What is Bone marrow transplant surgery?
Bone marrow transplant surgery, also known as stem cell transplant and hematopoietic stem cell transplant, is a surgical procedure that helps restore the blood and immune systems to normal using healthy stem cells. These stem cells are known to be master builders of blood. The cells are the ones that eventually grow into white blood cells, red blood cells, and platelets. In patients where the bone marrow becomes weak, damaged, or infected by a disease, a bone marrow transplant surgery helps restore the ability to produce these vital blood cells.
It is important first to understand what bone marrow actually does. Bone marrow is a soft, sponge-like tissue inside human bones that functions as part of the body that produces new blood cells to replace old and damaged ones. When the original bone marrow stops producing healthy cells or produces abnormal cells, the entire body suffers. This is where a bone marrow transplant surgery steps in as a way to support the body with new, healthy stem cells.
A bone marrow transplant is considered by a doctor when they suspect a serious issue with how natural bone marrow works. Disturbances in the normal functioning of bone marrow are usually due to blood cancers, immune disorders, genetic conditions, or disease conditions that affect the normal functioning of bone marrow, thereby producing abnormal blood cells and stopping the production of healthy cells. These complications in health cannot be regulated by using normal treatment techniques.
Bone marrow transplant is required in conditions like leukemia, lymphoma, multiple myeloma, aplastic anemia, thalassemia, sickle cell disease, and some immune deficiencies. Though all these conditions affect the body in a different way, the root cause of the problem remains the same that is bone marrow fails to supply healthy functioning blood cells. A transplant then acts as a support system to this vital process in the body to be restored to normalcy.
Types of Bone Marrow Transplant
Bone marrow transplant surgery is not a single method. It is made up of different methods, depending on where the stem cells actually originate from. The choice of bone marrow transplant depends on the medical condition of the patient, the availability of doctors, the availability of donors, and the health conditions of the donor’s bone marrow itself. The types of bone marrow transplants are given in detail below:
- An autologous transplant is where the patient himself acts as a donor of stem cells. Healthy stem cells are collected from the patient’s own peripheral blood or bone marrow before the patient is subjected to high-dose chemotherapy or radiation to kill the cells of cancer cells. After the chemotherapy or radiation treatment, the healthy stem cells that were extracted are reinfused into the blood of the patient.
- An allogenic transplant is where the stem cells are obtained from another donor. This technique is utilised when the patient’s own bone marrow is diseased or when an autologous transplant itself is at risk of relapse. The donor must have a closely matching tissue type (human leukocyte antigen or HLA) for the patient to reduce the risk of the body rejecting the donor cells (graft vs host disease or GVHD).
Allogenic bone marrow transplants are of various subtypes depending on the relationship and genetic match of the donor, namely, they are
- Matched related donor transplant (MRD) is where the donor is a close blood relative of the patient, typically a brother or sister, who is most normally a very close genetic match.
- Matched unrelated donor transplant (MUD) is a donor other than a closely related family member, who has a closely matching human leukocyte antigen marker.
- Haplocidentical transplant (Half-matched) is a bone marrow transplant surgery option for a patient who cannot find a fully matched donor. A half-matched donor, such as a parent, child, or half-sibling, is normally utilized as a donor. Modern developments in medical care and the availability of immunosuppressive drugs have made this option possible in recent times.
- Umbilical cord blood transplant is a bone marrow transplant technique, where the stem cells are collected from newborns’ umbilical cord and placenta immediately after birth. The stem cells are then frozen and stored in a cord blood bank. Cord blood cells are less mature, and therefore make a less perfect match acceptable. But this technique usually makes recovery of blood count a lengthy process.
- Other variations of bone marrow transplant include reduced intensity conditioning (RIC) transplant, also known as mini transplant is a variation of allogenic bone marrow transplant, where a lesser and lower amount of toxic radiation is utilized to overpower the immune system’s power of bone marrow rather than destroy it.
- Tandem (Double-Auto) transplants are a process where, patient is subjected to repeated sequences of high-dose autologous transplantation.
| Procedure Name | Bone Marrow Transplant |
|---|---|
| Type of Surgery | Infusion of stem cells is similar to a blood transfusion |
| Type of Anesthesia | No anesthesia, stem cell transplantation is done while the patient is awake |
| Procedure Duration | The patient first receives a high dose of radiation for 5 to 10 days to prepare the body, and after that, stem cells are infused into blood bloodstream. Patients are usually awake. Donor stem cells are collected by subjecting them to local or general anesthesia or from the blood through a process called apheresis. The infused blood cell multiplication takes 2 to 4 weeks |
| Recovery Duration | Initial recovery takes 2 to 6 weeks, and full recovery in an autologous transplant takes several months, whereas in the case of an Allogeneic transplant, it can take 1 to 2 years. |
Bone Marrow Transplant: Pre-Op & Post-Op Care
Because of the involvement of multiple phases and a lot of close medical guidance, the entire procedure of bone marrow transplant surgery is divided into pre-operative, intra-operative, and post-operative stages. Each phase plays an important role in making sure that the procedure is safe, the engraftment is conducted normally, and therefore aids in the long-term recovery of the patient.
