Bone Marrow Transplant (BMT)
What is Bone Marrow Transplant and Bone Marrow Transplant
Bone marrow
is the spongy tissue found in the center of bones, responsible for producing blood cells, including red blood cells, white blood cells, and platelets. In patients with conditions such as leukemia, aplastic anemia, or genetic disorders like sickle cell disease, the bone marrow may not function properly.
Bone marrow transplant (BMT)
is a critical treatment option for patients suffering from certain types of cancers and other serious blood disorders. This procedure aims to replace diseased or damaged bone marrow with healthy stem cells, enabling the production of new, healthy blood cells.
Types of Bone Marrow Transplant
Autologous transplant
In this type, the patient's own stem cells are collected, usually from their blood or bone marrow, before undergoing intensive treatment such as chemotherapy or radiation. After treatment, these stem cells are returned to the patient.
Allogeneic transplant
This involves using stem cells from a donor who is genetically matched to the patient. The donor can be a relative (usually a sibling) or an unrelated individual found through donor registries. It is frequently performed for patients with leukemia, lymphoma, and other blood disorders.
Syngeneic transplant
This type of transplant uses stem cells from an identical twin, ensuring a perfect genetic match between donor and recipient. It can be advantageous because they eliminate the risk of graft-versus-host disease (GVHD) due to the genetic identity of the donor and recipient.
Diseases Treated with BMT at our Center
Allogeneic Transplant
- Hemoglobinopathies like thalassemia and sickle cell anemia
- High risk leukemia or lymphoma (Various types)
- Bone marrow failure syndromes
- Immune deficiencies
- Some metabolic diseases like Adrenoleukodystrophy
Autologous Transplant
- Neuroblastoma
- Wilms Tumor
- Lymphoma
- Other solid tumors
Your Bone Marrow Transplant Journey: An Overview
Step 1: Finding a stem cell donor
The first step is to check for a matching donor within the family, usually siblings, as they have the highest chance of being compatible. If no suitable family donor is available, the search extends to unrelated donors through national and international registries.
Step 2: Donor Evaluation & HLA Typing
Once potential donors are identified; they undergo human leukocyte antigen (HLA) typing to determine compatibility with the patient. This involves blood tests to match specific genetic markers essential for reducing the risk of transplant rejection.
Step 3: Stem Cells Collection
If a suitable donor is found, stem cells are collected either through peripheral blood stem cell donation or bone marrow donation. In peripheral blood donation, donors receive medication to increase stem cell production before collection via apheresis, while bone marrow donation involves extracting cells from the pelvic bone under anesthesia.
Step 4: The Transplant Process
The patient undergoes pre-transplant conditioning, which may include chemotherapy and/or radiation therapy to prepare their body for the new stem cells. Once ready, the collected stem cells are infused into the patient’s bloodstream through an intravenous line.
Step 5: Post-transplant Care
After the transplant, patients are closely monitored for signs of complications and to support recovery. This includes managing side effects and preventing infections due to a weakened immune system.
Step 6: Discharge after BMT
Once patients stabilize and their condition improves, they may be discharged. However, ongoing follow-up care is crucial for monitoring recovery and managing any long-term effects of the transplant.
Why Us
Our center stands out for its commitment to personalized care. Each patient receives an individualized treatment plan tailored to their unique medical needs. From initial evaluation through recovery and long-term follow-up, we prioritize open communication, patient education, and family involvement.
Our supportive environment helps patients and their loved ones feel empowered and cared for every step of the way.
Finding a Stem Cell Donor
Related Donors
Sibling or other family member donors are preferred due to their higher likelihood of being a close match. About 25 out of 100 patients have a family member who is fully matched. If more than one family member matches, we will choose the most appropriate donor using blood tests and clinical information.
Unrelated Donors
If no suitable family member is available, the search expands to unrelated donors through registries.
Umbilical Cord Blood
Cord blood can be used as an alternative source if suitable donors are not available. While it may have less stringent matching requirements, it often contains fewer stem cells than bone marrow or peripheral blood.
Donor Evaluation & HLA Typing
Human Leukocyte Antigen (HLA) Testing: The first step in finding a donor is HLA testing, which checks special markers on white blood cells. These markers are like a “genetic ID” passed down from parents—half from mom and half from dad. A good match means the donor’s markers closely match the recipient. A match is classified as a 9/10 if nine alleles correspond, and a 10/10 if all ten match. We perform 12 HLA allele matching to maximizes the compatibility between the donor’s and recipient’s immune systems.
Here are the key ways in which HLA matching improves outcomes:
- Reduced rejection rates
- Improved graft survival
- Decreased Graft-Versus-Host disease (GVHD)
- Lower immunosuppression requirements
- Enhanced immune system reconstitution
- Long-term health benefits
Health Screening of Donors
- Medical history and physical examination: Potential donors undergo a thorough medical evaluation, including a physical examination, electrocardiogram (EKG), chest X-ray, and additional laboratory tests. This evaluation helps ensure that donors are in good health and can safely undergo the donation process.
- Screening for infectious diseases: All potential donors undergo rigorous testing for infectious diseases to minimize the risk of transmitting infections to the recipient. This includes blood tests for viruses such as HIV, CMV, hepatitis B and C, and other transmissible pathogens. Ensuring that donors are free from these infections is essential for patient safety.
