells your body needs.

Types of Bone Marrow Transplants

Most people who need to undergo a bone marrow transplant have cancer, such as leukemia or lymphoma. There are different types of bone marrow transplants. The type and severity of your disease determine what type of bone marrow transplant you will need.

Allogeneic Bone Marrow Transplants

An allogeneic bone marrow transplant involves receiving donor bone marrow or peripheral stem cells. This bone marrow transplant donor is genetically matched and can be related or unrelated to you. An autologous transplant involves receiving your own bone marrow or peripheral stem cells. A syngeneic bone marrow transplant involves receiving your identical twin's bone marrow or peripheral stem cells.

Allogeneic Transplants

An allogeneic bone marrow transplant involves receiving very high-doses of chemotherapy and/or radiation therapy, followed by the infusion of your donor's bone marrow or peripheral stem cells. The high-dose cancer fighting treatments are given to eliminate the cancer in your body. The infusion of the new marrow or peripheral stem cells during an allogeneic bone marrow transplant replaces the bone marrow destroyed by the chemotherapy and/or radiation therapy.

You may be a potential candidate for an allogeneic bone marrow transplant if you have leukemia, aplastic anemia, myelodysplasia, myelofibrosis, high-grade lymphoma or other types of cancers.

A non-myeloablative (“mini”) allogeneic bone marrow transplant involves receiving low-doses of chemotherapy and radiation therapy followed by the infusion of your donor's bone marrow or peripheral stem cells. The objective of the bone marrow transplant is to suppress your own bone marrow by receiving just enough chemotherapy and radiation therapy to allow your donor cells to engraft and grow within you. The hope is these donor cells will mount an immunologic attack against your underlying cancer, generating a response called the "graft-versus-leukemia" effect or “graftversus- cancer” effect.

You may be a potential candidate for a mini allogeneic transplant if you have a slow growing, indolent disorder, such as chronic leukemia, multiple myeloma, myelodysplasia, low-grade lymphoma, and in some cases, renal cell carcinoma. The mini allogeneic transplant is not appropriate, for example, if you have fast-growing acute leukemia.

Autologous Bone Marrow Transplants

An autologous bone marrow transplant involves receiving very high-dose chemotherapy followed by the infusion of your previously-collected peripheral stem cells or bone marrow.

The high-dose chemotherapy treatments are given to eliminate the cancer in your body. The infusion of your new marrow through a bone marrow transplant or peripheral stem cells replaces the bone marrow destroyed by the chemotherapy and/or radiation therapy.You may be a potential candidate for an autologous bone marrow transplant if you have lymphoma, multiple myeloma, Hodgkin's disease, germ cell cancer, breast cancer or certain types of leukemia.

Bone marrow transplant procedure in India

Bone marrow transplant procedure in India comprises two major activities: the harvesting of the stem cells and the transplantation of the stem cells.

The procedure for harvesting stem cells is the same for both autologous and allogenic bone marrow transplants in India. Under general anaesthesia, bone marrow is extracted from major bone structure is such as the hip and the spine. There are no surgical incisions, just skin punctures to insert the needles. The harvested stem cells may need to be processed to make them fit for transplantation.

In the second phase, the actual transplantation procedure is performed. All hospitals that perform bone marrow transplant procedure in India have a special and segregated bone marrow transplant unit which is highly sterile. This is because bone marrow transplant patients are susceptible to infections on account of lower levels of immunity.

Prior to the procedure, catheters are inserted to allow administration of drugs, nutrition etc. Patients would receive medications such as antibiotics and antivirus to prevent as well as to treat infections of any kind. Patients scheduled for allogenic transplant will also receive special medications to prevent rejection of the donor cells by the patients immune system.

Healthy stem cells are introduced into the body through the bloodstream, and no surgery is normally necessary. The stem cells upon reaching the bone marrow, engraft there and after a couple of weeks commence production of normal blood cells.

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Tuesday, 24 December 2013

How Bone Marrow Transplant is performed - Stages Process

Bone Marrow Transplantation - Stem cell transplantation in India

Having a bone marrow transplant is a complicated five stage process.

