Bone Marrow Transplant in Singapore
Bone Marrow Transplant
When stem cells, normally found in the Bone marrow are extracted , filtered and replaced to the same patient or another one, then this total process is called as Bone Marrow Transplant.
Why is the Bone Marrow Transplant performed?
The stem cells in the Bone Marrow eventually produce blood cells. Bone Marrow is a critical part of our body as Bone Marrow is basically the main factory of blood cells. A person can fall ill or even can die if there is something wrong or deficient in his Bone Marrow.
Diseases like Leukemia and Aplastic anemia are the result of unhealthy bone marrow. The main objective of a bone marrow transplant is to replace healthy stem cells in place of the unhealthy ones. This process can cure the disease easily.
Sources of Bone Marrow Stem Cells
- Bone Marrow Harvest: This is a process of collecting stem cells by taking them directly from Bone.
- Apheresis: This is a process to collect stem cells after filtering the blood for peripheral blood cells.
- Umbilical Cord blood: In this Process stem cells are filtered from blood in the umbilical cord after the birth of a baby.
The majority of the transplants are made using Apheresis as this method gives better results for both donor and the recipient.
Procedure of Transplant
Bone marrow is made of the soft, fatty tissue inside our bones. Stem cells are basically immature cells in the bone marrow that give rise to all of your blood cells.
Blood is made of
- Red blood cells (which carry oxygen to your tissues)
- White blood cells (which fight infection)
- Platelets (which help your blood clot)
Bone marrow transplant helps us gain new healthy stem cells when our own old bone marrow is damaged or non-functioning.
There are three kinds of bone marrow transplants:
Autologous bone marrow transplant:
Here "Auto" means "self." Before the patient gets chemotherapy or radiation treatment, Stem cells are taken from the patient. When the patient is done with the chemotherapy, the patient gets their stem cells back. This is called a "rescue" transplant. It allows the patient to receive high dosage of chemotherapy and radiation.
Allogeneic bone marrow transplant:
Here "Allo" means "other." Stem cells come from another person (donor). Donor stem cells come from the donor’s bone marrow or their blood. Most of the times, a donor must have the same genetic typing as the patient, so that their blood "matches" with the patient. To check out the compatibility special blood tests are being performed. A patient’s brothers and sisters have the highest chance of being a good match (25% chance for each full sibling). Sometimes even parents and children of the patient and other relatives may be matches. Donors who are not related to the patient may be found through national bone marrow registries.
- Umbilical cord blood transplant: In this case Stem cells are filtered from an umbilical cord right after the deBone Marrowy of an infant. The stem cells are tested, counted and frozen until they are placed for a transplant. Umbilical cord blood requires less stringent matching because the stems cells are so immature.
The patient gets the stem cells through a tube called a central venous catheter. The process is similar to receiving a blood transfusion. The cells go right into the bloodstream and find their own way to the bone marrow. No surgery is required in this case.
Donors may sometimes need minor surgery to collect their bone marrow and stem cells. For a bone marrow harvest, they will be unconscious and pain-free (anesthesia) while their bone marrow is removed from their hip bone. Stem cells can also be collected right from the blood in many cases.
When receiving stem cells, a patient may face several of the symptoms:
- Chest pain
- Drop in blood pressure
- Shortness of breath
- Funny taste in the mouth
Before the Procedure
The health care provider will ask about health record of the patient and the detailing of physical examination. Before the treatment begins they are going to ask for many tests.
Respective doctor or nurse should discuss the emotional stress of having a bone marrow transplant the patient and his/her Family may meet with a mental health counselor to help them understand and prepare for the whole thing.
One or two catheters are inserted into larger blood vessels before the transplant, usually in the neck, for you to receive treatments, fluids, and sometimes nutrition.
After the Procedure
Most of the cases the patient will stay in a bone marrow transplant unit in the center to limit their chance of getting an infection. Some patients who choose to undergo autologous or non-myeloablative allogeneic transplants do not have to stay in the hospital or medical center.
Most of the patients will be in the hospital for 4 to 6 weeks. The patient will be isolated and watched closely during this time because of the increased risk of infection.
While the patient is in the hospital, these things may happen:
- Close monitoring of blood and vital signs
- The patient may have to take antibiotics, antifungal medications, and antiviral medications to prevent or treat infection.
- The patient may need many blood transfusions.
- The patient may have to stay in a room where special things are done to prevent infection.
- The patient may have to take medicine to prevent graft-versus-host disease.
What are the RISKS in Bone Marrow Transplantation?
Bone marrow transplant surgeries are often accompanied by serious and life-threatening risks. Furthermore, they are not always an absolute assurance of a cure for the underlying ailment; a disease may recur in the future. Approximately 30% of all people receiving allogeneic transplants do not survive. Autologous transplants have a much better survival rate (nearly 90%) but are not appropriate for all types of ailments requiring a bone marrow transplant.
In the short term, there is the danger of pneumonia or other infectious disease, excessive bleeding, or Bone Marrow disorder caused by blocked blood vessels. The transplant may be rejected by the recipient's immune system, or the donor bone marrow may launch an immune-mediated attack against the recipient's tissues. This complication is called acute graft versus host disease, and it can be a life-threatening condition. Some prominent signs of the disease include fever, diarrhea, rash, Bone Marrow problems, and a compromised immune system.
Approximately 25-50% of bone marrow transplant recipients develop long-term complications. Chronic graft versus host disease symptoms include skin changes such as dryness, altered pigmentation, and thickening; abnormal Bone Marrow function tests; dry mouth and eyes; infections; and weight loss. Other long-term complications include cataracts, abnormal lung function, hormonal abnormalities resulting in reduced growth or hypothyroidism, secondary cancers and infertility.
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