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When we talk about Bone Marrow Transplantation (BMT), many people believe that it is only used for the treatment of cancer which is not true. Also, it is commonly believed only family members can donate stem cells for transplantation. There are many such misconceptions about bone marrow transplant.
Below, Dr Punit Jain, Consultant Haemato Oncology and Bone Marrow Transplant Physician, Apollo Cancer Centers, Navi Mumbai, has cleared some of the common misconceptions about Bone Marrow Transplantation (BMT). Keep reading:
Fact: BMT is mainly used in treating blood cancers like multiple myelomas, high-risk Leukaemias, lymphomas and certain precancerous conditions like myelodysplasias and myelofibrosis. Other indications include cancers like neuroblastoma and rarely Ewings sarcoma.
Fact: BMT is also used in the treatment of certain non-malignant conditions. These include single gene disorders such as Thalassemia, Sickle cell anaemia, immunodeficiency syndromes, osteopetrosis and some inborn errors of metabolism. Specific important indications include bone marrow failure syndromes like red cell aplasia, aplastic anemia, and certain auto-immune diseases like multiple sclerosis and sclerodermas.
Fact: BMT and Peripheral Blood Stem Cell Transplant (PBSCT) include two main types of transplants, (i) Autologous transplants, where patients receive their own stem cells; (ii) Allogeneic transplants where patients receive stem cells from another individual, be it a related sibling, parent or an unrelated donor.
Although peripheral blood stem cell collection is more common nowadays, the bone marrow remains a choice in certain conditions and stem cells are taken from the pelvic (hip) bone for BM transplant. The stem cells are collected through a procedure called "Stem cell harvesting". The procedure is done using either general or spinal anaesthesia. The process involves inserting needles through the skin over and into the bone marrow . The harvested bone marrow is then processed to remove blood and bone fragments. The whole process takes about two hours. PBSCT is done through special catheters inserted in the arms or neck, and once the procedure is completed, the catheter is removed. PBSCT does not need general anaesthesia.
Fact: The donated bone marrow can be preserved using a special cryopreservative called DMSO. Once adequately mixed in sterile conditions, it is frozen in deep freezers at ( 80) degrees Celsius to keep the stem cells alive. This process is known as cryopreservation. The stem cells can be preserved for a long time till the need arises.
Fact: The recipient receives the stem cells through an intravenous (IV) line, just like a blood transfusion, which takes 1 to 2 hours. Before this, the recipient is treated with high-dose anticancer drugs and radiation. The stem cells travel to the bone marrow and produce new blood cells, including RBCs, WBCs and platelets, over the next two weeks post-transplantation. This process is known as "engraftment", which is the first successful step toward the discharge of the transplant recipient.
A procedure like BMT needs a team of transplant-trained physicians, infectious disease physicians and nurses, a robust Intensive care unit, a fully equipped blood bank with good laboratory support and an organization tuned to high-end cancer care.