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BONE MARROW TRANSPLANT

Find out what bone marrow transplant procedure is all about ? Why you should travel to India for bone marrow transplant procedure ? How Treatment Assistance can help you at every step so that you can have a great experience traveling to India for your bone marrow transplant procedure ?

What is bone marrow ?

Bone marrow is a spongy tissue found inside the bones and bone marrow present in the breast bone, skull bone, hip bone, ribs and spine produces stem cells. These stem cells eventually develop into blood cells. Since bone marrow acts as an important source for the production of blood cells, if something is wrong with the marrow then a person can become very ill or even might die. Certain types of cancers may cause serious problem to the bone marrow. Diseases such as leukemia and aplastic anemia, can cause serious damage to bone marrow. When the problem becomes very serious then bone marrow transplant procedure becomes an important treatment option.  Most people who need to undergo a bone marrow transplant have blood cancers, such as leukemia or lymphoma. There are different types of bone marrow transplants and the type and severity of your disease determine what type of bone marrow transplant you may need.

What is a bone marrow transplant (BMT) ?

In a bone marrow transplant the stem cells that are normally found in the bone marrow are taken out, filtered, and given back either to the same person or to another person. Bone marrow transplant is a relatively new medical procedure being used to treat diseases once thought incurable. The first successful Bone Marrow Transplant was done in the year 1968. Bone Marrow Transplant procedures have been used to treat patients diagnosed with following diseases.

  • Aplastic anemia
  • Leukemia
  • Lymphomas such as Hodgkin’s disease
  • Multiple Myeloma
  • Immune deficiency disorders
  • Some solid tumors such as breast and ovarian cancer.

In patients suffering with leukemia, aplastic anemia, and some immune deficiency diseases, the stem cells in the bone marrow start behaving abnormally. They produce excessive number of defective or immature blood cells or low blood cell counts. These defective blood cells interfere with the production of normal blood cells, accumulate in the bloodstream and may invade other tissues. In order to destroy such cells large doses of chemotherapy and/or radiation are required .These therapies, however, not only kill the abnormal cells but can destroy normal cells found in the bone marrow as well. A bone marrow transplant helps the doctors to treat these diseases with aggressive chemotherapy and/or radiation by allowing replacement of the diseased or damaged bone marrow after the chemotherapy/radiation treatment.

What are the types of bone marrow transplants ?

The new bone marrow which is infused into the patient’s blood-stream during a successful Bone Marrow Transplant Procedure, migrates to the cavities of the large bones, engrafts and begins producing normal blood cells. The patient’s diseased bone marrow is replaced  by new bone marrow.

There are two major types of Bone Marrow Transplant Procedures

  1. Autologous Bone Marrow Transplant
  2. Allogenic Bone Marrow Transplant

In an Autologous bone marrow transplant the donor is the person him/herself. The bone marrow is extracted from the patient prior to transplant and may be cleaned to remove malignant cells in case if the disease has afflicted the bone marrow. Stem cells are taken from the patient before the patient gets chemotherapy or radiation treatment. When chemotherapy or radiation is done, the patient gets their stem cells back. This is called a “rescue” transplant. It allows the patient to receive high doses of chemotherapy and radiation.

In an Allogenic bone marrow transplant procedure the stem cells come from another person, who is called a donor. The healthy stem cells are taken from the bone marrow of the donor. It is very important that a donor must have the same genetic typing as the patient, so that their blood “matches” the patient’s blood. Hence special blood tests are conducted to determine whether or not the donor’s bone marrow matches the patient’s bone marrow. If the donor’s bone marrow is not a good genetic match, it will perceive the patient’s body as foreign material to be attacked and destroyed.  Such a situation if arises, may be life threatening. There are high chances that a patient will have a sibling whose bone marrow is a perfect match.

Some of the important sources of Bone Marrow Stem Cells are, Bone marrow harvest(Stem cells directly collected out of the bone), Apheresis (stem cells are collected by filtering the blood for circulating blood cells  and Umbilical cord blood ( stem cells are filtered from blood in the umbilical cord after a baby is born).The majority of bone  marrow transplants are made using stem cells collected by apheresis, since this method has better results for both the donor and the recipient.

There are certain important factors to be considered before a patient undergoes a Bone Marrow Transplant. Some of the important factors are as follows.

  • Age
  • General physical condition
  • Patient’s diagnosis
  • Stage of the disease

The patient needs to be healthy enough to face the rigours of such a major procedure. Post Bone Marrow Transplant procedure, a battery of tests is carried out to ensure the patient is physically capable of undergoing a transplant. A thorough physical examination and history taking is done by the treating doctor and tests of the patient’s vital organ functions are carried out.

