Bone marrow is a spongy tissue present in some of the bones (, including the hip and thigh bone), and they contain the immature cells called as stem cells. These cells can differentiate into red blood cells, white blood cells, and platelets. In cases of damaged or diseased bone marrow, it is replaced with healthy stem cells.
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Stem cell transplant is one modern technology that is undergoing rapid improvements. It is said these days that instead of investing in various life insurance policies that are making the rounds in the market, to secure the future and precious life of your child go for stem cell technologies. This can later cure him or her from any life threatening terminal disease like cancer. Stem cell transplant has been used in recent times as a cure for cancer, but the technique is different from the stem cell bank that is maintained these days for new born.
The bone marrow which is part of the bones is responsible for making blood cells. It is soft and spongy tissue lodged inside the bone having hematopoietic stem cells. These cells either turn into bone marrow cells or can turn into any other kinds of cells or the blood cells. But there are certain forms of cancers that can keep these cells from developing normally.
A patient is recommended to get a blood as well as bone marrow stem cell transplant if they are in a condition which prevents the body from producing new healthy blood cells. Some of the conditions and diseases that prevent the bone marrow from doing so are given below:
The oncologist or hematologist shall decide for a stem cell transplant for a patient depending upon overall age and health, severity of the diseases and other treatment possibilities.
So the stem cell transplant is a kind of treatment to treat blood disorders or any types of cancer. Even blood diseases are also treated with transplants. Previously patients had to undergo a bone marrow transplant due to the fact that stem cells are collected from the bone marrow. But today stem cells get collected from the blood. And for this particular reason they are now called stem cell transplants. Nowadays stem cell therapies are used to combat hair loss and many other aesthetic related issues.
Some of the different types of stem cell treatments available are discussed below
Autologous transplant: These kinds of transplants are known as auto transplant. This kind of transplant has the scope of very high dose chemotherapy paired with autologous stem cell rescue. In this process usually the doctors treat the cancel and then make use of the stem cells from the patient itself. From the blood, stem cells are collected and the health care team then freezes it. These cells are usually placed back in the blood after thawing them in the frozen state post the chemotherapy. The cells take almost 24 hours to reach the bone marrow and start multiplying to give rise to healthy blood cells.
Allogenic transplantation: This is better known as an allo transplant medically. In this case stem cells are obtained from another individual. But this individual needs to be someone with whom the bone marrow of the patient matches. Due to presence of proteins in white blood cells called the human leukocyte antigens (HLA) it is important that bone marrow matching takes place. The most compatible stem cell donor will have the HLA matching with that of the patient.
But the process of matching can also give rise to a very severe condition named graft versus host disease or GVHD but then it is not very likely. In this kind of a disease the healthy cells obtained from transplantation will start attacking the cells of the patients. In such cases siblings are considered to be the best match. And if they are not available then some other close family member can also work. Once the donor is fixed then the patient starts receiving chemotherapy session with or without radiotherapy. The other person’s stem is then placed in a vein via a tube. These cells unlike the previous ones are not frozen so they can be given immediately after the completion of chemotherapy.
There can be two types of Allo transplantation depending upon the age, condition and the disease that is being addressed:
The first kind is ablative where high dose of chemotherapy is used and in the second kind milder doses of chemotherapy is employed.
When the assigned health care team is unable to find a matched adult donor then are other options that must be considered like the Umbilical cord blood transplant and these days cancer centers all around the globe make use of cord blood.
Parent child transplant and haplotype mismatched transplant: In these kinds of transplants which are commonly employed the match found is 50% instead of 100% and the donor can be a parent, child or brother and sister.
The first step in bone marrow transplant is to reduce the tumour so that the stem cell transplant success rate is improved. The process of harvesting stem cells takes around three to four hours, depending on the number of stem cells collected. The entire process may take around three to five days to complete. Blood count is daily monitored during collection of stem cells to ensure that it does not go below the admissible levels in the donor, which may contribute to anaemia.
A catheter is placed in the donor’s arm during the actual stem cell transplant procedure. The catheter is connected to a special machine that separated stem cells from the blood. After extracting the stem cells, the remaining blood is infused back into the donor's body.
The stem cell concentration in the bone marrow is almost 10 to 100 times more than the levels found in peripheral blood. The hip bone is considered to have the greatest amount of marrow in the active state and a large number of stem cells can also be extracted from there.
The process of harvesting the stem cells from the bone marrow is carried out in an operating room. The donor is given either general anaesthesia, an epidural, or spinal anaesthesia.
The surgeon makes a number of punctures over the skin covering the pelvic bone. A special kind of needle attached to a syringe is then inserted through these punctures. The needle penetrates the bone marrow and blood is drawn out along with marrow through the syringe. The process is continued several times to ensure enough numbers of stem cells are collected as required for the transplant. The whole duration can last for a period of one to two hours. The amount of blood and marrow removed will vary according to the weight and concentration of stem cells in the marrow of the donor. At the end of this procedure, the surgeon covers the puncture region with pressure dressing and bandages. The collected cells are filtered to separate fat particles and fragments of bones. The donor is taken to the recovery room where the hospital team checks for signs of pain, bleeding or any other side effects of the procedure. The donor can leave the hospital in a few hours after his or her body has recovered. But in some cases, they may be required to stay overnight for better monitoring.
The hip area of the donor remains sore for a few days and it is important to take medicines as directed to relieve the pain. Until the blood cell counts increase, doctors may suggest iron supplements t to enhance the ability of the bone marrow to replenish blood cells.
High dose of chemotherapy is given to the patient immediately after stem cell collection or can even be done at a later stage. Stem cells are injected into the bloodstream of the patient after the completion of high dose chemotherapy. These stem cells travel all the way to bone marrow to start producing new blood cells, which is important as a number of healthy blood cells are lost during high dose chemotherapy.
Until the bone marrow is in a position to make sufficient blood cells, the patient is at the risk of contracting infections and diseases. Therefore, the patient is kept in an isolation room following stem cell transplantation to protect him or her from contamination. The stay in isolation room lasts for over a week or until the level of blood cells is back to normal again.
Isolation is more important in the case of allogeneic stem cell transplant than autologous stem cell transplant. This is the reason why some hospitals do not prefer to keep a patient who has had an autologous transplant isolated.
During the recovery period, only one or two visitors are allowed to visit the patient. Those who are already ill should strictly avoid visiting the patient. There are a few hospital who conduct autologous stem cell transplant on an outpatient basis. However, the patient must come for follow-up 0vists regularly for monitoring of their health.
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