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Amit Bansal
The human skeletal system comprises various bones. A soft, spongy tissue is found inside various bones, including the hip and thigh bones. The bone marrow is this delicate, porous tissue. The ribs, vertebrae, and skull may also contain bone marrow.
Sometimes you come across various transplantation terms such as bone marrow transplantation and stem cell transplantation. What is the difference between bone marrow and stem cells? Bone marrow comprises two types of stem cells. One is the hematopoietic stem cells which can differentiate into various blood cells and the other one is stromal stem cells which produce cartilage, bone, and fats. In almost all cases of bone marrow transplantation, the hematopoietic stem cells get transplanted. Some of the hematopoietic stem cells get released in the bloodstream from bone marrow. These stem cells can also be used for transplantation.
Hematopoietic stem cells may give rise to various types of blood cells depending upon the requirement. These stem cells may transform either into RBC (Red Blood Cells), which carry oxygen throughout the body, or WBC (White Blood Cells) which help the body fight against infections or blood platelets that help blood clotting in case of injury.
Bone marrow transplantation is the process of replacing damaged or abnormal bone marrow with healthy bone marrow stem cells. In actual sense, the stem cells get transplanted, thus the process is also known as stem cell transplantation.
When the transplanted stem cells are derived from bone marrow, the method is termed bone marrow transplantation, and when the stem cells for transplantation are taken from blood, more accurately the peripheral blood, the procedure is known as peripheral blood stem cell transplantation or simply stem cell transplantation. However, in a general sense, all types of stem cell transplantation whether hematopoietic stem cell transplant (HSCT), peripheral blood stem cell transplant (PBSCT) and bone marrow stem cell transplant come under the broad umbrella of Bone Marrow Transplantation.
Following are the different types of bone marrow transplantation depending upon the type of donor:
Autologous Bone Marrow Transplantation: In this type of bone marrow transplantation, the patient himself is the donor of stem cells. Before undergoing intense chemotherapy or radiation treatment that might destroy all of the receiver’s stem cells, the recipient has their stem cells extracted. Until they are needed for transplantation, the stem cells are stored in a refrigerator. The expired stem cells are replaced with the newly collected stem cells.
Allogeneic Bone Marrow Transplantation: In cases where the autologous bone marrow transplantation is not feasible, stem cells of the genetically matched stem donor is transplanted. The donor is usually a sibling of the patient.
Matching Unrelated Donor Bone Marrow Transplantation: This type of bone transplantation is an alternative for those patients who are not able to get the matched sibling. Often found through bone marrow registries, these donors are not the relatives of patients yet they have matched human leukocyte antigen.
Haploidentical Bone Marrow Transplantation: Haploidentical bone marrow transplantation is a relatively new technique in bone marrow transplantation. A haploidentical donor may provide the stem cells if the patient is unable to find a related or unrelated identical donor. An individual with at least a 50% match to the patient or recipient is considered a haploidentical donor. Complications after the transplant can be discussed owing to new therapeutic choices and technological advancements. The haploidentical donor may be siblings, parents or children.
Bone marrow transplantation is a process of replacing older stem cells with newer stem cells. The new stem cells may either be collected from the recipient himself or a donor. This depends upon the disease to be treated through transplantation. A stem cell may be extracted either from bone marrow or from peripheral blood. Most of the current transplant procedures involve stem cells collected from peripheral blood. Bone marrow transplantation involves the following steps:
Increasing The Number Of Stem Cells In Peripheral Blood: This process is done when the stem cells are collected from the peripheral blood. Medicines are usually administered to increase the number of stem cells in the blood. This process is not done in case stem cells are collected from the bone marrow.
Collecting The Stem Cells: The procedure used to extract stem cells from peripheral blood and bone marrow differs. While the extraction of stem cells from bone marrow requires surgery, peripheral blood collection does not. Under general anesthesia, bone marrow is harvested for stem cells. Using a syringe, bone marrow is removed after a needle is placed in the center of the pelvic bone. To obtain enough bone marrow for a transplant, the extraction process takes one to two days. Peripheral blood stem cell collection is accomplished using a specialized machine. Blood leaves the body through a tube that is attached to a vein in one arm, flows into the device that extracts the stem cells, and then leaves the body again through a different arm.
