Bone Marrow Transplantation

Bone Marrow (Stem Cell) Transplantation Center
A medical team consisting of a professor of hematology experienced in stem cell transplantation, a specialist medical doctor, a biologist with expertise in the field of apheresis and bone marrow cryopreservation, and experienced nurses and personnel are responsible for providing the highest standards of care in our bone marrow transplantation unit with 20 inpatient beds.

All rooms are for a single occupancy and equipped with world-standard HEPA filters that filter dust and microbes from the air. The content and quality of the food served to our patients are continuously checked by an experienced dietician, particularly with regard to neutropenic diet (free of microbes).

Our specialist psychologist provides the required psychological support to our patients before and after the transplantation. Also, a pharmaceutist is responsible for the preparation and storage of chemotherapeutic and other pharmaceutical agents.

What is bone marrow and a hematopoietic stem cell?
Bone marrow is an tissue in the interior of bones that contains blood and stem cells. Stem cells transform into red blood cells, white blood cells, and platelets.

What is bone marrow transplantation?
Bone marrow transplantation allows the administration of adequate and curative doses of drugs in certain malignant or benign diseases of the blood, lymphatic system or bone marrow. When high doses of drugs are given, patients are unable to produce adequate number of blood cells for prolonged periods of time and they may suffer serious complications such as bleeding and infection that may lead to death. Thus, bone marrow transplantation allows recovery of the patients by shortening this period.

What is the source of stem cells in bone marrow transplantation?
Bone marrow
Blood
Umbilical cord
There are three types of bone marrow transplantation:
Allogenic transplant: The patient receives stem cells from another person – usually a sibling or a family member, but sometimes an unrelated donor with matching tissue groups.

Autologous transplant:  Patient’s own stem cells are first taken and stored, then used for transplant.

Syngeneic transplant: A patient receives stem cells donated by his or her healthy identical twin.

How is autologous bone marrow transplant done?
Initially, appropriate treatment to destroy the diseased cells is given. Then, certain drugs to prevent the recurrence of the disease are administered and stem cells are retrieved and frozen. After this stage, a high dose chemotherapy is given to destroy the remaining cells. Finally, the healthy stem cells are transferred back to the patient.

Are there any risks associated with autologous bone marrow transplant?
Generally the procedure is well tolerated by the patients. Since patients’ own stem cells are used, risks are much lower in this patient group. High-dose medications may result in side effects such as vomiting, nausea, diarrhea, or hair loss, which generally disappear following the completion of treatment.

How is allogeneic bone marrow transplant done?
Initially appropriate treatment to destroy the diseased cells is given. Stem cells are retrieved from siblings or non-relative donors with matching tissue characteristics. During this stage, high dose chemotherapy is given to destroy the remaining disease. Then, the cells retrieved are given back to the patient. There are no risks for the donors, and it is similar to blood donation. The required stem cells are quickly replaced by new stem cells, preventing diseases or disorders.

Are there any risks associated with allogeneic bone marrow transplant?
Since perfectly healthy stem cells are transplanted, the recurrence risk is very low. Even in the case of a complete match between siblings or tissue groups, the immune systems may not show complete compatibility. The immune cells of the donor may react against the organs of the receiver. A condition called “Graft Versus Host Disease” may occur that causes skin and intestinal disorders, which requires treatment.

How are stem cells collected?
Although they can be retrieved from the bone marrow, this method is now rarely used. Instead, stem cells are collected by “apheresis” devices through the use of the veins of the arm or a catheter in a neck vein. Stem cell collection does not require anesthesia both for the donor and patient.

Why are stem cells frozen in blood marrow transplantation?
The collected bone marrow stem cells can be immediately used or frozen for future use. Freezing requires a minimum low temperature of -80 °C. After melting, the stem cells begin to function as before. Usual storage temperature is -196 °C. This technique is referred to as “cryopreservation”. Stem cells can be preserved for many years with this technique.

How are peripheral blood stem cells retrieved for transplant?
Currently this is the most commonly used stem cell collection method worldwide. The stem cells in donor’s circulation are collected using a method named as “apheresis”. The method is similar to blood donation in blood banks. Stem cells of the donor or patient are collected in the apheresis unit and the procedure usually takes between 2 and 4 hours. After counting, stem cells are frozen until their use. Apheresis rarely causes symptoms such as temporary faintness, tingling sensation in the lips, shivers, or cramps in the hands.

What happens after stem cells transplanted?
After entering the blood circulation, stem cells are settled in the bone marrow to produce red blood cells, white blood cells, and platelets. Blood production after transplantation usually requires 2 to 4 weeks. The time to complete recovery of the immune functions depends on the type of transplant. This period is usually several months for autologous transplant recipients, and 1 to 2 years in allogenic transplant patients.

Which patients can benefit from bone marrow transplant?
Acute Myeloblastic Leukemia
Acute Lymphoblastic Leukemia
Non-Hodgkin Lymphoma
Hodgkin Lymphoma
Multiple Myeloma
Myelodysplastic Syndrome
Chronic Myelocytic Leukemia
Aplastic Anemia
Paroxysmal Nocturnal Hemoglobinuria
Primary Amyloidosis
Genetic Disorders: Thalassemia

How is life after bone marrow transplant?
Following discharge from the hospital, recovery usually takes around 1 year for allogeneic transplant patients and 2-4 months in autologous transplant patients. Patients are generally not allowed to start full-time working for a period of 6 months after transplant. The patient may feel very weak during the initial couple of weeks. However, he or she should try to walk around the house. Before discharge, a detailed education is provided to each patient regarding relevant lifestyle measures, nutrition, and follow-up visits.

Which tests should be done in patients and donors before stem cell transplant?
Blood, urine, lung, liver, hepatitis, and infection tests are performed both for the patient and donor before the transplant. The results guide the future management. Dental problems such as carries are treated. Particular emphasis is placed on the assessment of respiratory and cardiac conditions. Liver problems are dealt with and psychological evaluation is performed. When required, supportive treatment is given. Information on stem cell transplant is provided to the patient. After consent is obtained from the patient, the treatment is commenced as required.

How are stem cells collected?
A catheter is placed to the patient or donor. Chemotherapy to quickly recruit stem cells into circulation or drugs to promote their growth are administered. A special device called “apheresis device” that can differentiate stem cells from other types of cells is used to collect stem cells from the patient or donor at the appropriate time.