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Bone Marrow Transplant: Procedure, Risks, Cost in India

low cost Bone marrow transplant in India

  • 2021-04-24

Get Bone Marrow Transplant in India. The average Bone Marrow Transplant cost ranges from USD 40000 - 60000. in the best hospitals from the top Hematologist in India.

What is Bone Marrow Transplantation?

Bone marrow transplantation is a procedure to replace bone marrow that has been destroyed or damaged by the treatment of infection, disease, or cancer. This treatment includes stem cell transplantation, which travels to the bone marrow where new blood cells are produced and stimulate new bone marrow formation. Bone marrow transplantation and hematopoietic stem cell transplantation (HSCT) have been used more and more to treat many malignant and benign diseases across the world. Hematopoietic stem cell transplantation continues to be an advanced field in disease treatment with improvements in techniques, indications, and therapeutic intervention.

The first successful allogeneic bone marrow transplant in India was performed at Tata Memorial Hospital on March 20, 1983, in the case of Acute Myeloid Leukemia. From 2000 to 2020, the latest data shows that so far, a total of 19,000 transplants have been performed in the country, with allogeneic transplants preferred by most centers. The Center for International Blood and Marrow Transplant Research (CIBMTR) has 12 centers in India reporting their data to them. These figures are not large, however, and the centers that practice regular HSCT are minimal because of a variety of reasons, such as lack of adequate infrastructure, skills, and lack of awareness, efficiency, and cost of the procedure, both in the general public and the entire medical fraternity.

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Sources of Stem Cells for transplantation

The hematopoietic stem cell is the most important cell that is needed for a successful transplant. Bone marrow, peripheral blood, and umbilical cord blood are the major sources of stem cells for transplantation. It is possible to collect these from various donors. When they are gathered from the recipient, they are referred to as autologous. It is called allogenic when they come from someone other than the recipient.

Bone Marrow Transplantation Indications

Non- Malignant Diseases/ Conditions

Adrenoleukodystrophy

Hurler syndrome

Osteopetrosis

metachromatic leukodystrophy

Severe Combined Immunodeficiency

Wescott-Aldrich Syndrome

Acquired Immuno-Deficiency Syndrome- HIV

Pure Red Cell Aplasia

Sickle Cell Anaemia

Beta Thalassemia

Falconi Anaemia

Severe Aplastic Anaemia

Systemic Sclerosis

Severe Systemic Juvenile Rheumatoid Arthritis

Lupus

Multiple Sclerosis

Chron Disease

Malignant/ pre-malignant Diseases/ Conditions

Acute Lymphoblastic Leukemia (ALL)

Acute Myeloid Leukemia (AML)

Chronic Myeloid Leukemia (CML)

Juvenile Myelomonocytic Leukemia

Myelodysplastic Syndrome

Plasma Cell Disorders

Hodgkin’s Lymphoma

Non- Hodgkin’s Lymphoma

Causes

Radiation and chemotherapy treatments

Exposure to toxic chemicals

Use of certain drugs

Autoimmune disorders

A viral infection

Pregnancy

Unknown factors

Bone Marrow Transplantation Types

There are three types of Bone Marrow Transplantation. They include:

1. Autologous bone marrow transplantation - Also called Rescue transplantation. Before an individual receive high-dose chemotherapy or radiation treatment, stem cells are removed. The stem cells are then stored in a cold environment, such as a freezer. Then, the stem cells are put back into the body to make normal blood cells after high-dose chemotherapy or radiation treatments.

2. Allogeneic bone marrow transplantation - The term Allo means different. Stem cells are removed from another individual called a donor. Most of the time, the genes of the donor must at least partially match one’s genes. Special tests are done to see if the donor is the right match. Parents or siblings of the individual can be a good match.

3. Umbilical Cord Transplantation - This is a type of allogeneic transplantation. Stem cells are removed from the umbilical cord of a newborn baby immediately after birth. Stem cells are frozen and stored until they are needed for transplantation

Process of Treatment

Pre-transplantation Process

Before starting the bone marrow transplantation, a bone marrow evaluation is to be conducted. The bone marrow analysis is performed to determine the types of bone marrow cells that the patient needs.