Freezing Stem Cells: Once the stem cells are collected, freezing is done in the laboratory until they are required.
Conditioning: Conditioning is the process of killing the remaining stem cells to make space for new stem cells. Conditioning is done through chemotherapy and/or radiation therapy. In some cases, conditioning is performed to completely or partially eliminate the immune system.
Transplanting Stem Cells: Freeze stem cells are thawed before transplanting. The stem cells are then infused into the recipient’s body through a large vein, usually of the chest. The donor cells circulate in the bloodstream and migrate to the bone marrow where they start producing new and healthy cells.
Supportive Medical Care: Supportive medical care is an important step for a successful transplant. The patient should be protected from infection and Graft-versus-host disease. Intensive care is provided for at least 4-6 weeks as the immune system of the recipients builds.
Bone marrow is largely responsible for the formation of various types of blood cells such as RBC, WBC, and platelets. The diseases which can be treated with bone marrow transplants, are thus, generally related to blood. It has been found that bone marrow transplants may help in curing more than 70 diseases ranging from common blood cancer to rare diseases like polycythemia vera. Following is a comprehensive list of diseases that can be treated with bone marrow transplants:
Human Leukocyte Antigen (HLA) is a protein present in cells. The immune system of the body identifies HLA to decide whether to initiate an immune response against a particular cell. When immune cells come into contact with body cells, for instance, the information is analyzed using HLA matching, and the immune system does not launch an attack on those cells. But in the event of a bacterial infection, the immune system’s cells recognize the invading cells as foreign ones due to an HLA mismatch, which triggers an immunological response that destroys the invading bacteria.
A similar process applies to the transplanted stem cells obtained from a donor. The stem cells have HLA on the surface. If the HLA of donor stem cells matches the HLA of host cells, the immune system does not attack the transplanted cells and the chances of a successful transplant is high. The severity of the immune response depends upon how closely the HLA of the donor matches with the host’s HLA.
The matching of HLA is done based on 8 or 10 markers. For a successful and favorable bone marrow transplant, a greater number of HLA markers should match. Half of the HLA markers are inherited from the mother and half are inherited from the father. Thus, there is a 25% chance of a complete match, 50% chance of matching half markers and a 25% chance of not matching any of the markers.
When bone marrow transplantation is advised, the sample of siblings is taken to match the HLA markers. In case the sibling is not a proper match, samples of other family members such as parents or children are taken. If the matching fails, the medical staff of the hospital may contact the concerned authorities to search in the International registries for the best match from an unrelated donor.
Conditioning chemotherapy is a step performed during bone marrow transplantation. It is generally done through chemotherapy which may or may not be complemented with radiation therapy.
Induction chemotherapy is also known as adjuvant chemotherapy. This chemotherapy is done before surgery or radiation therapy. Induction chemotherapy is done according to the principle of spatial cooperation. In previously untreated patients, systemic chemotherapy is recognized as a highly active treatment regimen.
Conditioning in bone marrow transplantation is done for the following reasons:
When the symptoms of cancer are reduced or disappear, the disease is said to be in remission. There is no way for the doctor to find all the cancerous cells in the body, so if the symptoms of cancer are completely gone, they prefer to use the term “remission” rather than “cure”.
In the case of life-threatening diseases such as acute myelogenous leukemia (AML), bone marrow transplantation according to the timing of remission has an impact on the overall survival rate.
