IntroductionIn bone marrow tissue of bones, stem cells which are in an undifferentiated form are present. These cells have the capability of modifying themselves into any form of cells in our body. Such healthy stem cells will be collected from patients bone marrow, patients close relatives, or from donors and injected into the blood of the patient. Bone marrow transplantation will be mostly used in treating blood cancer, thalassemia, anaemia, etc.
Stem cells present in the bone marrow are two kinds- Myeloid stem cells and Lymphoid stem cells. Myeloid stem cells have the ability to form RBC, neutrophils, platelets and other different types of WBC. Lymphoid stem cells help to form lymphocytes and plasma particles.
Types of bone marrow transplantationStem cells from bone marrow are collected and will be introduced into the patient's blood intravenously. Usually, this bone marrow transplantation will be done in two ways.
Autologous stem cell transplantationIn this transplantation, stem cells collected from the patient's bone marrow are introduced into the same patient's blood. This type of bone marrow transplantation will be followed if a patient is treated for lymphoma, it reappears again in the patient. These patients will be first treated with four cycles of chemotherapy and then they proceed for this type of treatment.
Allogenic bone marrow transplantationIn this transplantation, stem cells collected from donors will be injected into patients blood intravenously. But the stem cells collected from a donor must match with the cells of the patient in HLA marker matching otherwise these cells will be rejected by the patient's immune system. So usually stem cells from brothers or sisters or parents only will be used for this treatment. If such a facility is not available, donor blood which suits patients blood in HLA marking will only be preferred to collect stem cells from the donor. Mumbai is the only place in our country where stem cells storage centres are present. So for this type of treatment, donor stem cells can only be obtained from these centres only.
Stem cells collection in bonemarrow transplantation (Courtesy:-wikipedia.org)
Procedure followed for bone marrow transplantationUsually for bone marrow transplantation, stem cells from bone marrow will be collected. But sometimes, stem cells from blood and cord blood also will be used. During the stem cells collection, first, the patient will be given anaesthesia. Then stem cells along with blood will be collected from the bone (present in the pelvic region) with the help of a needle. Granulocyte stimulating factor will be given to the patient four days before the collection of stem cells. Before bone marrow transplantation, the patient will be given chemotherapy treatment. For new stem cells to form in bone marrow after chemotherapy it takes 4 weeks time. So until then, the patient will be kept in an isolated room to avoid infection. Meanwhile, the patient will be injected with RBC and platelets. As the number of WBC decrease during this treatment, immunity problem may arise which will be treated with antibiotics.
Benefits of bone marrow transplantationCancer can be completely cured through this treatment. Even if cancer is not cured completely it can be kept under control. Aplastic anaemia can be cured up to 80% with the help of this treatment. Acute Myeloid, Lymphomas, Myeloma, Aplastic anaemia, Thalassemia can be treated by using this method.
Risks of bone marrow transplantationInfection is the major problem with allogeneic bone marrow transplantation. Due to chemotherapy treatment immunity levels of the patient decrease and infections may be caused. Immune-suppressants used in this treatment also cause immunity problems. So patients easily get bacterial, fungal and viral infections. If these medicines are not used donor stem cells get rejected by the cells of the patient through graft versus host cells reactions. After allogeneic transplantation, close monitoring is very essential. If graft versus host cell reaction occurs skin allergies, liver, digestive system troubles arise. Sometimes after treatment Jaundice, Diarrhea like fatal diseases may be caused which leads to death. This is the reason why allogeneic bone transplantation will be rarely used. Doctors prefer Autologous bone marrow transplantation as the stem cells are derived from the same patient or his family members which do not pose rejection, graft versus host cell reactions. The immediate and long term risks of bone marrow transplantation are given below.
Immediate side effects
Long term side effects
Check the video attached below to know about bone marrow transplantation:-