Bone Marrow/Stem Cell Transplant

Bone Marrow/Stem Cell Transplant

Narayana Health has a state-of-the-art bone marrow transplant (BMT) unit. The BMT unit, has carried out over 800* bone marrow transplants done, which is the largest number in Karnataka and one of the largest in the country. This unit has emerged as a referral centre for national and international patients for both autologous and allogeneic stem cell transplants. Patients have been referred from Oman, Iraq, Yemen, Afghanistan, Sri Lanka, Nigeria, Bangladesh, Nepal, Burma, Kenya, UAE, Indonesia, Bhutan, Malaysia, Philippines and Pakistan for stem cell transplant procedures.

A cord blood banking facility has been recently established in collaboration with Rotary International, which functions both as a public and private cord blood facility. With a large number of cord blood units being available in our country, cord blood transplants can be offered to a large number of patients who do not have HLA matched sibling donors.

Highlights

  • Personalized care
  • Faculty with high profiles
  • Quality Care
  • Protocol based treatment
  • Customised treatment for acute leukaemia
  • Characterisation of leukaemic stem cell for treatment interventions
  • Study of mesenchymal stem cell interactions in leukaemic cells
  • Haploidentical bone marrow transplant using newer modalities

Achievements Of The Department

  • The department is one of the leading centres for Bone Marrow Transplant and has performed over 800 transplantations.
  • Non-myeloablative or mini-transplants for older patients or patients with multiple health problems allows for transplants in patients otherwise not suitable
  • Cord blood transplants and haploidentical transplants
  • Significant reduction in post-transplant complication making way for increased survival rates
  • Capability to handle very small paediatric patients.

Key Statistical Information

  • Allogeneic - 513
  • Autologous - 182
  • Haplo-identical - 105

800 BMT’s completed till now

0
months
Youngest baby to have undergone Pediatric Transplant
0
years
Oldest adult to have undergone transplant

Services & Facilities

Cord blood banking

HLA typing

Stem cell cryopreservation

Unrelated donor searches

The conditions which necessitate a BMT can be broadly classified into 2 groups:

Cancerous Conditions

  • Acute Myeloid and Lymphoblastic Leukemia
  • Chronic Myeloid and Lymphoblastic Leukemia
  • Hodgkin’s and Non-hodgkin’s Lymphoma
  • Myelodysplastic Syndrome
  • Myeloproliferative Neoplasms, Primary Myelofibrosis etc
  • Multiple Myeloma
  • Solid Tumors – like Neuroblastoma, Brain Tumors etc

Non-Cancerous Conditions

  • Aplastic Anaemia
  • Haemoglobinopathies such as Thalassemia and Sickle Cell Anaemia
  • Immunodeficiency disorders
  • Congenital errors of metabolism
  • Congenital storage disorders

  • Physical examination – to assess recipient’s health status
  • Harvesting – the process of obtaining stem cells to be used in the transplant
  • Conditioning – preparing the body for transplant
  • Transplanting the stem cells
  • Recovery period

Routine diagnostic tests such as complete haemogram, kidney function test, liver function test, X-ray, and urinalysis are performed. Also Human Leukocyte Antigen (HLA) typing and blood grouping are done to assess recipient/donor compatibility. This assessment of compatibility is essential to reduce risk of rejection of transplant.

• Autologous Bone Marrow Transplant: The donor is the patient himself. Stem cells are taken from the patient either by bone marrow harvest or apheresis (a process of collecting peripheral blood stem cells), frozen, and then given back to the patient after intensive treatment.

• Allogeneic Bone Marrow Transplant: The cells are taken from a healthy donor. Stem cells are taken either by bone marrow harvest or apheresis from a genetically matched donor, usually a brother or sister. Other donors for allogeneic bone marrow transplants may include the following:

  • A parent/relative. A haplo-identical match is when the donor is a parent and the genetic match is at least half identical to the recipient
  • Unrelated bone marrow transplants. The genetically matched marrow or stem cells are from an unrelated donor. Unrelated donors are found through national bone marrow registries.

• Peripheral Blood Stem Cell Transplant: The process of peripheral blood stem cell transplant is routinely performed, when compared to the bone marrow harvest method has this procedure is less invasive and easy to perform. Some studies even suggest that the stem cell yield by this method is higher when compared to bone marrow harvest. The process takes 4-6 hours after administering necessary medication for 4 days.

Donors are injected with Granulocyte Colony Stimulating Factor (GCSF) for a duration of 4 days to stimulate stem cell proliferation. The donor stem cells are collected by a process of apheresis and administered intravenously to the patient. The donor stem cells have the property of stem cell homing whereby they migrate to the patient’s bone marrow and override his defective stem cells. This restores the ability of the patient’s bone marrow to produce blood elements.

• Umbilical Cord Blood Transplant: Umbilical cord blood is a rich source of stem cells. After delivery or birth of the infant, cord blood can be collected from the umbilical cord (which is a waste, by-product of child birth) and preserved for later use. Cord blood possesses a higher concentration of stem cells than the adult blood. Around 80-100 ml of cord blood is collected and these stem cells are ideally suited for transplants in children. Before storage and preservation, the cord blood stem cells are typed, counted and tested. Cord blood cells are frozen until necessary for transplant.

The conditioning process involves high doses of chemotherapy and sometimes radiation. It is carried out for three reasons:

  • Destruction of the existing bone marrow cells to make room for the transplanted stem cells
  • Destroy any existing cancer cells
  • Suppression of activity of the immune system to decrease chances of rejection of donorstem cells

The process of Bone Marrow Transplant does not involve the physical insertion of the marrow stem cells into the marrow of the recipient, but is more of an intricate and delicate blood transfusion method. The harvested stem cells are administered via a central venous catheter into the bloodstream from where they find their way to the marrow by a property of stem cells known as stem cell homing.

Recovery: The patient is constantly monitored to assess the success of the transplant. However, the procedure does involve a few risks, these include:

  1. Graft versus host disease (GvHD)

In this disease, the transplanted stem cells (“graft”) attack the recipients cells (“host”) as they are considered alien to the body.

There are two types of GvHD:

  • Acute GvHD – Occurs during the first three months following the transplant. Chronic
  • GvHD – Develops from acute GvHD and can cause symptoms for many years.
  1. Infections

As a consequence of chemotherapy and bone marrow suppression, the body is transiently unable to produce cells to combat infections.

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