Apart from chemotherapy, sometimes radiation therapy is also performed during the conditioning process. The main aim of radiation therapy is to kill those cells that have escaped the effect of chemotherapy. Further, the decision to combine chemotherapy and radiation therapy may also depend upon the side effects of the overall conditioning process.
| Dr. Banu Atalar | Dr. Raimon Mirabell |
| Dr. Kirti Ranjan Mohanty | Dr. Gagan Saini |
Bone marrow transplant drains you emotionally, physically, and mentally. So it is advised that before the procedure gets started you should prepare yourself for bmt. The following guidelines may help you prepare for this process:
Preparation For The Donor:
The approximate charges for bone marrow transplants in various countries vary.
| Country | Cost of Allogenic Transplant (USD) | Cost of Autologous Transplant (USD) |
| BMT Cost in India | 25,000 | 35,000 |
| BMT Cost inTurkey | 50,000 | 80,000 |
| BMT Cost in UAE | 100,000 | 300,000 |
| BMT Cost in Thailand | 50,000 | 80,000 |
Comprehensive BMT package in India
Allogenic Bone Marrow Transplant From Fully Matched Donor
Allogenic Bone Marrow Transplant From Fully Matched Donor
Consult online with the top BMT surgeons
| Dr. Erdal Karaoz | Dr. K D Sadhwani | Dr. Gaurav Dixit |
| Dr. Suradej Hongeng | Dr. Umesh Gupta | Dr. Yasemin Altuner Torun |
Most people have expressed that their quality of life has been improved after having a stem transplant. Further, it is also exciting for some to have another life.
>>Recovery Process Post-transplantation For Adults
Recovery after a stem cell transplant is a slow process. The body is drained after chemotherapy and/or radiotherapy and transplant process. After emotional, mental and physical stress before and during transplant patient requires sufficient rest to regain lost energy.
Discharging from Hospital: You may get discharged from the hospital when your blood counts have reached a safe level and you have sufficiently recovered from side effects. It’s also possible for you to walk on your own and the medication is not required to be given via injections or injection lines
Preventing infection: You have a greater chance of infection and the lowest functional immune system after the procedure. You need to look after yourself more. Avoid contact with unhealthy individuals and wash your hands with alcohol-based hand sanitizers.
Follow a Healthy Lifestyle: Follow a healthy lifestyle during the recovery period. Certain foods, that carry a risk of infection should be avoided and a healthy and balanced diet should be maintained.
Follow-Up Visit: A follow-up visit schedule is provided to the patient and the patient should strictly adhere to this schedule. The patient must make additional hospital visits throughout the first few months. The frequency of hospital visits reduces as the patient’s vital signs and condition stabilize and as their recovery progresses as planned. It is important to remember that, contrary to allogeneic transplantation, follow-up visits are less frequent in the case of autologous transplants.
Routine Activities: To improve the muscle tone, you can take a gentle walk. As the blood count increases, the period of exercise can gradually be increased. Drive only when you are comfortable with it. As the body is undergoing a recovery phase, it is hard to concentrate on driving because of tiredness. Further, side effects of certain medicines may also affect your ability to drive.
>>Recovery Process Post-transplantation For Children
Stem cell transplantation is a complex procedure and various drugs are prescribed for successful bone marrow transplantation. In some cases, radiation therapy after bone marrow transplantation is also recommended.
Radiation Therapy: In some cases, chemotherapy is not able to kill all the cancer cells. In such cases, radiation therapy is advised.
Antibiotics: Antibiotics are prescribed to reduce the risk of infection as the immunity of the patient is at a minimum level.
Immunosuppressive Drugs: To prevent Graft-versus-host disease, immunosuppressive drugs are prescribed. The immunosuppressive drugs are commonly used in a patient undergoing allogeneic stem cell transplant.
Supervision: Follow-up visits and strict supervision are the keys to a successful bone marrow transplant. The patient should undergo regular check-ups and should be under the strict supervision of the transplant surgeon.
#1: How is a bone marrow match determined?
A: Human Leukocyte Antigen (HLA) is used to match donors to patients. HLA is a type of protein present in most of the body cells. Various HLA markers are present that make a particular tissue unique. Some markers play an important role in bone marrow transplants. These markers are required to be matched in the donor-patient group. If more than one closely matched donor is found, the doctors then decide the donor based on age, gender, height, weight, and blood type.
