Stem cell transplant procedure is an advanced technology used to save the lives of people with life-threatening diseases. Stem cell transplant is nowadays used for the treatment of cancer and as a secondary procedure when the original stem cells of the patient are destroyed as a result of chemotherapy or radiation therapy.
The bone marrow, which is a part of the bones, is responsible for making blood cells. It is soft and spongy tissue lodged inside the bone and has hematopoietic stem cells. These cells either differentiate into bone marrow cells, blood cells, or any other type of cells in the human body. But there are certain forms of cancers that can keep these cells from developing normally.
A patient is recommended to undergo bone marrow transplantation if his or her stem cells are not able to differentiate into new, healthy blood cells. Bone marrow transplant procedure is also recommended in case the healthy stem cells are destroyed during the chemotherapy or radiation therapy treatment for some form of cancer such as breast cancer and leukemia.
The following are some of the conditions that may warrant the need for stem cell transplant procedure:
A team of oncologist or hematologist decides whether the patient should undergo bone marrow transplantation or not. Their decision depends on a number of factors, including the age and health of the patient, the need for stem cell transplantation, and the overall chances of survival post-transplant.
Autologous stem cell transplant: This type of stem cell transplant involves the extraction and use of stem cells from the patient’s body. Before administering cancer treatment, a team of specialists extracts stem cells from the blood of the patient. The stem cells are frozen for later use.
In autologous stem cell transplant, the extracted cells are placed back in the blood after thawing once chemotherapy is done. The cells take almost 24 hours to reach the bone marrow, following which they start multiplying to differentiate into healthy blood cells.
Allogenic stem cell transplantation: In this procedure, stem cells are obtained from another individual. The donor is someone whose bone marrow is compatible to that of the patient. Tests are performed to check the presence of proteins called human leukocyte antigens (HLA) on the surface of white blood cells. The HLA of the donor should match with that of the recipient.
The stem cells derived from a donor are not generally frozen. Instead, they are freshly extracted and transplanted as soon as chemotherapy of the patient is over.
Before the treatment, you will be asked to undergo a series of tests so that the physician can assess your overall health status. The intention of conducting certain tests is to confirm whether you are physically fit to undergo bone marrow transplantation or not.
The total evaluation period may last for a few days. Additionally, the surgeon will also place an intravenous catheter into the large vein in your neck or chest. This catheter will remain as is during the course of treatment and is later used to infuse medications and stem cells into your blood.
Stem cell collection for both autologous stem cell transplant and allogenic transplant is done at this stage. In some cases, stem cells from preserved umbilical cord are retrieved for infusion.
Once all pre-surgery tests are over, the medical and radiation oncologists would conduct chemotherapy and radiation therapy sessions to achieve the following things:
This preparatory step is also known as conditioning.
The first step in bone marrow transplant is to reduce the tumor 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 anemia.
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 anesthesia, an epidural, or spinal anesthesia.
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 allogenic 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.
The donor may experience certain side effects at the time of collection of stem cells. Light-headedness, chills, and numbness in the lips, fingertips, and toes. These side effects usually result due to lowered levels of blood calcium during harvesting. They can be easily dealt with by administering calcium supplements.
Some of the stem cell transplant side effects that the patient may experience after the actual procedure include the following:
Cost of bone marrow in India is cheaper as compared to other popular medical tourism destinations in the world. It is estimated that the stem cell transplant cost in India is less than one-tenth the cost of the same procedure in the Western countries, especially the US and the UK.
There are several factors that control the total bone marrow transplant cost in India. Some of these factors include the following:
The following table highlights the difference in the cost of stem cell transplant in India and other popular countries:
Q. How much does stem cell transplant cost?
A. Bone marrow transplant cost may vary from $20,000 to $200,000, depending on the needs of the patient.
Q. Is autologous stem cell transplant safer than allogenic transplant?
A. By thumb rule, using stem cells from one’s own body is any day better. However, a potential risk of side effects is associated with both the types of stem cell transplant.
Q.What is the average length of stay for bone marrow transplant?
A. The average length of stay for stem cell transplant may vary between one to two weeks, depending on the recovery of the patient. In some cases, the hospitalization stay is less than one week.
Q. How long does it take to recover from stem cell transplant?
A. The time it takes for the body to replenish the lost blood cells varies from one patient to another. Typically, the body recovers from stem cell transplant in two to six weeks.
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