Bone marrow transplantation includes introducing into the organism healthy hematopoietic donor cells in order to replace damaged or diseased ones. This method is one of the best in the treatment of blood diseases.
Donor selection is performed by searching for the blood that is similar to patient’s. More similarity in the major histocompatibility complex is, better the donor is. Clinics in the developed countries have huge donor bases.
Hospitals in the developed countries have modern equipment. To find the best hospital for a bone marrow transplant, you may contact Booking Health.
The cost of treatment depends on the hospital where you undergo treatment. Average price for a bone marrow transplant is 40,000(€).
Earlier transplants were performed only in young patients. Now, thanks to the methods of preparation for transplantation and methods of supportive therapy during the transplantation (antibiotics therapy, transfusions of blood components), it became possible to perform this procedure for patients over 60 years. In addition, immunotherapy after transplantation improves control of blood cancer symptoms. Inclusion of biological agents that prepare the body for the upcoming bone marrow transplantation in the treatment program have significantly improved the results of transplantation. Also, this made it possible to expand the contingent of patients for whom bone marrow transplantation is indicated (in particular, by age) and appropriate (we are talking about expanding the spectrum of diseases in which this procedure is indicated).
Regardless of the initial prognosis for patients with blood cancer and other types of cancer, from 15 to 20% of them are resistant to chemotherapy, and 20-40% of them have relapses.
- Bone marrow transplantation – how does this work?
- Poor response is not a sentence
- Methods of bone marrow transplantation in Germany
- Stages of the bone marrow transplantation
- Outpatient care after bone marrow transplantation
- Prevention of infections
- Out of home
- Rehabilitation period after bone marrow transplantation
- Cost of bone marrow transplant in Europe
Bone marrow transplantation – how does this work?
Cancer therapy also affects the patient’s healthy bone marrow cells, which disrupts the process of generating new blood cells. Therefore, to restore the hematopoietic system, a person needs donor for bone marrow transplant. When bone marrow transplantation is performed, even if the blood cells are selected taking into account the main histocompatibility antigens, the bone marrow transplant may not survive. What to do in this case? Previously, patients with cancer had practically no chance to live without the constant introduction of blood cells, as their own hematopoietic system ceased to cope with this task. In addition, such patients could only live in a sterile environment.
German doctors have proved that the solution of this problem could be bone marrow transplantation. Bone marrow transplant of mesenchymal stromal cells (MMSCs) have demonstrated significant clinical success. After transplantation of MMSCs, hematopoietic bone marrow stem cells survive much better in patients with blood cancer. After the first bone marrow transplant, the level of blood cells and elements in the peripheral blood increases.
Poor response is not a sentence
During the bone marrow transplant, 1/50 part of the donor material is typically enough for isolating sufficient amount of MMSCs for transplantation to patients. In addition, the bone marrow transplantation departments of large hospitals have the latest technological developments in field of bone marrow transplantation. Hospitals are equipped with the latest technologies, so you can take advantage of accurate diagnostics and highly effective methods of cell therapy. Hematologists, oncologists and onco-radiologists work together at the hospital in order to provide patients with high-quality medical care and an individual approach.
Methods of bone marrow transplantation in Germany
Bone marrow transplantation is more often indicated for patients with blood cancer. Given that in this type of cancer the blood suffers significantly, the patients' chances for recovery were not so great. Now, applying transplantation of bone marrow to treat blood diseases, patients' blood counts and immunity can be normalized. There are the following types of the procedure:
- Allogeneic transplantation. This is a type of bone marrow transplant from a donor. The treatment results are much better when bone marrow donor is compatible with the patient according to the immunological indications, i.e. a donor is the close relative of the patient.
- Autologous bone marrow transplant. In this case, own patient’s cells are used. They are harvested before the chemotherapy start, when the bone marrow is not damaged.
You can undergo both types of transplantation in German hospitals. If you don't have the related donor for the allogeneic procedure, German specialists will find the one in the International bone marrow donor registry. Autologous procedures are carried out with all the precautions, so that the harvested cellular material doesn't contain malignant cells.
Stages of the bone marrow transplantation
Bone marrow transplant clinics have the best conditions for patients who need stem cell transplantation abroad. Bone marrow transplantation clinics in Germany offer the following procedures:
- Diagnostics. At the hospital a patient undergoes a series of studies, namely, ECG, blood tests, X-ray examination, CT, MRI, bone marrow biopsy, and others.
- The donor search (is done in allogeneic transplantation). In Germany clinics use the services of central register of donors of the bone marrow ZKRD. This is the second largest base of bone marrow transplant donors in the world. As a rule, the duration of the search of bone marrow transplant is from two to six weeks.
