Cavities of our bones are filled by a soft, spongy blood forming tissue that consists of immature blood cells (stem cells) and mature blood cells, including white blood cells, red blood cells, and platelets. This tissue generates new blood in big bones and is called as Bone Marrow. 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. Bone marrow transplant (BMT) is a procedure in which the diseased or damaged bone marrow is replaced with healthy bone marrow. In order to replace the diseased bone marrow with healthy bone marrow, the diseased bone marrow is first destroyed by chemotherapy and/or radiation therapy. The replacement marrow or the healthy bone marrow, if comes from the patient is called an autologous bone marrow transplant and if it is from an identical twin, it is termed a syngeneic transplant. If the marrow is from a donor (not an identical twin), the procedure is an allogeneic bone marrow transplant.
Our network Bone Marrow Transplantation centre was established in October 2004 in Bangalore city, India with a vision to make this bone marrow transplant treatment affordable to the common man. At this centre 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 BMT 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 BMT for these children with thalassemia is repeated blood transfusions and chelation therapy, which is both expensive and distressing to the patients and their parents. BMT offers the only hope of a cure. Bone marrow transplant for thalassemia has been carried out successfully on many patients at this centre.
Allogeneic Bone Marrow Transplant at Bone Marrow Transplantation Centre in Bangalore, 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 Bone Marrow Transplantation Centre in Bangalore, 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.
Why to choose this Bone Marrow Transplantation Centre for Stem Cell or Bone Marrow transplantation Treatment?
The Bone Marrow Transplantation Centre in Bangalore City will have India’s largest bone marrow or stem cell transplant facility, and advanced treatment facilities like immunotherapy, gene therapy and biomodulators. This centre has been catering to both national and international patients. Many International Patients come from Oman, Srilanka, Bangladesh, Nigeria, Kenya, Rawanda, Iraq, Nepal etc. About 35% of the patients are international patients. At this centre, 25% of the transplants are done for thalassemia and another 25% is for acute myeloid leukemia. The cost of bone marrow transplant at this centre is extremely reasonable when compared to costs 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 centre has also taken the initiative in starting cord blood transplants and matched unrelated donor transplants. The centre has also initiated the cord blood transplant program for disease like leukemia in children and also for immunodeficiency syndromes. The centre has also a cord blood facility to collect cord blood units for public banking for usage for cord blood transplants. The centre is also 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 centre also has tie-ups with several research institutions in India and abroad, such as GANIT labs, Strand Genomics, Cornell University, University of California, Irvine.
Highly Experienced and Skilled Multi-disciplinary Team
The medical team at this centre consists of haematologists, medical oncologists and pediatric oncologist . This 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
The centre is an integral part of 100,000 sq.ft state-of-the-art facility for cancer treatment. This centre has the most advanced therapy modalities used in the treatment of cancer and other complex diseases under one roof.
The BMT centre has 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
- A special isolation room called a positive pressure HEPA filtered room.
- An air filtration system (HEPA)
- 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.
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:
- Nausea and vomiting
- 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.
Autologous bone marrow transplant: Autologous means own or belonging to self. An autologous blood or marrow transplant is the transfusion of stem cells or bone marrow taken from your own body. These cells may be stored up to 5 years, after which time they will be destroyed if not used.
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 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.
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. 1)Cover your skin as much as possible with clothing. 2) Make sure you wear a hat, especially until his or her hair has grown back. 3)Use lots of sunscreen on your patient skin.
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.
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.
Information on Bone Marrow Transplant in India
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