A successful bone marrow transplant requires a multi-disciplinary approach and expert medical team. Some of the hospitals in India have world-class facilities, most advanced technology, experienced medical team and affordable treatment packages.  These hospitals treat a large number of patients from all over the world.

Why you should travel to India for bone marrow transplant procedure ? How Treatment Assistance can help you at every step so that you can have a great experience traveling to India for your bone marrow transplant procedure ?

Our network bone marrow transplant hospitals in India are established with a vision to make quality bone marrow transplant treatment affordable to the common man. At our network bone marrow transplant hospitals in India, the bone marrow transplant procedure is used to treat various diseases that may be cancerous like acute myeloid leukemia, acute lymphatic leukemia, myelodysplastic syndromes, myelofibrosis etc or non-cancerous diseases like thalassemia, aplastic anemia, sickle cell disease, fanconi’s anemia, immunodeficiency syndromes etc. One of the best examples of a non-cancerous disease, which can be treated by using bone marrow transplant procedure, is Thalassemia. There are many children in different parts of the world that are born with Thalassemia major every year. The only option besides bone marrow transplant for these children with Thalassemia is repeated blood transfusions and chelation therapy, which is both expensive and distressing to the patients and their parents. Bone marrow transplant offers the only hope of a cure. Bone marrow transplant for Thalassemia has been carried out successfully on many patients at our network bone marrow transplant hospitals in India.

Our network bone marrow transplant hospitals in India have large bone marrow or stem cell transplant facility, and advanced treatment facilities like immunotherapy, gene therapy and biomodulators. Our hospitals have been catering to both national and international patients. The cost of bone marrow transplant at our network bone marrow transplant hospitals in India is extremely reasonable when compared to cost of bone marrow transplant in the US and Europe. A large number of patients with thalassemia, aplastic anemia, leukemia etc have been able to avail of this facility. In addition to HLA identical sibling transplants, the hospitals have also taken the initiative in starting cord blood transplants and matched unrelated donor transplants. The hospitals have also initiated the cord blood transplant program for disease like leukemia in children and also for immunodeficiency syndromes. The hospitals have also a cord blood facility to collect cord blood units for public banking for usage for cord blood transplants. We also have a hospital in our network that is one of the few transplant centres with facility for total body irradiation (TBI) which is used during conditioning for lymphoid malignancies and also in the reduced intensity conditioning transplants. The hospital have tie-ups with several research institutions in India and abroad.

Allogeneic bone marrow transplant at our network bone marrow transplant hospitals in India:

 In an allogeneic bone marrow transplant, a donor is usually a HLA (Human leucocyte antigen) identical sibling without the disease. When a HLA identical sibling donor is not available a matched unrelated donor can be used from one of the donor registries or a cord blood can be used in some particular diseases. Stem cells are harvested from the bone marrow or collected from peripheral blood in a pheresis machine, and given to the recipient, after destroying the bone marrow of the recipient with chemotherapy. The recipient (patient) is kept in sterile room called the BMT unit, until the donor cells multiply and replace the diseased marrow. The average duration of this procedure is 4- 6 weeks.

Autologous Bone Marrow Transplant at our network bone marrow transplant hospitals in India:

Autologous stem cell transplants are usually done for diseases like Myeloma, Lymphoma, Neuroblastoma, Ewings sarcoma etc. Here a donor is not required. Stem cells are collected from the peripheral blood from the patient after finishing the chemotherapy cycles. The stem cells are cryopreserved. High dose chemotherapy is them administered to the patient after which the cryopreserved stem cells are re-infused.

Highly Experienced and Skilled Multi-disciplinary Team :

The medical team at our network bone marrow transplant hospitals in India consist of  haematologists, medical oncologists and pediatric oncologist . Their combined experience makes it a major referral centre for stem cell transplants. The nurses on the BMT team are specially trained to care for bone marrow transplant and immunology patients. They work closely with doctors in the divisions of hematology/oncology and immunology to Assess your needs , Plan the care required and Provide treatment. The nurse coordinator will help in planning all the activities that are needed to prepare for you for the transplant. The nurse coordinator will follow the care during your stay in the hospital, and in the follow-up clinic after transplant has been completed. You will get to know several doctors during your stay at the hospital for a bone marrow transplant. The staff transplant doctor works with you and the BMT team to make all the major decisions about your medical care and to decide on the right procedures and medicines to use. The dietician monitors the nutritional needs, and daily food and fluid intake. He or she will meet with BMT team every day and give suggestions about oral and tube feeding as well as intravenous(IV) or parenteral nutrition(TPN). If any special nutritional needs, the dietician will meet with you. A social worker can also provide support and counselling as you adjust to the hospitalization of your patient.

