Bone Marrow Transplant in India: Turning challenges into triumphs
- August 5, 2024
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A bone marrow transplant (BMT) is a medical procedure used to replace damaged or destroyed bone marrow with healthy bone marrow cells. The bone marrow is a crucial part of the body that produces blood cells. BMT is often used to treat conditions such as leukemia, lymphoma, multiple myeloma, and other blood disorders.
Types of bone marrow transplants:-
The patient’s own human cells are collected and stored before undergoing intensive treatment. After the treatment, the stored human cells are returned to the patient’s body to help recover and regenerate the bone marrow.
Human cells are collected from a donor whose tissue type closely matches the patient’s. This type of transplant is more complex due to the risk of graft-versus-host disease (GVHD), where the donated cells attack the patient’s body.
The success of a BMT depends on various factors, including the patient’s overall health, the type of disease being treated, and the match between the donor and recipient (in allogeneic transplants). The procedure involves several stages: pre-transplant tests and procedures, conditioning (treatment to destroy diseased cells), the transplant itself, and post-transplant care and monitoring.
BMT can be life-saving but comes with significant risks and potential complications, including infections, GVHD, and organ damage. The procedure requires a highly specialized medical team and is typically performed in specialized centers.
When does the doctor advise the Bone Marrow Transplant?
The decision to transplant depends on certain situations. Each patient is evaluated to determine if the transplant is feasible for them or not. Patients with the following conditions may need a Bone Marrow Transplant. Some conditions include:
- Thalassemia
- Sickle Cell Anemia
- Leukemia
- Lymphoma (Hodgkin or Non-Hodgkin)
- Multiple Myeloma
- Myelodysplastic Syndromes
- Myelofibrosis
- Myeloproliferative Neoplasms
- Paroxysmal Nocturnal Hemoglobinuria (PNH)
- Severe Aplastic Anemia (SAA)
- Multiple Sclerosis
- Some immunodeficiency conditions
Procedure Details
Step 1: Donor identification. A matched donor must be found before the ALLO transplant process can begin. Your HLA type will be found through blood testing. Then, your health care team will work with you to do HLA testing on potential donors in your family, and if needed, to search a volunteer registry of unrelated donors.
Step 2: Collecting human cells from your donor. Your health care team will collect cells from either your donor’s blood or bone marrow. If the cells are coming from the bloodstream, your donor will get daily injections (shots) of a medication to increase white cells in their blood for a few days before the collection. Then, the human cells are collected from their bloodstream. If the cells are coming from bone marrow, your donor has a procedure called a bone marrow harvest in a hospital’s operating room.
Step 3: Pre-transplant treatment. This step takes 5 to 7 days. You will get chemotherapy, with or without radiation therapy, to prepare your body to receive the donor’s cells.
Step 4: Getting the donor cells. This step is your transplant day. Your health care team puts, or infuses, the donor’s human cells into your bloodstream through the catheter. Getting the donor cells usually takes less than an hour.
Step 5: Recovery. During your initial recovery, you will get antibiotics to reduce your risk of infection and other drugs, including medications to prevent and/or manage GVHD. Your health care team will also treat any side effects from the transplant. Read more details below about bone marrow transplant recovery.
What is HLA typing?
Human leukocyte antigen (HLA) typing is a simple blood test done for the patient and prospective donors to identify the degree of matching between the recipient and prospective donors. This enables the selection of the best possible donor for allogeneic transplant.
How is HLA Typing Done?
HLA typing involves analyzing a sample of blood. The DNA is extracted from the sample and examined to determine the HLA type.
Types of HLA Matches
Full match: This is the ideal situation where all HLA markers of the donor and recipient match perfectly.
Half match: Only some of the HLA markers match between the donor and recipient. The risk of GVHD is higher in half matches compared to full matches.
Matching within the family – what are the odds?
The chances of a match are highest within the immediate family but are not 100%. Statistically, 70% of patients must search the registries for a stranger who shares their HLA type, most often someone of the same genetic heritage or ethnicity.
Each of us inherits 50% of our HLA from our biological mother, and the other 50% from our biological father. The genes that determine HLA are split up when being passed down to a child, with a half-set coming from each parent to make a complete set for the child. There are four possible combinations of HLA from the parents. Each child has the same chance – 25% – of getting one of these four profiles in the genetic lottery when a human egg is fertilized. There is no way to predict which of the four combinations any given child will receive.
Which of the four possible HLA combinations you inherit from your parents is fairly random. You could get any one of these four combinations.
But what about your other siblings? Each one of them has the same 25% chance of inheriting any one of the four available HLA combinations. Every sibling has the same 25% chance of being your match. Since they could inherit one of two half-matched profiles, there are two 25% chances (or a 50% chance) that a sibling of yours is a half match. There is also a 25% chance for each sibling that they do not match you at all because they inherited the two HLA factors you did not get.
Although the chances are higher of finding a match within the family, there is no guarantee. You are always a half-match with each of your parents, since you inherited half of your HLA from each of them. That means that parents and children are always half matches, but never a full match. You have a 25% chance of matching each one of your siblings.
Siblings are more often preferred donors for bone marrow transplants because they have a higher chance of sharing similar HLA.
Conclusion
HLA typing is a vital step in the bone marrow transplant process. It helps find the best possible match between the donor and recipient, increasing the chances of a successful transplant and reducing the risk of complications.
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