Bone marrow is a soft and spongy body tissue containing hematopoietic stem cells. These cells are at the centre of the bones or in the blood, moving throughout your body. They are very important cells carrying different jobs. However, under some circumstances, they get damaged and do not produce enough white blood cells, red blood cells and platelets. 

So, doctors often have to perform bone marrow transplants to replace them with healthy stem cells. Keep reading this piece to clearly understand what a bone marrow transplant is, the things it treats, its types and other factors.

A bone marrow transplant or stem cell transplant is a medical procedure doctors carry out to infuse healthy blood-forming stem cells in place of damaged bone marrow that cannot produce the same. This procedure may also serve as helpful in case of infection or chemotherapy. 

Also, to perform this surgery, the doctors can take healthy stem cells from a donor or your body. However, if taken from the body, the stem cells are first harvested and grown. Then later, they are stored and transplanted as healthy cells. As a result, your body will again be able to produce enough platelets, white blood cells, and red blood cells to avoid infection, anaemia or bleeding.

There can be several conditions due to which your bone marrow may not be able to function properly and produce enough stem cells. For example, it can be because of a disease, chronic infection or cancer treatments. The list of diseases treated by bone marrow transplantation are:

• Cancer affecting bone marrow like lymphoma, leukaemia, and multiple myeloma
• Aplastic anaemia, in which bone marrow stops making any new blood cells
• Sickle cell anaemia, in which the blood disorder causes red blood cells to misshape 
• Congenital neutropenia, which results in recurring infection
• Thalassemia, which results in an abnormal formation of haemoglobin affecting the production of red blood cells

The following are the different types of bone marrow transplants available to you. However, which one you should go through will depend on the reason for the transplant:

1. Autologous Transplants

In autologous transplants, the healthy stem cells come from your own body. They typically involve the harvesting of cell processes, i.e., before chemotherapy and radiation therapy. The doctors remove and rescue your stem cells as these treatment plans often damage them, thus affecting your immune system. Later, after the treatment is done, your stem cells are returned to their original place. Benefits related to this transplant include:

• Benefits
  • No need to go through immunosuppressive therapy
  • Lower risk of developing an opportunistic infection
  • Rapid immune reconstitution 
• Survival Rate After Surgery: 
  • The five-year survival rate of Autologous Transplant ranges from 50% to 60%.
• Cost of Surgery
  • Approximately ₹1500000 to ₹1700000

2. Allogeneic Transplants

Allogenic is another type of transplant where stem cells are extracted from another person called the donor. However, this donor cannot be anyone. He or she should be someone with a close genetic match. So, it often includes a compatible relative. This process is mainly suggested when you have damaged your bone marrow cells. The benefits of the process is discussed below:

• Benefits
  • Formation of the new immune system 
  • Cells will be free of cancer or any other disease
  • The donor can provide more stem cells if required
• Survival Rate After Surgery: 
  • The 10-year survival rate after undergoing Allogeneic Transplants amounts to 80%. 
• Cost of Surgery
  • Approximately ₹2500000 to ₹3000000

3. Umbilical Cord Blood Transplant

This is a type of bone marrow transplant in which the doctors attract stem cells from umbilical cord blood. An umbilical cord is an extension that connects the mother to the baby before birth. Doctors mainly recommend this process when the patient's stem cell is completely damaged and there is no fully matched available donor. The benefits are as follows:

• Benefits
  • Reduced chances of developing graft-versus-host disease
  • Lesser risk of Human Leukocyte Antigen (HLA) mismatch
  • Easy availability
• Survival Rate After Surgery: 
  • The three-year survival rate after going through Umbilical Cord Blood Transplant amounts to 95%. 
• Cost of Surgery
  • Approximately ₹2100000 to ₹2800000

Getting a bone marrow transplant is a big thing. Thus, you must make proper arrangements before entering the treatment process. Some of the points you may need to cover include:

• Remember to stay hydrated and eat a healthy diet.
• Exercising will help keep the body strong enough to withstand and recover from the surgery.
• Taking medical leave from work to give yourself some time to recover
• Understanding the terms and applying for insurance coverage because the process can be expensive
• Asking your loved ones/caregivers to stay with you as you will need assistance
• Making arrangements for convenient travel from and to the hospital

Apart from these, make a list of questions you want to ask your doctor about this operation. It will give you the confidence and clarity needed to go through the transplant smoothly. Also, if required, you can even take sessions from hospital counsellors.

There are several risks that bone marrow transplants can pose to people. While some are minimal issues, others can be life-threatening. So, ensure you keep your doctors updated at all points. The complications include:

• Skin rash
• Infection
• Bleeding
• Muscle spasms or leg cramps
• Fertility problem
• Low blood cell count
• Inflammation
• Breathing problem
• Organ damage
• Cancer

Before going through a bone marrow transplant, the doctors suggest you undergo various physical exams and tests to identify the best transplant for you. It will involve checking your blood and the condition of your lungs, heart, liver and other organs. 