Patiently friendly and World-class Infrastructure :

Our network bone marrow transplant hospitals have state-of-the-art facility with most advanced therapy modalities used in the treatment of cancer and other complex diseases under one roof. The hospitals have different rules about visiting, diet and patient activity than other patient units in the hospital. These are all meant to protect the patient from infection. The rooms are High Efficiency Particulate Air (HEPA) Filtered rooms .Since your immune system will be rendered ineffective in preparation for a bone or marrow transplant, special isolation rooms are needed to protect you from infection. The rooms have special air flow that filters the air in the room 500 times an hour. It is mandatory that anyone entering the room wear a special gown and perform a special hand wash called a scrub. You will be shown how to scrub and gown before entering HEPA room. You will be placed in a HEPA room from the day of conditioning for the transplant and will not leave the room until the doctor decides that it is appropriate. The attached bathroom is for patient use only. Only the water from the geyser is to be used. Each HEPA room has a TV and telephone. We encourage kids to bring favorite toys, pictures and games, although stuffed toys are not allowed. Food may not be kept in the HEPA rooms because of the risk of infection . Only patients may eat in these rooms. The small refrigerator in the anteroom is used for your patient drug that needs to be kept cold. Food items should not be kept in this refrigerator. After the transplant, once your new bone marrow starts to grow and your blood counts begin to rise, the doctor will decide whether you can be discharged. When you are admitted to the HEPA room, you will be placed on a special low-bacteria diet. No food from home is allowed for the duration of isolation. Food is supplied at the timely manner from the hospital dietary. Protective isolation is used to protect the transplant patient from infection caused by bacteria, viruses and fungus. This form of isolation include the use of the following.

  • A special isolation room called a positive pressure HEPA filtered room
  • An air filtration system (HEPA)
  • Gown
  • Very good hand washing
  • Special cleaning procedures
  • A nurse will explain to you all the special things that you need to do before entering this room

To prevent the spread of infection from person to person, all hospital staff, parents and everyone else entering the room must wash their hands in the scrub sink in the anteroom. A full two minutes scrub should be done first thing in the day, after meals and after bathroom breaks. At other times, a 15- second hand wash.

All supplies and personal items brought into room must be clean. No special cleaning or sterilizing technique are needed except when equipment is shared among patients, such as scales, blood pressure machine or toys. Shared equipment must be wiped off with a towel that has been soaked with disinfectant. Anything that falls on the floor must be removed from the room and cleaned with disinfectant before it may be brought back to the room. Toys brought from home should be washed with soap and water at home and then wiped off with disinfectant just before they are brought into the room.

All staff and parents are required to wear sterile dress in the room. We suggest that you wear light weight clothes (sterile) under this gown. The nursing staff wear masks when they do any sterile procedure, like changing the CVL dressing or the CVL caps. They do not wear masks for routine care. While inside the room it is must to wear cap and the mask.

Treatment Procedures :

 A few weeks before the blood or marrow transplant , you will be started on chemotherapy drugs. These drugs will help: 1) Destroy all the cells in the old bone marrow, including both healthy and diseased cells. 2) Suppress the immune system. The type of chemotherapy drugs will depend on your diagnosis. Each drug has different side effects. Some of the short term effects of chemotherapy include the following.

  • Nausea and vomiting
  • Diarrhea
  • Blood in the urine
  • Hair loss
  • Mouth sores
  • Fluid retentions
  • Bleeding from any place in the body

Medication can be given to help your patient to relax, and to help control the nausea and vomiting.

You will notice that nurses wear gloves when handling body fluids. This is because chemotherapy drugs leave the body in body fluid. It is important for your own protection that you wear gloves when handling body fluids during the time that your child is receiving chemotherapy and for a short while afterwards.

The transplant procedure is actually fairly simple, the stem cells or bone marrow cells to be transplanted are given through the central venous line (CVL). The procedure is just like getting a blood transfusion, except that there are a few extra precautions taken.

