Haematology & BMT
Bone Marrow Transplantation is a specialized treatment for cancers like leukemia, lymphomas and some non-cancerous diseases like thalassemia. In a haploidentical transplant, the donor cells with only 50% match are used. This is in sharp contrast to transplant of perfectly matched cells. The donor can be a family member that includes parents, children and siblings. Haploidentical Bone Marrow Transplant is advised only during certain conditions, when there is no fully human leukocyte antigen (HLA) matched family donor or matched unrelated donor.
Facts about Haploidentical Bone Marrow Transplant :
- Advised only when there is no fully HLA matched family donor
- A half HLA matched parent or sibling is the donor for bone marrow or blood stem cells
- BMT from a half matched unrelated donor is not possible as there is incompatibility of HLA antigens of donor and recipient
- Only the Bone Marrow or Stem Cell enriched blood of a donor can be transfused into the patient to replace his diseased Bone Marrow. The stem cell enriched blood is called the ‘GRAFT’
- Even amongst family members, the selection of the right haploidentical donor is very crucial. To prevent Graft Versus Host Disease (GVHD) either the graft is processed or a combination of immunosuppressive drugs are used
- Haploidentical Bone Marrow Transplantation demands specialized infrastructure and expertise of specialists. Importantly, the bone marrow transplant facility should be free of bacterial and fungal infections. The installation of highest quality HVAC system at our BMT facility ensures complete protection to the patient from airborne infections.
The Bone Marrow or Stem Cell Transplant Center at Yashoda Hospitals is equipped with :
- Dedicated Air Handling Unit
- Anteroom for maintaining 12-15 hepa-filtered fresh air changes per hour with right air pressure
- BMT rooms maintained as per class 1000 clean rooms with,
- Stainless steel doors
- Vinyl flooring
- Wall cladding for maintaining clean surfaces
- Double outlets for oxygen, vacuum, six parameter monitors, infusion pumps, syringe pumps and crash cart
Highest quality irradiation procedures are facilitated by innovative technologies. The entire bone marrow is targeted with higher doses of radiation, without exposing other organs to its harmful effects.
Importantly, the condition of sick patients with zero white blood counts is crucial, as they are at greater risk of life. These patients are placed in the special BMT unit which has a stand by ventilators, dialysis machine, ultrasound and X-ray machine.
The Bone Marrow or Stem Cell Transplant Center at Yashoda Hospitals provides :
- 8-colour Flow-Cytometry based diagnostics for Leukemia, Lymphoma and Aplastic Anemia
- Detection of Minimal Residual Disease (MRD)
- Molecular diagnosis for Leukemia
- HLA typing, NK Cell Genotyping and CD34 + Stem Cell Estimation
- Comprehensive donor selection for Haplo-identical BMT based on NK-KIR Profile.
- Magnetic Separation of Cells using MACS Technology.
- Long Term Cryopreservation of Stem Cells at -196 °C liquid nitrogen freezer in vapour phase
- Conventional and Real Time PCR for Viral Pathogens
- Drug Levels for BMT
PROCESS OF BONE MARROW TRANSPLANTATION
The four stages of the BMT process includes,
Stage 1. Evaluation of the patient
Each patient needs to undergo a complete medical check-up to evaluate his/her suitability for the bone marrow transplant process. The medical check-up includes blood tests, chest X-ray and CT Scan, heart and lung condition, and bone marrow check. Patients are counselled about the BMT procedure, complications and chances of success.
Stage 2. Preparation of the patient
The patient is given high dose of chemotherapy or radiotherapy to destroy the diseased marrow. The stem cells or bone marrow cells are given to the patient through the Central Venous Line (CVL). Possible complications that may occur due to bone marrow transplant like allergic reactions, high blood pressure and high heart rate are effectively treated. Immunosuppressants are given to suppress the immune system and reduce the risk of rejection of new stem cells or bone marrow.
Stage 3. Pre-engraftment
The patient is kept in the clean room of the BMT facility. Blood and platelet transfusions are given and the infections are treated with antibiotics.
Stage 4. Post-engraftment
In the first three months following bone marrow transplant, the white blood cells (neutrophils and lymphocytes) count is ensured to be above the critical value, before the patient is moved out of critical isolation. This condition shows that the transplanted blood cells are working normally. Significantly, if the neutrophils increase to normal or near-normal levels, the patient is ready for discharge. In the next twelve months, as the risk of graft-versus-host disease (GVHD) is very high, the patient has to undergo regular check-ups and blood test (2-3 times a week) to check the WBC count as there is still the risk of infections from viruses and fungus.