Blood and Marrow Transplantation
The Blood and Marrow [Stem Cell] Transplantation Program at Amrita Institute of Medical Sciences commenced in January 2013 comprising of both autologous and allogeneic transplants. This is the only centre in the private sector in Kerala.
The facility is 6-bedded and fully HEPA filtered. Dr. Neeraj Sidharthan leads the Blood and Marrow Transplantation Team. The Unit has full time nursing staff, duty doctors, Medical Social Worker/Counsellor.
The team has, so far, performed 142 transplants which includes 74 autologous and 68 allogeneic blood and marrow transplants.
Highlights of the Blood and Marrow [Stem Cell] Transplantation Program at AMRITA
- Performs both paediatric and adult blood and marrow transplants.
- One of the fastest growing stem cell transplant programs in India.
- We have performed haploidentical and matched unrelated donor transplants, both of which are First in the State.
- Performs unrelated donor apheresis and has also setup an exclusive unit for Stem Cell Cryopreservation with liquid Nitrogen (N2).
- CD34 detection lab facility.
- Registered with Indian Stem Cell Transplant registry and The Asia Pacific Blood and Marrow Transplantation (APBMT) group.
- Unrelated donor search in collaboration with DKMS (The German Bone Marrow Donor Center ) Germany and DATRI.
- In-house HLA testing.
- First successful treatment for acute blood cancer (myeloid leukaemia) in the country through a relatively new treatment protocol named ‘Microtransplant’.
- First ever Haplo Identical or Half Matched Stem Cell Transplantation in the State.
More on Stem Cell Transplantation
1. Stem Cell / Blood or Marrow Transplant
A stem cell transplant or a blood or marrow transplant, is the infusion of healthy stem cells into the body to replace damaged or diseased stem cells.
A stem cell transplant might be needed if the bone marrow stops working and doesn't produce enough healthy stem cells.
It may also be required if high-dose chemotherapy or radiation therapy is initiated in the treatment of blood-related diseases such as leukemia, lymphoma, multiple myeloma, sickle cell anemia or thalassemia.
Stem cell transplant can help the body make enough white blood cells, red blood cells or platelets, and reduce the risk of life-threatening infections, anemia and bleeding.
Depending on the source of the stem cells, the procedure may be known as bone marrow transplant, peripheral blood stem cell transplant or an umbilical cord blood transplant.
When body's own are used for the transplant, it is called autologous stem cell transplant and when a donor's stem cells are used, it is known as allogenic stem cell transplant. Syngeneic transplant is the stem cell transplant from as identical twin.
2. How is it helpful
Stem cell transplants can benefit people with a variety of both malignant (cancerous) and benign(non cancerous) diseases.
A stem cell transplant may help to treat blood disorders by:
- Killing Malignant cells: Powerful drugs(chemotherapy) with or without radiation therapy to kill the cancer cells.
Healthy stem cells collected from the patient itself or donor are then infused into the body. These new stem cells migrate to the bone marrow and over a course of time produce healthy new cells. The donor cells also are capable of destroying some types of cancer cells.
- Help you recover faster from high doses of chemotherapy and radiation: The healthy cells infused in a stem cell transplant may enable the patient to recover faster from chemotherapy and radiation.
Stem cell transplant poses many risks and complications, some potentially fatal.
Chances of complications depend on the reason for the transplant, the type of transplant, patient's age and the overall health of the patient.
However, some people experience very little problems with a transplant. Some people may develop serious complications which may require immediate attention or even hospitalization. The complication may vary depending on many factors. For example, Autologous transplant have respectively fewer complication rate.
Complications that can arise with a stem cell transplant include:
Graft-versus-host disease (allogeneic transplant only), Stem cell (graft) failure, Organ injury, Infections, Cataracts, Infertility, New cancers or even Death.
4. How to prepare for a stem cell transplant
When it is planned for a stem cell transplant as a treatment option, they do an assessment to find out if the person with cancer (recipient) is a suitable candidate for the procedure. Doctors may do several examinations and diagnostic tests to determine if candidates are physically and mentally prepared for the procedure. The recipient may also need other procedures to prepare for the stem cell transplant.
- Diagnostic tests : The doctor may do the tests to determine if a person is a suitable candidate for stem cell transplant such as complete medical history and physical examination, routine blood tests, such as complete blood count (CBC) and blood chemistry tests, tests for certain viruses, such as hepatitis, herpes and HIV, bone marrow biopsy, human leukocyte antigen (HLA) typing, electrocardiogram (ECG), echo cardiogram (Echo) or check heart function, chest x-ray and pulmonary function test (PFT) to check lung function.
- Consulting with the healthcare team : Members of the healthcare team teach the person with cancer and the family about the procedure and what to expect. They discuss the risks and benefits of stem cell transplants. They will also arrange:
- Dental care – Bad dental care may cause higher risk during or after a Stem Cel Transplant.
- Nutritional assessment – A dietitian can help make sure the recipient is eating as well as possible.
- Social work assessment – A social worker can help identify social support needs, find available resources and provide support throughout the transplant experience.
- Psychological and emotional evaluation – This assessment determines the person’s strengths and coping strategies.
- Fertility counselling – Infertility can be a side effect of high-dose chemotherapy or radiation therapy.