#2: How are bone marrow and peripheral blood stem cell (PBSC) donations different?
A: If you want to donate the stem cells, you have two options. One is bone marrow donation, the other is peripheral blood stem cell donation. Peripheral blood stem cell donation is a non-invasive procedure, however, bone marrow donation requires surgery. Granulocyte colony-stimulating factor injections are given daily to increase the amount of stem cells in peripheral blood, as there are fewer stem cells in blood when donating peripheral blood stem cells. The process of receiving peripheral blood stem cells is quick, but the process of donating bone marrow might take anywhere from 60 to 90 minutes. As peripheral blood stem cell donation is a non-surgical method, it is the most commonly used procedure.
#3: Can there be any medical complications for Bone Marrow Transplantation?
A: Due to advancements in technology and highly sophisticated instruments used during the stem cell donation process, the medical complications are minimal in context to the donor. Complications reported in some donors include respiratory disturbances, splenic rupture, and triggers of inflammatory reactions.
#4: Are there any side effects of Donating your Bone Marrow?
A: The side effects of the donation process are not severe. Muscle pain, headache, nausea and vomiting, and bone pain are common side effects of peripheral blood stem cell donation while the risk of infection, pain, and numbness, bruising, bleeding and feeling of discomfort are associated with bone marrow donation. In most cases, the side effects disappear after a few days.
#5: What can I do to recover well after donation?
A: Your recovery time varies with the process of stem cell donation. If you have donated the stem cell through peripheral blood stem cell, you can fully recover within seven days, while donating stem cells through bone marrow requires approximately 20 days to get fully recover. However, the recovery depends upon your age and the side effects experienced by you during or after the procedure. In most cases, the donors return to have their routine activities within a week after the donation.
#1: How long will the entire treatment be?
A: The complete procedure of bone marrow transplantation is divided into various stages. The time taken in each step depends upon the condition of the patient but it typically spans several weeks to months
#2: Will there be any side effects after Transplantation?
A: You may have various side effects based on whether you have undergone an allogeneic transplant or autologous transplant. Most side effects occur due to radiation therapy or chemotherapy. It is to be noted that your immune system might not achieve similar activity after a bone marrow transplant.
If you have undergone autologous bone marrow transplantation you may have the following side effects:
Infection: As your bone marrow is responsible for generating cells that fight against the infectious organism, destroying bone marrow cells through chemotherapy/radiation therapy increases the risk of infection. This risk is very high in the initial weeks after transplant. Another risk is of opportunistic infection. Pathogenic organisms are living in the body and are kept under check by the immune system. As the immune system becomes weak, these pathogens may cause infections. Some patients require a year-long course of antivirals and antibiotics.
Short-term side effects: You may experience the following side effects immediately after bone marrow transplantation:
Long term side effects: You may have side effects that may occur months or years after bone marrow transplant. These side effects include:
#3: Is spinal tap painful?
A: Cerebrospinal fluid is present in your brain and spinal cord and protects them from injuries. Spinal tap, also known as lumbar puncture, is the process done to take a sample of your cerebrospinal fluid to diagnose various diseases such as leukemia or meningitis. In this process, the fluid is removed by inserting a needle in the space between two lumbar vertebrae. Sometimes you may also have a spinal tap to administer chemotherapy drugs or anesthetics. Although a spinal tap is recognized as a safe procedure, you may have the following effects after a spinal tap:
Explore the Cost of Bone Marrow Transplant by Country
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Amit Bansal is a serial entrepreneur, Co-Founder, and CEO of MediGence. He has more than 17 years of strong technology experience. Having worked for some of the recognized companies in India, Australia and traveled worldwide to help businesses to grow multi-folded under his leadership and strategic guidance.
Last modified on
at Jul 01, 2024
Amit Bansal is a serial entrepreneur, Co-Founder, and CEO of MediGence. He has more than 17 years of strong technology experience. Having worked for some of the recognized companies in India, Australia and traveled worldwide to help businesses to grow multi-folded under his leadership and strategic guidance.
(+1) 424 283 4838