- Typing for HLA. This is a blood test that helps determining the genetic compatibility of a potential recipient and the donor.
- Examination of the donor to assess his health state.
- Harvesting hematopoietic cells from the bone marrow. It is also possible to take cells from the peripheral blood. In the latter case, the donor or the patient receives drugs that stimulate the formation of blood hematopoietic cells. As for the bone marrow transplant, the material is harvested under general anesthesia by aspiration from the femur. Patient spends some time in the hospital and takes painkillers.
- Chemotherapy. With the treatment the patient also loses immunological protection, since immunocompetent cells are also destroyed. In order to avoid infections, the patient is placed in a ward with a high level of sterility.
- Bone marrow transplant. As a rule, in Germany, the introduction of hematopoietic cells occurs 2 days after previous stage.
- Bone marrow transplant engraftment. For about three months, the patient stays in the clinic under the supervision of doctors. At this time, cell engraftment and body repair take place.
Outpatient care after stem cell transplant
Before you return home after bone marrow transplantation, you and your caregiver should prepare for this. You will still need to take precautions to prevent infections.
This phase of your recovery after bone marrow transplant will take a long time – 1 year (or more) from the moment of discharge after bone marrow transplantation. You should remember that regardless of the fact that the composition of your blood returns to normal levels, your immune system is still very weak and you need a special care. You will still need to take medicines.
Your transplant crew will give you the detailed recommendations, including medications intake and control examinations.
Prevention of infections
It usually takes from 3 to 12 months to restore the immune system after transplantation. The first year after transplantation is comparable to the first year of a newborn’s life. Such constraints are the price of your healthy life. Depending on the results of blood analyzes, recommendations below may be adjusted to your current state.
There are some general tips to help prevent infection:
- Wash your hands with water and antibacterial soap, or use an alcohol-containing antiseptic
- Stay away from sick or newly ill people
- Wear a mask in a public place or when there may be strangers near you (if the transplant crew asks you to)
You are allowed to have close physical contact with loved ones. However, it should not be close to contact with those who are ill, or who have symptoms of the disease. Wear a mask if you have an information, that someone has been in the same room with a sick person.
Out of home
Go for walks regularly, but avoid polluted places and building sites. Hiking is an excellent way to restore strength and endurance.
Try to withhold from visiting crowded places, since the cost of your stay in such places may be the development of infectious complications. You can visit these places during those hours when they are not so crowded.
We appreciate that you may need to use a taxi, passenger services or other means of transport. When using these types of transport, we recommend that you wear a mask. Your doctor will give you information when these restrictions expire partially or fully, but only after checking your blood counts.
Rehabilitation period after bone marrow transplantation
Upon completion of bone marrow transplant procedures, patients in German clinics undergo immunosuppressive therapy and vaccination. It should be understood that the human immunity after bone marrow transplantation is still weakened, and doctors need to take all measures to protect the patient's body from infectious complications.
In this regard, the following measures are recommended:
- Hygienic procedures. During the rehabilitation period, until your health system becomes stronger, you should pay special attention to care for your body, oral cavity and adhere to measures for the herpes prevention.
- Avoid crowded places to minimize the risks of getting flu, colds and other viral or bacterial pathologies.
- For a while, you need to exclude walks in direct sunlight.
- For some time (as agreed by the doctor), the intensity of physical activity should be limited. The doctor tell you when it will be possible to return to the usual rhythm of life without any risk for your health.
Failure to comply with the rules can cost a person health or even life.
Cost of bone marrow transplant in Europe
One of the crucial points for patients with cancer is the cost of therapy. It is difficult to answer the question how much a bone marrow transplant treatment cost in Germany, since each clinic has own prices. The price may vary depending on the city, the scientific degree of the doctor and many other factors. Throughout the world this procedure is quite expensive. The main amount of money is spent on immuno-replacement therapy in the postoperative period.
Thanks to many years of cooperation between Booking Health and German clinics, Booking Health patients undergoing treatment abroad do not pay the additional fees for foreign patients. Due to this, the price of treatment is significantly reduced. Booking Health has vast experience in working with cancer patients who need bone marrow transplantation abroad, so the company takes into account all needs of the patient. We can assure you that we will do our best for patients. We also provide interpreter, transfer, accommodation and visa services. Our company will become your assistant and will give you information about treatment cost or any other you are interested in.
Authors: Dr. Nadezhda Ivanisova, Dr. Farrukh Ahmed