- ll the medical team can be called in for the fitness before the procedure.
- nce recipients have been fully informed about all procedures and agree to have a stem cell transplant, they sign a consent form (informed consent).
- Central venous catheter : A central venous catheter (CVC) is a thin, flexible tube. It is placed into the large vein above the heart, usually through a vein in the neck, chest or arm. It is also called central venous line or central line. A local or general anesthetic is given before the doctor places the CVC.
One end of the catheter stays outside the body. It is used to take blood samples, give medicines and fluids, give the stem cells
The catheter is put in at the time of stem cell harvest or before the high-dose chemotherapy is given. It stays in place until it is no longer needed.
- Donor preparation : For allogeneic stem cell transplants, the recipient’s transplant doctor identifies potential matches and arranges donor testing.
- Matching : To increase the chance of a successful transplant and to reduce complications, the transplanted stem cells must match the recipient’s as closely as possible. Most matches are between close family members (related donor), so the search for a donor starts with the recipient’s brothers and sisters. The closest match is an identical twin because identical twins have the same HLAs.
- HLA typing is usually done by a special blood test.
- A match of 6–10 specific antigens is thought to be important.
- A transplant is sometimes done with a match that is slightly less than perfect.
- There is a 1 in 4 (25%) chance that a sibling will be a match.
- The more siblings a person has, the higher the chance of finding a match.
If a sibling match is not found, parents or extended family members, such as aunts, uncles and cousins, may be tested. Parents and children of recipients are unlikely to be perfect matches because they pass on or receive only 3 of the 6 genes needed for a perfect match.
If a match is not found within the family (often, only brothers and sisters were tested), the search starts for an unrelated donor in the general public, the Bone Marrow Donor Registry like Dhathri (in India) and DKMS (in Germany). And also there is a feasibility of umbilical cord blood transplant where the matched cord blood can be obtained from cord blood registry
- Evaluation : Donors are checked to make sure that they are in good health and physically able to donate stem cells. Tests may include: complete history and physical examination of the donor, additional blood and urine tests, electrocardiogram (ECG) and chest x-ray.
Once donors are informed about the donation process and agree to proceed, they sign a consent form (informed consent).
When children are matched donors
When children are stem cell donors, a social worker or child-life specialist may be able to help them cope with the medical procedure.
- Harvesting the stem cells : The process of collecting the stem cells is called harvesting. Harvesting differs based on where the stem cells are collected from. Stem cells may be collected from bone marrow, peripheral blood or umbilical cord blood.
Stem cells may be harvested or treated differently for different types of stem cell transplants (allogeneic, syngeneic or autologous stem cell transplants).
For an autologous transplants, the stem cells are usually harvested when the person is in remission and has recovered from other treatments.
Occasionally, the stem cells are specially treated to destroy any remaining cancer cells. This process is called purging.
For some allogeneic and syngeneic transplants, the stem cells may be given to the recipient within several hours of being harvested from the donor. In other transplants, stem cells are harvested and mixed with a preservative so that they can be stored by a special freezing process. This is called cryopreservation. This process helps keep stem cells alive until it is time for the transplant.
Stem cells may be collected from the umbilical cord shortly after a baby is born. They are processed from the cord blood, frozen and stored until they are needed.
5. What to expect during and after your stem cell transplant
- During the stem cell transplant
Stem cell transplantation involves infusing donor stem cells through a central line into the body after completion of several days of chemotherapy, radiation therapy or both. The infusion usually takes a few hours, and the patient will be awake during the procedure.
The transplanted stem cells make their way to the bone marrow, where they begin creating new blood cells. It can take a few weeks for new blood cells to be produced and for the patient's blood counts to begin to recover.
Bone marrow or blood stem cells that have been frozen and thawed contain a preservative that protects the cells. Just before the transplant, the patient may receive medications to reduce the side effects the preservative may cause.
The patient may also likely be given iv fluids (hydration) before and after the transplant to help rid of the body of the preservative. Side effects of the preservative may include headache, nausea, fever, diarrhea, chills, hives or red urine
Not everyone experiences side effects from the preservative, and for some people these side effects are minimal.
- After the stem cell transplant
In the days and weeks after the stem cell transplant, the patient will have blood tests and other tests to monitor the condition.
- Medicines may be require to manage the complications such as nausea and diarrhea.
- The patient has to be under close medical observation.
- If the patient experience infections or other complications, they may need to remain in the hospital for several days.
- The patient may have to live in close proximity to the hospital in rate to facilitate close monitoring.
- The patient may also need periodic transfusions of red blood cells and platelets until the bone marrow begins producing enough of those cells on its own.
- The patient may be at greater risk of infections or other complications for months to years after the transplant.
A stem cell transplant can cure the diseases in some and put others into remission.
Goals of a stem cell transplant depend on the individual situation but usually include controlling or curing of the blood disorder, extending the life, and improving the quality of life.
Some people complete stem cell transplantation with a few side effects and complications. Others experience several challenging problems, both short and long term.
The severity of side effects and the success of the transplant vary from person to person and sometimes can be difficult to predict before the transplant.
It can be discouraging if significant challenges arise during the transplant process. However, it is sometimes helpful to remember that there are many survivors who also experienced some very difficult days during the transplant process but ultimately had successful transplants and have returned to normal activities with a good quality of life.