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Bone Marrow Transplant

Dr. T. Narender Kumar, Friday, July 9, 2021


What is bone marrow – it is a soft gel like substance in the long bones of the body, which produce red blood cells, white blood cells and platelets, which are important components of blood. In simple terms – bone marrow is the site where blood is manufactured.


Bone marrow transplant – it’s a very important procedure, where it can help in curing the patient diseases like blood cancer.

How it is done – by giving high dose of chemotherapy drugs, cancer cells are killed, in the process, the normal healthy stem cells will get killed. Marrow from a healthy donor is transplanted into patient, which regenerates into healthy cells and helps patient to recover.


Type of transplant 

There are two main types of hematopoietic cell transplantation: autologous and allogeneic.

Autologous transplant — patient own stem cells are removed before the high dose chemotherapy or radiation is given, and they are then stored at 4 degrees centigrade of frozen at – 70 degree centigrade for later use. 

After chemotherapy, the stem cells are warmed to room temperature and transfused into patient’s body.

Allogeneic transplant — in this procedure the stem cells are taken from donor, either from family member or unrelated donors. 

What MSD - matched sibling donor or related donor, means, genetically related donors, who can be a sibling or parents.

They can be 100% matched or 50% matched (these types of donors are called as haploidentical donors)


MUD – matched unrelated donor – genetically matched unrelated donor from outside the family.


Where can we get MUD donor – 

There are registries, like blood banks, where HLA information is stored and matched with patients on request.


Steps in bone marrow transplant

1. Donor evaluation – checking for the suitability of stem cell donation. 

2. Collecting and storing of stem cells from donor 

3. Stem cell collection is done by two methods – 1. From bone marrow. 2. From peripheral blood 

4. Giving high dose chemotherapy – called as conditioning. 

5. On day zero – stem cells are transfused into patient body. 

6. Post-transplant care – blood transfusion, treating infections and other complications. 


What are the complications of transplant? 

1. Infections – 

a. Bacterial infections during and post-transplant 

b. Fungal infections during and post-transplant and 

c. Viral infection – later part of transplant, mostly in 2 or 3 months


2. Graft versus host disease

a. Types 

i. Acute – in 100 days 

ii. Chronic – after 100 days


b. Organs affected. 

i. Skin

ii. Liver

iii. Gastrointestinal – liver, stomach, colon

iv. It can affect other part of body also.


3. Relapse – of leukemia

4. Late onset of caner – transplant related cancer can arise years after transplant.



BY

Dr. T. Narender Kumar

Consultant Medical & Hemato Oncologist and BMT Physician

KIMS Hospitals, Secunderabad. 





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