Bone Marrow Transplantation And Cellular Therapy
What is Bone Marrow Transplantation?
Bone marrow transplantation is the replacement of a damaged or completely destroyed bone marrow with new bone marrow cells. Bone marrow transplantation can be a life-saving method in Acute Leukemias and Lymphomas which are resistent to standard chemotherapy.
Types of Transplantation
Stem cells might be collected from our own body or another person. This other person is called donor.
Autologous transplantation is the procedure of using the person’s own stem cells. This method of transplantation is mainly used in Multiple Myeloma and Lymphoma patients.
Full Matched Allogenic transplantation is the procedure of using another person’s fully compatible stem cells. This is preferably a Full Matched sibling of a patient.
Matched Unrelated Donor Transplantation: Performed for patients who do not have a full matched sibling. It is found by searching National and International BoneMarrow Banks.
Haploidentical Transplantation: Performed for patients who do not have a full matched sibling and in urgent need of transplantation. Donor is a half matched sibling, mother, father or child of the patient. It is a relatively new method and can be as effective as Matched Unrelated Donor Transplantation in experienced centres.
How is the donor determined in Matched Unrelated Donor Transplantation (MUD)?
- If the patient doesn’t have a related donor National and then International(DKMS, BMDW) databases are searched for an unrelated donor using donor. 10 Parameter high-resolution HLA typing test will be performed in order to check donor registries.
- Once the patient’s HLA-type is known, a preliminary search can be performed. The preliminary search is a computerized search designed to identify potential bone marrow donors that have similar HLA antigens.
- If the preliminary search is successful in identifying potential donors a formal search is initiated. During this process, potential donors are contacted by the bank and blood samples are obtainedto confirm HLA-typing and perform other screening tests. These additional blood tests are more specialized and are designed to determine which donor is the best possible match.
- An unrelated donor search is a complex and time-consuming process. On average, it takes up to 3 months to complete the search process.Therefore, it is imperative to begin the unrelated search process as soon as possible.
- Once adequate number of stem cells are collected from the donor, stem cells will be sent to Altunizade Acıbadem Transplant Centre for the transplant procedure.
What is Haploidentical Transplantation?
A very special method oftransplantation that is currently perfomrned in only a few centers worldwide is the Haploidentical stem cell transplantation .This methodis likely to eliminate the problem of finding a donor completely and therefore considered as the transplantation method of the future. 10/10 tissue match is not considered essential in Haploidentical transplantation, and the mother, father, semi-compatible sibling or the child of the patient can be a donor even if ther e is only half compatibility.
Which diseases is BMT used for?
Bone marrow transplantation is performed in individuals who have diseases affecting the bone marrow such as leukemia or myelodysplastic syndrome, other hematological malignancies such as Lymphomas and Multiple Myeloma, Aplastic anemia where the bone marrow cannot provide adequate blood-forming cells. It can also be used in a number of chemotherapy unresponsive Oncological cancers such as testicular cancer, neuroblastoma and medulloblastoma and Congenital disorders such as Thalassemia, Sickle cell disease, Porphyrias, severe immunudeficiency disorders.
How long does the healing process take after the transplantation?
High-dose chemotherapy leads to nausea, diarrhea, fever, hair loss, and need for blood and platelet transfusion. Within two weeks after the transplantation, the new cells find their places and start producing cells. Patient’s general condition improves with elevating blood cells levels, and then, they get to a point where they can be discharged. From that point on, they return for follow-up visits at regular intervals.
How long do follow-up visits continue for?
The follow-up period after the transplantation at Altunizade Acıbadem Hospital varies between 3 months to a year depending on the progress of the patient who is then returned to be followed up in the home country. Within the first year, the patient’s immune system needs to be protected as it is affected by the therapy. They are advised to avoid crowded environments because even upper respiratory tract infections that are transmitted from other people may require inpatient treatment. Therefore, the patients are advised to reorganize their lives. Provided that these warnings are not ignored, majority of the patients can return to their work life within 3-6 months. Additionally, they are also advised to eat cooked meals and eat peeled fruits and vegetables for the first few months.
Is it possible to have a child for patients who underwent bone marrow transplantation in the following years?
In some cases, the fertility may be affected due to chemotherapy. Families who are planning to have children are sometimes able to do so using in vitro fertilization method. If there is time before initiating treatment, freezing sperms or ova might be an option.