If the individual is being treated for cancer, bone marrow aspiration and bone marrow biopsy should also be performed. Usually, a medical history will be required and a physical examination will be performed. This is an important step because the doctor needs to be sure that the recipient is an appropriate candidate for the transplant procedure. This phase of testing may take several days.

Bone Marrow Transplantation Process

The transplantation process consists of five phases

Conditioning

The conditioning period usually lasts between 7 to 10 days. The conditioning process is done to prevent the rejection of new stem cells and to create space for new cells. Total body irradiation (TBI) and cyclophosphamide or busulfan (Myleran, Busulflex), and cyclophosphamide are the most common conditioning regimens[6]. Patients generally tolerate conditioning well, although antiemetic therapy is used to prevent significant nausea that may occur.

Stem cell infusion and processing

Stem cell infusion is usually performed over an hour, but this period varies depending on the volume of the infusion. Stem cells may be processed before infusion if indicated. Depletion of T cells may be performed to reduce Graft versus Host Disease (GVHD). This is often done before haplotype-matched transplants or other transplants that may have a significant degree of mismatch. Stem cell CD34+ selection may be performed either for the depletion of T cells or the purging of tumor cells.

The patient is pre-medicated with acetaminophen and diphenhydramine before the infusion to prevent reactions. The cells are then infused through a central venous catheter, almost like a blood transfusion. Anaphylaxis, overload, and transient GVHD are some of the major complications.

Neutropenic phase

During this period (2-4 weeks), the patient does not have an effective immune system. The healing is poor and the patient is prone to infection. Supportive care and antibiotic treatment therapy are the key components of successful passage through this phase. Nosocomial infections may pose the greatest risk because they are often more resistant to the standard antibiotic regimens used. Fungal selection may occur during the initiation of widespread antibacterial therapy.

Typically, fever occurs 5-7 days after the start of a broad-spectrum antibiotic therapy and is treated empirically with antifungal agents such as amphotericin[6]. The use of oral antibiotics to reduce gut flora is controversial. They were shown to reduce the number of positive blood cultures attained but have not had a significant impact on outcomes. In addition to the risks of infection, nutrition is also a key issue. Oral intake is usually severely reduced due to the severe mucositis that most patients develop. Total parenteral nutrition is provided and is generally quite necessary, especially for children.

Engraftment phase

During this period, the process of healing starts with the resolution of mucositis and other acquired lesions. This may take up-to to several weeks. By this time, fever may start to reduce, and infections may begin to subside. Managing GVHD and preventing viral infections (especially CMV) are the challenges during this period. Rejection of the organ in solid organ transplants is a significant hurdle. However, in hematopoietic cell transplantation, the immune system is part of the transplanted organ; therefore, the new immune system can attack the whole body.

Patients undergoing allogeneic hematopoietic stem cell transplantation are typically placed on one or more immunosuppressive drugs to protect against the development of GVHD.

Besides, patients may develop an entity called Veno-Occlusive Disease (VOD). The etiology and effective management of VOD are unclear. VOD consists of a triad of hyperbilirubinemia, weight gain, and platelet- transfusion refractory[6]. Supportive care and effective monitoring of fluids are essential. Antifibrinolytic therapy has unproven benefits.

Post-Engraftment period

This period lasts from months to years. The key characteristics of this phase include the gradual development of tolerance, immunosuppression weaning, chronic GVHD management, and monitoring of immune reconstitution.

Most patients need reimmunization, usually starting one year after transplantation. Typically, tetanus (DT) is started with antibody titer obtained before and at least one month after the response has been documented. The use of DT vaccination is age-dependent Influenza vaccination should be given to all patients every year. Typically, after 2 years, vaccination with measles, mumps, and rubella (MMR) vaccines may only be administered if the patient has been effectively immunized with the vaccines referred to above, the patient has been immunosuppressed for more than 6 months and the patient has no Graft versus Host Diseases. All live virus vaccines should be avoided if at all possible.

