STEM CELL TRANSPLANT
What is a Stem Cell Transplant (Bone Marrow Transplant)?
A transplant is a treatment for a few sorts of tumour. For instance, you may have one on the off chance that you have leukaemia, myeloma, or a refractory lymphoma. Specialists additionally treat some benign blood disorders with Bone Marrow transplants.
Previously, patients who required a transplant got a “bone marrow transplant” done in light of the fact that the stem cells were gathered from the bone marrow. Today, stem cells are normally gathered from the blood, rather than the bone marrow, which is less painful for the patients.
Why are stem cells so important?
A piece of your bones called “bone marrow” makes blood. Marrow is the delicate, supple tissue inside bones. It contains cells called “hematopoietic” undifferentiated cells. These cells can transform into a few different sorts of cells. They can transform into mature bone marrow cells. Or on the other hand they can transform into a platelets, red blood cells and white blood cells as well.
Certain malignancies and different blood diseases make blood cells to grow irregularly and eventually this results in production of abnormal cells which over the period of time increase in number and further suppress normal cells. So transplant gives new and normal stem cells which make new normal cells and patients are cured in this manner.
Different types of Bone marrow transplant
Autologous transplant: We call this an AUTO transplant. First stem cells and collected and frozen. Then high dose chemotherapy is given for myelo-ablation following which patient’s own Stem cells are thawed (Defrosted) and transfused back. After few days these new stem cells make home in bone marrow and start producing new cells.
Allogeneic transplantation: We call this an ALLO transplant.
In an ALLO transplant, someone else’s stem cells are taken and transfused. Stem should be from a relative but it remains critical that his or her bone marrow should match because there are certain proteins like Human Leukocyte Antigen (HLA) which has to be matched first. Best results are when there is a full HLA Match. With less match mortality remains high. If there is no match with the relative, stem cells from matched unrelated donor can be used.
What will happen if stem cells don’t match for HLA Proteins?
In this case possibility of side effects remains high.
What kind of side effects? Graft vs Host disease (GVHD), Infection, mortality. So it is recommended that Stem cells should be from siblings, brother, sister or parents or relative. Two types of ALLO Transplant are there. And indication EXPLAIN will depend on umpteen factors like age, performance status, co-morbidities, nature of disease.
- Myeloablative, which utilizes high-dosage chemotherapy.
- Non-Myeloablative, which utilizes low dose chemotherapy and side effects from chemotherapy are less.
Umbilical blood transplant. Being used at some places. But needs lot of expertise.
Points to Ponder
- Picking a transplant
Your treating specialist will guide you as to which kind of transplant you need, what is the survival and long term toxicities. What is best for you and your patient? And do you or your patient need allogenic, autologous or Non-myelo ablative transplant. He will read your tests, interpret them and assess what will be best for you.
Picking a transplant is confusing. You will require assistance from a specialist who spends significant time in transplants.
Before transplant you will need to know these things:
- For how long will you have to remain far from your family members?
- How long you will remain off from your job and social obligations?
- How will you pay for such a costly procedure?
- Will your Insurance pay for transplant?
- Apart from doctors who will take care of you during transplant (somebody has to stay with you through this lengthy procedure which sometime last for more than a month)?
- What are the expected complications and when they occur how much more money will you need and for how long will you have to stay in the hospital?
- What are the long term complications from Bone marrow transplant?
- How a transplant functions
The data underneath reveals to you the fundamental parts of AUTO and ALLO transplants:
- AUTO transplant: Course of events
Phase 1: Collecting your stem cells.
First a transplant catheter is inserted in the large vein. It will be connected to a machine through which blood will circulate and will collect stem cells. Before this procedure patient will be given some injections for preparation. After collecting stem cells, chemotherapy will be given for myeloablation (to kill defected stem cells) and after that patient own stem cells will be transfused. Patient has to remain admitted for 1 to 2 weeks till his blood counts become normal because in low counts there is high chance of infection, which is the biggest concern during bone marrow transplant. It can be viral, bacterial or fungal infection.
Time: 2 to 3 weeks. Some times more
Where it is being done: Specialised rooms with special filters which does not allow microorganisms to pass through. It should be a highly sterile environment.
- ALLO transplant course of events
Collecting stem cells from donor who is first given Colony stimulating factor which will mobilize stem cells and becomes easy to harvest high number of cells.
The rest of the procedure will be the same as in AUTO transplant.
Phase 2: Transplant treatment
You get chemotherapy with or without radiation.
Time: 5 to 7 days
- How to say that a Transplant is successful
When all components of blood will normalize. All blood lines are back to normal