How Exactly is the Allogenic Transplantation Procedure?
- In all types of Allogeneic transplantation both patient and donor are analyzed by extensive pre-transplant tests including routine blood, cardiological, respiratory and dental work-up. HLA tests are repeated to check compatibility.
- In Haploidentical transplantation there are tests which can predict whether the cells of the donor has a high chance of rejection by the patient. If these tests are positive then the donor is changed and a new donor is asked to come.
- These tests usually take 4-5 days and if the donor is suitable mobilization of stem cells from the donor is commenced. As the donor arrives to the hospital a catheter is inserted in each arm and stem cell collection is commenced via an apheresis machine and continued until enough cells are obtained for the patient. This usually takes about 2 days.
- Once adequate number of stem cells are collected from the donor it is now time to start the transplant procedure. The donor may return to his country at this stage. Hence the duration of stay for the donor is approximately 10 days.
- The patient is admitted to the hospital and a central catheter is inserted into a neck vein. This catheter is used throughout the transplant procedure to give chemotherapy, other medications such as antibiotics, blood and platelet transfusion and to perform blood tests.
- The duration of chemotherapy for Full HLA matched Allogeneic transplants is 6 days, for Matched Unrelated Donor transplantation 7 days and for Haploidentical transplantation 9 days. Following a days rest the donor stem cells are infused just like transfusing blood through the catheter in the neck the next day.
- Following chemotherapy and during the latter parts of the transplant the patient usually has chemotherapy induced loss of appetite and diarrhea. There is need for blood and platelet transfusion. Pyrexia is frequent and treated by antibiotics administered through the catheter in the neck.
- Stem cells start to engraft approximately 10 days following the transplant. Symptoms of loss of appetite, diarrhea and others usually start to improve at this stage. However, the patient will be ready to leave the hospital after another 5-7 days as there will still be a need to stabilize the blood counts, electrolytes and adequate oral feeding. Hence the total duration of hospital stay is approximately 1 month.
- Once the patients are clinically stable they are discharged from the hospital andlooked after in approved apartment hotels where they stay with their family. Transport is provided for clinic controls and follow-up bloodtests. A translator is always present both for in-patient and out-patient purposes.
- Bone marrow analysis is usually performed 1 month after the day of the transplant to make sure that there is no disease and to check that the cells indeed belong to the donor.
- When determined to be in stable condition patients are transferred to their country. The estimated average time from the day of admission to the return date is approximately 2 to 3 months, but this may change if there are problems such as ongoing infections or slow rising blood counts or other complications.
- If there are complications, such as infections not responding to standard treatments during stay in home country thepatient may return Altunizade Acıbadem for further care.
Why Altunizade Acıbadem Hospital?
Services are provided in a sterilized environment conforming to international standards. Interdisciplinary work is important in bone marrow centers. When necessary, support is provided by all relevant branches such as intensive care unit, general surgery, cardiology, nephrology and ear-nose-throat. Transplanted stem cells are prepared in licensed GMP laboratory of Acıbadem Healthcare Group; and all cells are analyzed for vitality, count and activity prior to the transplantation procedure.
- Haploidentical transplants at Acıbadem Hospital are performed by alpha-beta T-cell depletion to reduce the lethal complication of Graft versus host disease and hence reduce patient loss as a result of this complication.
- CD19 positive cells are also depleted to avoid post transplant lethal Epstein Barr Virus (EBV) infection. This also avoids EBV related lethal Lymhoproliferative disease.
- Mesenchymal stem cell support which helps to reduce Graft versus host disease, aid engraftment and help speedy recovery of immune function is provided for all Allogeneic transplants including Full matched. Matched Unrelated and Haploidentical transplantation.
- CD45Ra depleted donor T-cells are routinely infused to all Haploidentical transplantation patients in order to boost the antiviral immunity.
- Virus specific T-cells are routinely provided for resistant CMV, EBV, BK virus, Adenovirus and Herpes Simplex Virus activation in the patient. This procedure can be life saving at times.
- Altunizade Acıbadem Hospital utilizes the latest transplant technologies and with the aid of an experienced clinical transplant team providing the patient with the best chance of survival.
- Altunizade Acıbadem Hospital presents economical transplant packages to establishments and is highly competitive in comparison with Western Europe and USA.