Before the Procedure

Before the procedure, the patient’s past medical history will be taken and a physical examination procedure will be done by the provider. Before transplantation, the patient will have one or two tubes, called central venous catheters, inserted into a blood vessel present in the neck or arms of the patient.

After the Procedure of Bone Marrow Transplant

Bone marrow transplantation is usually performed in a hospital or health center that are specialized for bone marrow transplantation procedure. Most of the time, the patient stays in a special bone marrow transplant unit to eliminate the chance of catching an infection. Regular follow-up checkups are necessary after the bone marrow transplantation.

 

 

FAQs

How expensive is a Bone Marrow Transplantation in India?

The cost of bone marrow transplantation in India ranges from Rs.15, 00,000 to Rs.40, 00,000. The actual cost will depend on which BMT procedure is recommended for you. But the cost is very much cheaper in India than in any other western country. What are dietary restrictions during the treatment process?

After your bone marrow transplant, you may need to adjust your diet to stay healthy and prevent excess weight gain. The Dietitian and other transplant team members will work to develop a healthy eating plan that meets the needs of the patient and complements their lifestyle. He may also provide suggestions for food intake to reduce the side effects of radiation therapy and chemotherapy, such as nausea. Some of the recommendations of your dietitian may include:

Follow Food Safety Guidelines to Prevent Foodborne Infections

Eating a wide variety of healthy foods, including vegetables; fruit; whole grains; lean meat, poultry, and fish; legumes; and healthy fats such as olive oil.

Limit the intake of salt

Restriction of alcohol

Avoiding grapefruit and juice due to the effect upon immunosuppressive medication.

Is bone marrow transplantation a painful procedure?

In the course of the procedure, the donor may experience pain after the anesthesia has gone. Painkillers might be needed for the next few days. The procedure is relatively painless for the recipient, as the cells are injected through a vein.

How to determine the success rate of a transplant?

Until now, daily blood tests have been used to assess whether the newly transplanted immune cells have survived and have begun to multiply in the bone marrow, a process called engraftment. But it takes two to four weeks, sometimes more, for the doctors to know if the transplant was successful.

Will the patient be able to resume the work immediately after the bone marrow transplantation?

Doctors usually suggest that allogeneic transplant recipients wait at least 1 year after transplantation to get back to work. That's because it takes 9 to 12 months for your immune system to recover. Some people may get their doctor's approval to go back to work sooner.

Are there any potential risks to the donor?

The risk associated with bone marrow donation includes the use of anesthesia during surgery. After surgery, you may feel tired or weak and have trouble walking for a few days. The area where the procedure was done may feel sore for a few days.

Best Bone Marrow Transplant Hospitals in India

Hospitals in India offer State-of-the-art equipment and the latest technologies. Fully equipped ICU, CCU to recover patients. ECG, Echocardiography, Cath lab, Doppler, TMT, and much more. Advanced Equipment, Modern Infrastructure along with CTVS Operation Theatre.

Fortis Memorial Research Institute, Gurgaon

Indraprastha Apollo Hospital, Delhi

Max Super Speciality Hospital, Delhi

Dharamshila Narayana Super Specialty Hospital, Delhi

BGS Gleneagles Hospital, Bangalore

Wockhardt Hospital North Mumbai

Gleneagles Global Health City

Kokilaben Dhirubhai Ambani Hospital, Mumbai

BLK Super Speciality Hospital

Medanta – The Medicity, Gurgaon

 

Best Bone Marrow Transplant Doctors in India

Dr. Suparno Chakrabarti, Hematologist, New Delhi

Dr. TPR Bharadwaj, Hematologist, Chennai

Dr. Rahul Bhargava, Hematologist, Gurgaon

Dr Soumya Bhattacharya, Hematologist, Kolkata

Dr. Srikanth M, Hematologist, Chennai

Dr. Pravas Chandra Mishra, Hematologist, Ghaziabad

Dr. Chezhian Subash, Hematologist, Chennai

Dr. A. Karthikeyan, Hematologist, Chennai


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