- Hemoglobinopathies screening: Donors are also evaluated for hemoglobinopathies; such as sickle cell disease or thalassemia. These conditions can affect the quality of the stem cells collected and may pose risks to the recipient. Blood tests are conducted to assess hemoglobin levels and identify any underlying disorders.
Stem Cell Collection
Peripheral blood stem cell collection (PBSC)
Stem cells are harvested from the donor’s bloodstream using a process called apheresis.
Bone marrow harvesting
Stem cells are extracted directly from the bone marrow, typically from the hip bones.
The Transplant Process
Pre-Transplant Evaluation
At our center, the journey begins with a thorough assessment conducted by our specialized healthcare team. This evaluation determines the patient’s eligibility for a BMT and allows us to create a personalized treatment plan. We conduct comprehensive tests and consultations to ensure patients are well-informed about the procedure and what it entails.
Central line insertion
A central line is crucial in the care of bone marrow transplant (BMT) patients, as it ensures dependable access to large veins for the administration of chemotherapy, antibiotics, intravenous nutrition, and other medications, while also allowing for blood draws during the transplant process. Typically, it is placed by an interventional radiologist under anesthesia before the conditioning regimen begins.
Conditioning Regimen & Total Body Irradiation
Before transplantation, patients undergo a conditioning regimen that typically involves high doses of chemotherapy and/or total body irradiation therapy (TBI). This crucial step is designed to destroy diseased bone marrow and create space for the new stem cells. Our team carefully monitors patients health during this phase, providing supportive care to manage any side effects.
Stem Cell Infusion
The next step is the infusion of healthy stem cells, which occurs through a central line, similar to receiving a blood transfusion. At our center, we take great care to ensure that this process is as comfortable as possible. Our experienced nursing staff will be with the patient throughout the infusion, providing reassurance and support.
Engraftment
After the stem cell infusion, the transplanted stem cells migrate to your bone marrow and begin producing new blood cells. This process, known as engraftment, typically occurs within 15 to 30 days’ post-transplant but can vary based on individual circumstances. Our team will closely monitor patient’s progress during this period, checking blood counts regularly to assess how well the new cells are establishing themselves.
Post-transplant care
Immediate post-BMT care is critical for ensuring patient safety and promoting recovery. Following the transplant, patients are closely monitored for signs of engraftment, which typically occurs within 2 to 4 weeks. During this period, healthcare teams focus on preventing infections, managing side effects, and providing supportive care. Patients may experience low blood counts due to the intensive chemotherapy received prior to the transplant, making them vulnerable to infections. Therefore, strict hygiene practices and regular vital sign monitoring are essential. Nutritional support and patient education on self-care are also emphasized to empower patients during their recovery. Our dedicated team ensures that each patient receives personalized care tailored to their needs, facilitating a smoother transition towards recovery and improved quality of life
Discharge after BMT
Patients may spend around one to three months in a hospital setting during recovery, and will be discharged once demonstrated readiness for recovery at home.
Discharge Criteria
- The new blood- making stem cells have engrafted
- No evidence of active infection
- GVHD is controlled
- Good oral intake is maintained
- Oral medications are well tolerated
Post Discharge Care
Following discharge, patients are required to attend outpatient clinic visits, initially scheduled twice a week. These visits are critical for conducting clinical assessments and laboratory evaluations, which help monitor potential infections, symptoms of graft-versus-host disease (GVHD), oral intake, medication-related issues, and the management of central lines. As the patient’s condition stabilizes, the frequency of these follow-up appointments will gradually decrease.
Central lines are usually removed when they are no longer necessary. This procedure is typically performed under sedation, with careful monitoring in place to address any potential complications that may arise during or after removal.
For international patients, there is the option to return to their home countries within 3 to 6 months post-BMT. Our team will facilitate ongoing follow-up care by collaborating with their primary care physicians to ensure continuity of care.
Long-Term Care
Continued follow-up is essential for the early detection of any late effects or complications that may develop after the transplant. Regular monitoring allows healthcare providers to identify and address issues promptly, ensuring the best possible outcomes for patients as they transition into long-term recovery.
Common Side Effects of BMT
- Side effects of chemotherapy and radiation during conditioning, like nausea, vomiting, mucositis and hair loss.
- Low blood cell counts leading to infections , fatigue or bleeding.
- Graft rejection or failure.
- Problems with heart, liver, kidneys or other organs.
- Graft-Versus-Host Disease (GVHD): Occurs when transplanted immune cells attack the recipient’s body. Types:
- Acute GVHD: Develops within 100 days post-transplant; affects skin, liver, and GI tract.
- Chronic GVHD: Occurs after 100 days; can affect multiple organs..
Possible Long-Term Side Effects after BMT
- Chronic GVHD
- Endocrine problems
- Problems with heart, liver, kidneys or other organs.
- Osteoporosis, cognitive challenges, chronic fatigue and dental problems
Chimerism Testing Post-BMT
After transplantation, chimerism testing may be conducted to monitor the proportion of donor versus recipient cells in the patient’s blood or bone marrow. This assessment helps evaluate transplant success and guide further treatment if necessary.