Bone Marrow Transplantation at Sri Shankara Cancer Hospital and Research Centre

Stem cell transplantation commonly known to people as Bone marrow transplantation is an important modality of therapy to cure incurable cancers and other blood related diseases.

I would use the term BMT to represent either Stem cell transplant or bone marrow transplant further in write up.

BMT came to light in early 1960s though it did not materialize well till late 1980s. By then two important events happened in science; firstly, identification of HLA antigens which are like blood groups present on every cell in body which needs to be matched between recipient and donor; and effective strategies to prevent donor cells becoming too much strong and kill the weak and diseased recipient.

Both the discoveries won Nobel prize, Dr. Jean Dausset for HLA typing and Dr. Donald Thomas for pioneering BMT for saving mankind from incurable diseases.

How is the procedure done?

Normally the blood is formed in bone marrow, that is the juicy part of the bone. Majority of blood cancers begin in this space. It is the home for blood cancer (Leukemia) cells to reside and cause trouble if left to stay there. These are resistant to conventional chemotherapies which are given for leukemia.

Majority of other diseases like Aplastic anemia, Thalassemia, Myeloma, Immuno Deficiency disorders do start in bone marrow. All these diseases can be cured with a bone marrow transplant.

The procedure in simple words follow like this,

1. We match between patient and potential donors using DNA PCR based HLA typing.

2. Once a match is identified, we evaluate the donor for fitness to donate and also evaluate for diseases donor can transmit to patient.

3. We evaluate patient for fitness to choose the right therapeutic strategies.

4. Once we have both evaluations in hand, we start with giving high dose chemotherapy or radiation to patients which will kill 99.9% of blood forming cells in bone marrow (which will have cancer cells or diseased cells), which typically lasts for 4-5 days. We choose doses carefully to make sure that we do not damage the other organs of body.

5. In the mean time we collect normal stem cells (blood forming cells) from donor using a special technique called apheresis using a specialized equipment called Therapeutic apheresis machine.

6. Once we have donor cells in hand we administer the donor cells through the large venous access (Central line or Hickman line) to patient.

7. These stem cells reach bone marrow which is their home and sit there and prepare towards forming new blood cells.

8. In about 10-20 days depending on different types of transplant these stem cells produce normal hemoglobin, white cells and platelets.

Major complications that can arise,

  1. Though the procedure looks pretty simple, it is not so in reality.

  2. One of the most beautiful part of transplant is the same blood forming cells also are the ones which form immune related cells.

  3. The strong immunity from donor cells compared to recipient; though is very helpful in fighting infections, cancer also can cause trouble.

  4. Main problem which happens with strong donor cells include Graft Versus Host Disease (GVHD), in which donor cells will start to fight against recipient cells. It often affects intestines, skin and liver. This can be life threatening if not prevented or treated early.

  5. Other important adverse event is infection. Patients will have no immune system for nearly 10-20 days till donor cells start becoming active and also immune system will not mature completely till 3 -12 months after transplant depending on drugs patient is on. It is vital for patients to be cared closely during this episode. They need clean air, water and food. Cross infection between patient and health care staff, neighboring patients need to prevented with utmost precision. Infections are the commonest cause of mortality in patients undergoing transplantation. They need prophylaxis for preventing infection with antibiotics, antifungals and antivirals etc.

  6. Other side effects include problems in Liver, kidney, brain can happen though are not frequent.

Coming to different type of transplantations include,