Allogeneic Bone Marrow Transplant Unit

The Centre for Bone Marrow transplant at Yashoda hospital is one of the most recommended units for patients needing highly specialized treatment for blood-related disorders. A team of internationally trained haematologists, haematopathologists, transfusionists, and transplant physicians provide optimum patient care using a multidisciplinary approach to develop a more effective treatment plan.

Intending to improve the quality of life of patients and their families, the Centre offers world-class treatment facilities using advanced technology and the latest therapies to treat most of the complex conditions requiring allogeneic transplantation.

What Is Allogeneic Transplant?

Allogeneic transplantation is a type of transplantation where a donor (a healthy person) is required to donate stem cells/Bone marrow. These stem cells are transferred to the patient's body after high-intensity chemotherapy or radiation. The donor can be a person whose bone marrow matches with the patient's bone marrow, genetically similar person like a brother or sister, or maybe an unrelated person.

The process of Allogeneic Transplant involves:

The transplant process can be performed either by using bone marrow harvesting or Peripheral blood stem cells:

• Bone Marrow Harvesting: Liquid bone marrow is extracted from the back of the pelvic bone by sedating the donor using general or regional anaesthesia and making several incisions that are less than one-fourth inch long and does not require stitches.
• Stem Cells Harvesting: Peripheral blood stem cells from the donor's body are harvested; this process is called Apheresis. In this process, the blood from the donor's arm is transferred to a special centrifuge called an apheresis machine. The stem cells are isolated from the blood, and the left-over blood is transferred back to the donor through another arm, and the stem cells are used for the transplantation process.

What Are The Indicators For This Transplantation?

There are numerous severe health conditions which require bone marrow transplant as a cure. Such illnesses include:

Non-malignant diseases

• Bone Marrow Failure States, including:
  • Severe aplastic anaemia
  • Fanconi's anaemia
  • Paroxysmal nocturnal haemoglobinuria (PNH)
  • Pure red cell aplasia: Acquired and inherited (DBA)
  • Amegakaryocytosis / congenital thrombocytopenia
• Immunodeficiency states
  • Severe combined immunodeficiency (SCID)
  • Wiskott-Aldrich syndrome
  • Chediak-Higashi syndrome
  • Congenital neutropenia
• Metabolic disorders
  • Hurler's syndrome (MPS-IH)
  • Adrenoleukodystrophy
  • Metachromatic leukodystrophy
  • Gaucher's disease
  • Nieman picks a disease
  • Osteopetrosis
• Hemoglobinopathies
  • Beta-thalassemia major
  • Sickle cell disease

Malignant diseases

• Acute lymphoblastic leukaemia (ALL)
• Acute myelogenous leukaemia (AML)
• Chronic myelogenous leukaemia (CML)
• Juvenile myelomonocytic leukaemia (JMML)
• Chronic Myeloid- Monocytic Leukemia
• Chronic Lymphocytic Leukemia
• Myelodysplastic Syndrome
• Multiple Myeloma
• Hodgkin's and Non-Hodgkin's Lymphoma
• Myeloproliferative disorders: Myelofibrosis

What Is The Procedure Of The Transplantation?

Allogeneic transplantation offers higher chances of curing the disease related to blood and bone marrow cancers and other disorders. Some preparation is made by the doctor before the surgery to ensure high safety and better outcomes which a patient must follow.

Step 1: Pre-transplant Process: To ensure their general health and the status of the current medical condition, a patient has to take a series of Pre-transplant tests and procedures. This process of analysis may take several days.

• Beginning Medical Evaluation
• Conference For Treatment Plan
• Central Venous Catheter Evaluation And Insertion
• Bone-Marrow/Stem Cells Harvest

Step 2: Conditioning Process: After the completion of the medical evaluation, a patient undergoes the conditioning process. This process involves the use of either chemotherapy or radiation therapy or a combination to:

• Destroy any cancer cells in case of malignancy
•  Preparing the patient's bone marrow for the growth of new stem cells.
•  Suppressing the patient's immune system

Step 3: Allogeneic Transplant: For the cytotoxic treatment, the patient has to undergo the transplantation of the harvested where processed cells are put back into the patient's body, through a central venous catheter. These cells then move through the bloodstream into the bones' places, where they tend to create new bone marrow. The transplant provides a patient's body with a tendency to create new blood cells in a process, which is known as engraftment.

Step 4: Engraftment: The patient is kept under close monitoring for the sign of the growth of new stem cells along with supportive care.

Step 5: The Patient undergoes Post Engraftment monitoring and continuation of immunosuppression

What Are The Precautions One Must Take Before And After The Transplantation?

The precautions a patient must follow on a doctor's advice, before and after the transplantation process include:

Before the Transplantation:

• Tell your doctor in detail about your medical history or if you are taking any medication.
• To remove the excreted drug in the form of sweat, through the skin, patients must shower twice a day after chemotherapy thoroughly.
• Perform the test prescribed by the doctor.
• Avoid drinking alcohol or smoking tobacco.
• Prepare yourself mentally and physically for the transplant.
• Do not eat a heavy meal a day before the transplant.

After the Transplantation:

• Follow a strict regime, advised by the doctor, because after transplant, your immune system is weak, and you might catch the infection.
• Administrate all the prescribed medicines on time.
• Avoid environmental exposure.
• Try to focus more on maintaining proper hygiene and stay in a neat and clean room.
• Make hand wash a regular habit.
• Get an adequate vaccination as prescribed by the doctor.
• Try to maintain a healthy weight and take a balanced diet.

Are There Any Complications Involved?

Usually, a patient receives high-intensity doses of chemotherapy or radiation therapy before a transplant, resulting in complications such as:

• Infections
• Mouth and throat sores
• Nausea
• Stomach and intestinal irritations
• Skin redness
• Bleeding
• Anaemia
• Organ problems in liver and lungs

Other complications due to transplant include:

• Pain
• Chills
• Fever
• Flushing of the face
• Nausea and vomiting
• Hives
• Chest pain
• Graft-versus-host-disease (GVHD): a condition in which new bone marrow from the donor attacks healthy cells. Thus it is suggested to use the more genetically close donor for the transplant.

There is a low success rate of allogeneic transplant bone marrow transplant as compared to autologous bone marrow transplant as it requires external donor for transplantation.