By Dr Pawan Kumar Singh (Max Hospital)
Bone Marrow Transplant is a treatment procedure by which we can cure diseases of the blood and other genetic diseases. In this treatment, the defective bone marrow is replaced by the normal. Transplantation means replacement of the recipient’s diseased organ by donor’s normal organ. In solid organ transplant it is simply taken out and replaced. Bone marrow is the internal part of long/flat bones where the blood cells are formed. In this treatment, first, the marrow of the recipient is destroyed by chemotherapy or radiation therapy (TBI-Total Body Irradiation) and then the Stem Cells from donor (HLA fully / partially matched) are infused through central line just like blood transfusion.
Diseases which can be cured by BMT
- Blood cancers
- Genetic diseases of blood cells
- Inborn errors of metabolism like storage disorders, Leukodystrophy, etc.
- Autoimmune diseases
Who can be the donor?
- HLA matched family donors: HLA (Human Leukocyte Antigens) typing is a must for Allogenic BMT. The chance of getting a full matched HLA donor is 1/3rd in siblings, and almost 1% in other members of family (increases in case of consanguinity)
- HLA mismatched family donor: With the remarkable developments made over 2 decades, Haplo-identical (half matched, 5/10) BMTs are being done with good results. We inherit half of our genes from either parent so Haplo donor can be any of immediate family member. With this the donor pool has increased a lot and now BMT can be offered to those remaining 2/3rd patients who are unfortunate not to have full matched donor.
- MUD BMT (Matched Unrelated Donor). In this, the donors are selected from worldwide registry of voluntary donors who are 9/10 or 10/10 HLA matched.
Risks associated with BMT
Risks are definitely associated with BMT and they are infections (bacterial and fungal), bleeding, rejection, VOD & regimen related toxicity in immediate post BMT phase and then infections (fungal and viral), GVHD, etc. But, in most cases, these complications can be managed effectively if timely interventions are done. The outcome of BMT depends on the type of disease with excellent results being in Aplastic Anemia, Primary Immunodeficiency diseases and thalassemia. And in blood cancers, also, seeing the chances of relapse, particularly in high-risk diseases, it is worth going for BMT because this treatment can provide cure and long term control of disease.
So BMT is a curative option in almost all disorders of blood and a good therapeutic option in many other diseases as well, especially Autoimmune diseases. We provide state of the art BMT facility.
(Dr Pawan Kumar Singh is Director, Centre for Bone Marrow Transplant – BLK – MAX Super Speciality Hospital)
