Bone Marrow Transplantation: Treatment, Cost and Side Effects

A bone marrow transplant or stem cell transplant is a medical procedure which is performed to replace damaged or destroyed bone cells with healthy bone marrow stem cells. The spongy, fatty tissue inside the bones which help to produce red blood cells (or erythrocytes), white blood cells (or leukocytes) and platelets is known as the bone marrow. This procedure will involve the transplant of new blood stem cells, which after travelling to the bone marrow will produce new blood cells and also promote growth of new marrow.

Bone marrows may get damaged and destroyed due to radiations, infection, disease, chemotherapy etc. When a person’s marrow does not function properly, patients may require to undergo a bone marrow transplantation. Mostly cancer patients are made to undergo this treatment. Also patients with aplastic anemia, sickle cell anemia, thalassemia, congenital neutropenia etc. have to have bone marrow transplantation.

There are two types of bone marrow transplantation. They are autologous transplants (using the patient’s own stem cells) and allogeneic transplants (using the stem cells from a donor).

In a bone marrow transplantation, patients begin with the first part of the stem cell transplant process. This process is known as conditioning. In this treatment procedure, patients are given chemotherapy and at times even radiation therapy to destroy the damaged bone marrow. This will help to suppress the body’s immune system and also prepare it for the new stem cells apart from destroying the cancer cells. The type of conditioning for the patient depends on factors like the disease, overall health and the type of transplant planned. The hematopoietic stem cells, after infusion will travel to the bone marrow and initiate blood cell production in the body.

Based on the disease of the patient and other factors, the doctor will recommend either allo- or auto- geneic treatment procedure. In order to select the appropriate transplant method, overall health of the patient and his/ her age and other factors are also taken into consideration. The donor (in case of allogeneic treatment) and the patient need to undergo certain tests prior treatment procedure. When autologous treatment method is opted, patients marrow cells are collected beforehand. If allogeneic transplantation is done, then the donor’s stem cells and patients’ must match.

In case of auto transplants, a thin tube called a “transplant catheter” is placed in a large vein which provides chemotherapy and other radiations to the patients and also help in the collection of stem cells. The patient is also provided with injections of a medication to raise the number of white blood cells which help to fight infections. The stem cells are collected and stored from the blood. Then, the patient is given chemotherapy and depending on the severity, radiation therapy through the tube. After a procedure of five to ten days, through the transplant catheter, doctors put back the stem cells in the patient’s body. This is how autogenic bone marrow transplants work. In case of allogeneic transplant procedure, the method is the same but instead of storing the patient’s stem cells, the donors stem cells are collected and stored. Injections are thereafter given to increase the white blood cells. After chemotherapy with or without radiation, the donor’s stem cells are put into the body of the patient with an operation.

Patients are advised bone marrow transplantation when the doctors detect damaged and destroyed bone marrow cells with degenerating health conditions. People with cancer cells (malignant) can undergo bone marrow transplantation treatment. Bone marrow or stem cell replacement therapy helps to treat cancer cells keeping in mind the health conditions of the patients. This procedure helps the patient to receive high doses of chemotherapy and radiation therapy. People with damaged bone marrow can be replaced with new stem cells. Bone marrow treatment is also beneficial for people with knee joint pains. New stem cells with the marrow transplant treatment help to reduce knee pain in patients with even advanced arthritis.

People with healthy body conditions and no signs or symptoms of cancer are not eligible for the stem cell transplant. Also, minor arthritis which can be treated with medicines and exercises are not eligible for this treatment. Also, this treatment depends on the health conditions of the patient. The patient will not be eligible for an allogeneic transplant unless donor bone marrow cells match.

There are many risks associated with bone marrow transplant. Side effects of bone marrow transplantation treatment depend mainly on the following factors. They include the type of drugs used in chemotherapy, if radiation therapy was given before the transplant, the type of transplant used and the overall health condition of the patient. Side effects of this methods of treatment can occur any time during, immediately after or days to months after stem cell transplant. Mostly, these side effects go away on their own or can be treated with the use of medicines, but some side effects can last for a longer time or become permanent in the patient. Most common side effects of the conditioning process are nausea and vomiting, infection, bleeding, anaemia, diarrhea, hair loss, mouth sores or ulcers, infertility or sterility, fatigue and cataracts. One major side effect is the organ complication in the heart, liver or lungs. They may start failing due to this treatment. Also, another side effect can occur which is known as the Graft-versus-host disease (GVHD). This disease occurs when the immune cells from the donor see the recipient’s body as foreign. This is mostly noted in allogeneic transplants. Apart from this, associated with allogeneic procedure is Hepatic veno-occlusive disease (VOD) where tiny veins and other blood vessels inside the liver become blocked. Also, several after years of treatment, cancer may relapse or new cancer cells may develop as a consequence of the treatment.

After the bone marrow transplant, patients will have blood tests and some other routine examinations to monitor their condition. In order to treat the side effects like nausea and diarrhoea, medicines and other drugs may be taken. People need to be under close medical care depending on the type of transplant and risk of complications for several weeks and months. Patients are also provided with periodic transfusions of red blood cells and platelets until the bone marrow becomes stronger. Maintaining a proper diet and routine can help lower the risks associated with stem cell transplantation. Diet of a patient should include plenty of fruits and vegetables, lean meats, poultry and fish, enough fiber et cetera. Keeping the body hydrated by drinking adequate amount of water and other fluids each day is needed. Exercises can also be beneficial for patients with bone marrow or stem cell transplant. Exercising regularly can help to control the weight of the body, strengthen bones and increase endurance and also strengthen the muscles and heart.

Time taken for recovery depends on the type of bone marrow transplant procedure and on the individual health condition of the patient. After an autogenic treatment, patients are provided with antibiotics and other drugs to prevent or cure any side effect. If required, they get blood transfusions through the transplant catheter. Time taken by the patients to recover after this treatment is approximately 2 weeks. For an allogeneic treatment method also, patients take antibiotics and other drugs which includes medications to prevent graft-versus-host disease. In this case, the time taken by each individual patient varies. For an ablative transplant procedure, patients are required to stay usually in the hospital for about 4 weeks in total. In the case of a reduced intensity transplant, patients either stay in the hospital or visit the clinic daily for about 1 week. After this, mostly, the patients show remarkable progress in their health conditions.

The cost of bone marrow or stem cell transplant is pretty high in comparison to other treatment options. This procedure can incur around Rs 450000/- to around Rs 650000/- depending on the type of treatment and severity of the condition. In some centres the treatment cost may be higher depending on the other associated tests and post treatment care.

Multiple clinical studies on patients with bone marrow transplant have shown that when effective, the results last for many years. Thus, the result can be considered permanent to some extent. But, sometimes, after several years of treatment, people may find recurring symptoms of cancer. These cancer cells could relapse or could be caused as an adverse effect of the stem cell transplant treatment. In such circumstances, the treatment thereafter becomes very difficult. Hence, people need to be very cautious and careful in order to prevent any further complications.

People with cancer can continue treatment with medicines and drugs as an alternative to bone marrow or stem cell transplant. Medicines that are commonly used by patients who do not undergo stem cell transplant are thalidomide, dex, velcade, doxil etc. Maintaining a very complex regimen of natural and homeopathic treatments can also bring an improvement in the condition of the patients, especially for those with knee joint pain and arthritis.