  1. Just before the infusion of the new bone marrow, you may be given medication to help avoid any allergic reactions.
  2. A monitor will be used to check your patient breathing, heart rate and blood pressure during the procedure. The nurse will monitor you closely throughout the infusion of stem cells or bone marrow.
  3. A doctor is available on the unit and will check in periodically. Medications may be given to deal with problems that may arise, such as high blood pressure or a fast heart rate. While receiving the transplant infusion, you may read or watch TV. The infusion will last several hours. After the infusion is finished, the monitor may be taken off. Breathing, heart rate and blood pressure will be checked every few hours, although your nurse will not be in the room the whole time.

Peripheral blood stem cell or bone marrow transplant:

 For this your patient will have had several apheresis treatments before being admitted to hospital for BMT. An apheresis procedure removes stem cells from the blood circulating in the body. These cells are responsible for making blood and for developing the immune system, which helps the body fight infection. After these cells are collected, they are frozen and stored in a cryopreservation lab. For your patient transplant, the frozen stem cells are transported to the BMTU, thawed and then given to the patient through his or her CVL.

Complications and their treatments :

After the infusion of stem cells or bone marrow, it takes 4 to 6 weeks for the new bone marrow to grow and function as it should. During this time, you may run the greatest risk of bleeding, or of having infections and other complications.  It occurs when the new bone marrow, called graft, does not recognize the person who receives it, called the host. The graft then sends out fighter white blood cells, called lymphocytes, to attack the host. It can be mild, moderate or severe and can involve the skin, the liver or the bowel. Rashes and diarrhea are symptoms. Sometimes tissue samples of symptomatic areas are taken to diagnose the disease. This complication is seen with allogenic transplants, in which the transplant comes from either a related or unrelated donor.

Signs to watch for Sign or symptoms of infection

  1. A fever above 38. 5 C or 101 F
  2. Any breathing or respiratory problems, or a cough, runny nose, sore throat or cold
  3. Stomach complaints, such as diarrhea, nausea, vomiting or cramps

Signs or symptoms of Graft-versus-host disease ( GVHD ) ( for patients with a donor transplant only)

  • A new rash on the body, palms of the hands, or soles of the feet
  • Watery diarrhea
  • Loss of appetite with weight loss
  • Jaundice, a yellow colour in the whites of the eyes or in the skin.

Visitors :

Visitors at home are allowed but they must be carefully screened. Family and friends should not visit if they are ill. Visiting children have greater chance carrying contagious diseases because they are more exposed to them in the school environment. Chickenpox, measles, mumps and cold sores are of particular concern. Please report any known exposure to these diseases to the BMT coordinator as soon as possible.

Skin care :

 Make sure your patient bathes or showers every day using non-irritating soap and shampoo. Always clean the tub with a cleanser first. If skin is dry apply Vaseline or paraffin oil to the skin. Protect your patient skin from the sun, especially if your patient had radiation or has GVHD. Follow these guidelines.

  • Cover your skin as much as possible with clothing.
  • Make sure you wear a hat, especially until his or her hair has grown back.
  • Use lots of sunscreen on your patient skin.

Mouth care :

 Make sure you care your mouth at least 3 times a day, preferably after meals.

  1. If your platelets are lower than 100,000 use toothette. If your platelets are higher, use a soft toothbrush. Use any mild toothpaste with fluoride.
  2. Make sure that the areas where the gums meet the upper and lower cheek are brushed thoroughly.
  3. Report any white patches, called thrush, or mouth sores to your patient physician.

Medications :

 You will still need medications at home. Your nurse and the pharmacist will explain the medication to you. Before you leave the hospital, please be sure that you understand what all the medications are for and how to give them. Some of these medications can be expensive.

Travel to India for bone marrow transplant procedure. Get the Treatment Assistance advantage

Treatment Assistance has been helping international patients from all over the world to travel to India for high quality and affordable bone marrow transplant treatment at some of the best cancer hospitals in India. Here is why you should choose Treatment Assistance as you preferred medical travel assistance provider to travel to India for your bone marrow transplant treatment.

  • Get free no obligation expert medical opinions from leading bone marrow transplant specialists in India
  • Get free cost estimates from top hospitals for bone marrow transplant in India
  • Get treated at most advanced and accredited hospitals for bone marrow transplant in India
  • Get multiple options from our wide network of hospitals across major cities in India
  • All major types of bone marrow transplants are offered at our network hospitals in India
  • From airport transfers to hotel bookings, get complete ground assistance services in India

For more information on traveling to India for medical treatment, you can write to us at medical@treatmentassistance.in or call or WhatsApp at +91 9900 244 323.

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