The five stages are:

a physical examination of your body to assess your general level of health
obtaining the stem cells that will be used in the transplant (known as harvesting)
preparing your body for the transplant (known as conditioning)
transplanting the stem cells
the recovery period, during which you will be monitored for any complications or side effects

The five stages are described in more detail below.

Physical examination

You will have a thorough physical examination before having a stem cell transplant. Your overall level of health before the transplant will play a big part in how well you recover after the procedure. As part of the examination, you may have some scans to check the condition of internal organs, such as your liver, heart and lungs.
Some medicines used in the conditioning and recovery process can occasionally cause problems with your organs, so it is important to know how well they are functioning beforehand. After the transplant, your risk of developing an infection will be increased, so it is vital to ensure you do not have any current underlying infections. If you have a cancer-related condition, you may need to have a biopsy. This involves removing a small sample of cancerous cells so they can be checked in a laboratory. The results of a biopsy can show whether your cancer is in remission (under control) and whether there is a high risk of it returning after your transplant.

Obtaining stem cells

When you've had a physical examination, the stem cells will need to be harvested. The usual method involves removing blood from the body, separating the stem cells from the other cells in the blood and then returning the blood to the body. Alternatively, the bone marrow itself can be collected by removing stem cells from the hip bone using a special needle and syringe. This may be recommended for certain conditions that require a transplant, or if the donor is a child.

Autologous transplantation

If they are suitable, it may be possible to use your own stem cells. This is known as an autologous transplantation. They can be harvested using either method described above. Your stem cells may need to be treated with radiation or chemotherapy to ensure that there are no cancerous cells left. If your bone marrow is being extracted, a needle will be used to remove about a litre of bone marrow. It will usually be removed from your hip bone while you are under general anaesthetic. The procedure is low risk but the area where the needle is inserted may be painful afterwards. The procedure may need to be carried out several times before enough bone marrow is harvested.

Allogeneic transplantation

If your own stem cells are not suitable, stem cells will be harvested from a healthy donor. This is known as allogeneic transplantation. There is a particular shortage of donors from African, African-Caribbean, Asian, Jewish, eastern European and Mediterranean communities.
The process of harvesting cells from a healthy donor is similar to the one used for an autologous transplant. For four days before the transplant, the donor will be given medication to stimulate the production of stem cells in their blood. On the fifth day, they will have a blood test to check they have enough circulating stem cells. They will then be connected to a cell-separator machine. A general anaesthetic is not needed, which means the harvesting can be done as an outpatient procedure. Blood is removed through a vein in one arm and passed through a filtering machine to separate the stem cells from other blood cells. It is then returned to the body through a vein in the other arm.

Preparing yourbody

As part of your conditioning, you will need to be given a range of medicines, so a tube will be inserted into a large vein near your heart. This is known as a central line and will avoid the need for you to have many painful injections.
The conditioning process involves using high doses of chemotherapy and possibly radiation. It is done for three reasons:

to destroy the existing bone marrow and make room for the transplanted tissue
to destroy any existing cancer cells
to stop your immune system working in order to reduce the chance of the transplant being rejected

The conditioning process usually takes four to seven days. You will probably need to stay in hospital throughout the procedure. Side effects from chemotherapy are common and include:

nausea (feeling sick)
vomiting
loss of appetite
mouth ulcers
tiredness

The transplant

It is usually possible to carry out the transplant one to two days after conditioning has finished. The donated stem cells will be passed into your body through the central line. The process can take from half an hour to several hours to complete, depending on the type of blood cells being used. The transplant is not painful and you will be awake throughout the procedure.

Recovery

You may feel weak after the transplant, and you may experience vomiting, diarrhoea and have a loss of appetite. To prevent malnutrition (a lack of essential nutrients), you will need to have nutritional support, with high-protein fluids taken by mouth or through a tube running through your nose to your stomach. The first stage of the recovery process involves waiting for the stem cells to reach your bone marrow and start producing new blood cells. This is known as engraftment and it usually occurs 15-30 days after the transplant takes place.
During this period, you will need to have regular blood transfusions because you will have a low number of red blood cells.You will also be at increased risk of developing an infection because you will have a low number of white blood cells. This means that you will need to stay in hospital in a germ-free environment.