Before the bone marrow transplant procedure
The pre-operative phase of a bone marrow transplant is the most preparation-heavy part of the bone marrow transplant journey. It usually is days to weeks long and involves examining the patient, finding the donor, managing the health of the patient, and preparing the body to receive new stem cells.
Initial examination involves the medical team conducting a detailed examination to ascertain that the patient can undergo bone marrow transplant surgery without any problems. The evaluations before the procedure include a complete blood test, which involves blood counts accompanied by liver and kidney function tests.
Imaging tests include chest x-ray, computed tomography scan, or positron-emitting tomography /computed tomography to evaluate the disease condition. The heart is examined using an electrocardiogram and echocardiography, the lungs are tested using a pulmonary function test, and viruses like hepatitis, hepatitis, HIV, EBV, and oral testing.
Bone marrow biopsy is the technique that is used for a precise understanding of the accuracy of the disease being treated by bone marrow transplant surgery.
If the patient is set to undergo an allogenic bone marrow transplant, the next step is to find a matching donor, which includes an HLA-matched transplant, a matched unrelated donor, a haploidentical donor, and umbilical cord units of blood.
The transplant team explains to the patient the overall process, possible risks, problems, hospital stay, and long-term follow-up.
A central venous catheter or Hickman line is placed under sterile conditions, which is important in providing chemotherapy, medicines, blood products, and drawing of blood samples without needles/ pricks.
Conditioning is one of the most important pre-operative steps and prepares the body for transplantation by creating space in the bone marrow for engrafting of the donor cells.
Suppressing the immune system reaction in the patient’s body by using immunosupressive drugs, therefore preventing donor rejection, and destroying the remaining cells of cancer cells.
The types of conditioning used are myeloablative regimen, high-dose chemotherapy, accompanied by total body irradiation, and reduced intensity regimen, where mild doses of chemotherapy or radiation are used, especially for patients of old age. Conditioning usually lasts for 4-7 days and ends one day before the transplant.
Intra-operative procedure
The operation part of bone marrow transplant surgery is similar to that of a blood transfusion, and unlike any other surgical procedure. The day stem cells are infused is termed day 0.
On day 0, the patient is pre-medicated by using anti-histamines, steroids, or anti-pyretics to prevent any allergies. Vital signs are then monitored before infusion.
The frozen stem cell product is then checked for quality, viability, and the correct identity of the patient.
Stem cells are infused through a central venous catheter, with no requirement for anesthesia either by autologous bone marrow transplant or allogeneic bone marrow transplant.
During the infusion of stem cells, heart rate, blood pressure, levels of oxygen, and temperature are closely kept an eye on.
The medical team observes for any reactions like chills, fever, or difficulty in breathing.
Infusion can take anywhere between 30 minutes to several hours, depending on the volume
After the infusion, the stem cells naturally travel to bone marrow, where they begin the process of engraftment.
After the bone marrow transplant
The post-operative phase of bone marrow transplant is its longest and most critical part, extending from immediate recovery, a few days after surgery, to months or years after the transplant.
Aplasia phase is a stage where the patient’s blood count drops suddenly; this period lasts for usually 1-3 weeks, during which the patient is highly prone to infections and bleeding. To manage this, protective isolation or HEPA-filter rooms may be used, broad spectrum of antibiotics, antiviral, and anti-fungal medicines are used, platelet and red blood cell transfusions are given as needed, and growth factors are utilised to boost white cell recovery.
Engraftment, which is where the transplanted stem cells start producing new blood cells, occurs between more than 10 days to 30 days. Signs of engraftment are an increasing count of neutrophils, increased levels of energy, and reduced need for transfusions.
After bone marrow transplant surgery, some problems may arise during the post-operative phase this including
Graft vs Host disease occurs only in allogeneic transplants. This is usually when donor cells react with the patient’s body. These can affect skin, liver, or gut. Immunosuppressive medications are commonly used to reduce the chances of Graft vs Host disease.
Due to decreased immunity, the risk of infections is quite high from bacteria, viruses, and fungi. Prophylactic medicines and vaccinations are quite important.
Mucositis is inflammation of the mouth and gut due to chemotherapy and may cause pain, ulcers, and difficulty in eating food.
Functions of vital organs are closely kept an eye on to diagnose any early signs of chemotherapy or radiation toxicity.
Nutrition includes high high-protein diet, supplements, and maintaining hydration.
Post-discharge follow-ups are usually after 1-2 months, and vaccinations are given again after 6-12 months because immunity is reset after transplant.
Full recovery of the immune system may take anywhere between 6 months to 2 years, and patients must follow safe food and hygiene practices, avoid any large crowds or sick individuals, wear masks, use medications on time, especially immunosuppressants. Regular blood tests and monitoring need to be done.
Benefits of Bone Marrow Transplant at Yashoda Hospitals
- Potential for a cure
- Restoration of healthy blood cell production
- Enabling high-dose cancer treatment
- Treatment of genetic diseases
- Improved quality of life
- Reduced risk of disease remission
- Graft vs Cancer effect
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