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Bone marrow transplant is one of the options associated with transplanting hematopoietic stem cells. Historically, the first surgery of this group, which includes:
- Bone marrow transplantation
- Cord blood transplantation
- Peripheral blood stem cell transplantation
A patient’s own bone marrow transplant is used less and less. Preference is usually given to the peripheral blood stem cell transplantation. The use of this type of surgery was made possible by the discovery and successful introduction of stem cell growth factors into practice.
Bone marrow transplant is an effective and very common surgery. Over a million of stem cell transplantations have already been carried out in medically advanced countries.
This technique annually treats tens of thousands of patients. The number of these operations is increasing every year.
Leukaemia is the most common indication for the bone marrow transplant. Nevertheless, there are many other diseases, which can be treated using this procedure.
In addition to leukaemia, these include the following malignant conditions:
- Myeloid disease
- Hodgkin's lymphoma
- Non-Hodgkin lymphoma
- Ewing's sarcoma
- Myelodysplastic syndromes
Non-malignant diseases, the treatment of which may also require bone marrow transplant:
- Aplastic anaemia
- Fanconi anaemia
- Sickle-cell anaemia
- Infantile osteaopetrosis
- Congenital immunodeficiency syndromes
- Some autoimmune diseases
Currently the possibility of combining bone marrow transplant with intensive chemotherapy and radiation therapy is being investigated. If other methods fail to manage the disease, this one can help to treat cancer of different locations. The research on the effectiveness of the procedure for the treatment of type 1 diabetes is also ongoing.
Principle of the treatment method
There are two main types of bone marrow transplant:
- Autologous - healthy cells for the transplant are obtained from the patient
- Allogenic - cells are taken from donor’s organism
Despite a well-established name - bone marrow transplant - in fact, stem cells are mostly obtained from peripheral blood. People are first prescribed drugs that stimulate the release of hemopoietic cells from the bone marrow. The blood obtained from the vein is subjected to apheresis. The unnecessary cells are eliminated, while the relevant ones are used for cultivation and transplantation.
The recipient’s bone marrow is inhibited by chemotherapy and radiotherapy before the transplantation. Myeloablative (complete destruction of the bone marrow) or non-myeloablative (its inhibition aimed at reducing the activity of immunity) chemotherapy is carried out. The decision is made by the doctor, depending on the purpose of the treatment and a specific clinical situation.
Features of autologous transplantation
The transplantation of a patient’s own stem cells cannot completely cure the disease. Nevertheless, such a surgery has a number of advantages:
- Rapid restoration of immunity
- Low risk of infection
- No risk of graft-versus-host disease
- No need to use drugs for suppressing immunity
The disadvantage is a high probability of relapse.
Peculiarities of allogeneic transplantation
Compared with autotransplantation, bone marrow transplant from a donor is less safe, but more effective.
Allogeneic transplantation involves the use of bone marrow, donor’s peripheral blood or frozen umbilical cord blood. The donor should have a good tissue compatibility with the recipient. To assess it, HLA-matching is performed (it determines person’s white blood cell antigens). The higher the compatibility, the lower the risk of complications. If five antigens coincide, it is a full compatibility.
As a rule, one of the relatives can become donor. The chance for both brother and sister to have the full tissue compatibility with the patient is 25%. However, the patient does not always have suitable relatives. Often it is necessary to look for the donor among strangers. There are special bases for it. One of the largest bases exist in Germany. It includes more than 5 million potential donors. This accounts for about 20% of all the world's bone marrow donors.
The donor’s stem cells are usually obtained from his/her peripheral blood. They are marked with magnetic marks. Then the blood is filtered out - the marked cells remain, while the remaining ones are removed. They are cultivated for a certain period thus increasing their amount.
If the patient needs his/her own bone marrow transplant, it can be obtained from the pelvic bone. The procedure is performed under anaesthesia and takes about 2 hours. The donor gives only 5% of the total bone marrow volume. It is completely restored within several weeks after the procedure.
Bone marrow transplant is a dangerous surgery with a high risk of complications, including fatal ones. Therefore, it is performed within strict regulations.
There are two main causes of death after the transplant:
- Graft-versus-host disease. The new bone marrow perceives the body as "alien" and produces immune cells that affect the skin, intestine, liver and other organs.
- Infectious complications. When the old bone marrow has already been destroyed and the new one has not yet been transplanted, the person actually does not have immunity. In addition, to prevent bone marrow rejection, the recipient takes immunosuppressants after transplant.
Nevertheless, positive outcomes are much more common. Bone marrow transplant can contribute to a full recovery of severe cancers or hematological diseases. It can also help to achieve a long-term remission.
It is impossible to predict the exact outcomes of bone marrow transplant for all patients straight away. The effectiveness of the procedure depends on many factors:
- Patient’s age
- Underlying disease and its stages
- Type of bone marrow transplant (allotransplantation or autotransplantation)
- Donor’s and recipient’s tissue compatibility
- Conditioning mode (non-myeloablative or myeloablative)
- Technical capabilities and resources of the institution, experience and skills of the doctors working there
Young people have the lowest mortality rate of not more than 5-10% around the age of 35. In the older age groups the risk of death during the procedure or shortly after can reach 30%.
Where is bone marrow transplantation conducted?
Bone marrow transplantation requires the skills and expertise of a highly qualified team of experienced doctors. For an incomparable medical treatment, German hospitals are highly recommended for the best medical procedures.
In order to choose a state-of-the-art clinic, use the online-platform of Booking Health. Here you can:
- Find an exceptional medical centre where bone marrow transplantation can be performed
- View the actual prices at this moment and choose the most attractive offer
- Enjoy the services of our consultants, who have vast experience in this sort of medical procedures and will be able to find the most suitable clinic to suit your needs regarding bone marrow transplantation.
By using our online-platform Booking Health you get reliable health care together with first class treatment. You will also save on costs for diagnostic and therapeutic costs, enabling you to save unto 70% on the total cost of the treatment. You also be provided with medical insurance that covers all unexpected expenses.
Choose treatment abroad and you will for sure get the best results!
Author: Dr. Nadezhda Ivanisova