The healthcare experts will also call you to the hospital a few days before for collecting cell purposes. On this day, a long thin tube called an intravenous catheter will be implanted in the large vein of your chest or neck. It will stay inside you until the treatment since they will use it later to collect blood and give you medicines. 

Collecting Cells for Autologous Bone Marrow Transplant

The doctors will use a procedure of apheresis to collect your blood stem cells if the transplant of your own stem cell has been planned. However, to prepare for apheresis, you will have to take daily injections to boost the production of stem cells. 

In the process, medical experts will draw blood from your vein and circulate it through a machine. This helps separate different parts of your blood, including your stem cells which are then collected and frozen for later use in the transplant. The blood left is again returned to your body. This entire process will take 1 or 2 hours

Collecting Cells for Allogeneic Bone Marrow Transplant

In the case of transplanting another person's stem cell into your body, you will have to find a donor that matches your genetics. For this purpose, your doctor will try and match someone who contains the same type of protein in their white blood cells as you. This is called human leukocyte antigen (HLA). 

You and your family members have the same HLA, but even if your donor is a relative, the doctors will still check by following this process.

Collecting Cells for Umbilical Cord Transplant

You can think of an umbilical cord transplant as a type of allogeneic transplant in which the doctors collect stem cells from umbilical cord blood. The cord is stored and frozen in medical centres until doctors use it to perform the transplant. However, in this case, doctors can only extract fewer stem cells than other bone marrow transplant methods. 

Nevertheless, stem cells collected from umbilical cord blood can grow more blood cells. They are also immunologically naïve as they are free of exposure to any infection. Thus, making it more tolerant of tissue mismatch.

If you are looking for how a bone marrow transplant is done, you must know it is a series of procedures that you may have to go through. First comes the conditioning or reduced-intensity conditioning, and then a bone marrow transplant. The process is as follows:

Conditioning Process

After the pre-transplant tests and procedures are over, you enter the conditioning process in which you undergo chemotherapy or radiation therapy for ten days. This is important to suppress your immune system, destroy cancer cells if you have cancer with a possibility of spreading to other parts, and prepare your bone marrow for a stem cell transplant. 

The type of conditioning processes the doctors will suggest to you will depend on various factors. For example, it may include your overall health, the type of transplant, and the disease they are treating. However, there will be certain side effects of the conditioning process, which include:

• Hair loss
• Diarrhoea
• Nausea and vomiting
• Bleeding
• Cataract
• Infection
• Fatigue
• Mouth sores or ulcers
• Anaemia

Reduced-intensity Conditioning

If your age or health does not permit a high-dose conditioning process, the doctors may recommend you to opt for a lower dose or other types of radiation and chemotherapy. This is referred to as reduced-intensity conditioning. 

This process helps destroy some cancer cells in your body and suppress your immune system. Later, doctors infuse cells from your donor into your body, which further replaces your bone marrow cells over time. Finally, immune factors present in the donor cells then try to destroy the remaining cancer cells. 

Bone Marrow Transplant

After the conditioning process, the doctors will prepare you for a bone marrow transplant. On the day of the surgery, they will infuse stem cells into your body through a central line. This process is painless, so you will be awake throughout. 

Once the new stem cells reach your marrow, they will again start growing red blood cells and white blood cells. The process is known as engraftment and generally takes a time span of 2 to 4 weeks.

Upon completing the procedures for a bone marrow transplant, the medical experts will shift you to a ward where they can keep a close view of you. So, you can expect to stay in the hospital for a few days or longer for treatment if any complication arises. 

For the first few weeks, the professionals will take your blood samples to test the progress of engraftment. Later, you will be allowed to return home if you satisfy certain bone marrow transplant recovery criteria. For example, you must have no fever for two days and attain a specific blood cell count. 

Remember, your immune system will take some time, like a year or more, to heal after the transplant. So, you must attend every appointment and take prescribed medication to avoid graft-vs-host disease.

There are certain side effects of bone marrow transplants that show rejection of the operation. In case these symptoms are visible to you, you must immediately call your doctor:

• Mucositis, inflammation or sores in the mouth
• Bacterial or fungal infection 
• Bruising and bleeding
• Interstitial pneumonitis and other lung problems
• Graft-versus-host disease
• Graft failure
• Hepatic venous-occlusive disease 

The cost of a bone marrow transplant in India ranges from ₹ 14,25,000 to ₹ 30,00,000. However, this range can change depending on various factors like the extent of complications, the type of transplant and the city you are getting your treatment in. 

This is all the information regarding what a bone marrow transplant is. Hope this guide has helped you understand the procedure and know the types of transplantation available and the risks involved. 

Remember, it is an intensive process, so before you go through it, get assistance from your loved ones first. Lastly, recovery may take time, so be patient with yourself.