Bone Marrow & Hametalogy

BMT & Hematology Treatment

Haematology is the branch of medicine which deals with the study of blood, a vital fluid which is essential for our existence. The bone marrow is a soft, spongy tissue present inside the bones and produces the red and white blood cells and the platelets. The marrow also contains unspecialized cells called Hematopoietic. Stem cell transplant surgeon in india which can turn into other types of cells such as bone marrow cells or any type of blood cells.

India has one of the best BMT and haematology hospitals concerned with the diagnosis and treatment of both benign and malignant disorders of the blood, which is caused by an abnormality in the functioning of the bone marrow. The Department of BMT & Haematology is staffed with skilled and qualified haematologists practicing evidence-based treatment adhering to international standards as well as cutting edge facilities, making it a highly preferred centre for bone marrow treatment and haematology treatment in India. Our haematologists are adept in the complete spectrum of haematology treatment, including bone marrow transplantation, blood cancer treatment, treating leukaemia disease, and other conditions such as an abnormal white blood cell and/or platelet count, enlarged lymph nodes and bleeding or clotting disorders. Our expert specialists are also proficient in the field of paediatric haematology.

Pediatric Hematology:

Paediatric Haematology is a sub-specialty which deals with the diseases of the blood in pre-teens and adolescents. These ailments can be hereditary, such as thalassemia or sickle cell anaemia, autoimmune diseases affecting the blood like autoimmune haemolytic anaemia, and other white blood cell diseases. For this we adopt a multidisciplinary approach where specialists from different department work in tandem to treat the patients effectively.

Hemato-Oncology:

India is a leader in the combined fields of haematology and oncology, as it has the required expertise and infrastructure to diagnose and treat the complete range of blood cancer as well as non-cancerous blood diseases. We are constantly involved in researching different forms of cancer in order to treat them more effectively. We also provide best-in-class patient care and a customized cancer therapy for our patients.

Treatment for Types of Blood Disorder Condition:

Anemia:

This condition is characterized by low levels of iron content or haemoglobin in the blood. Haemoglobin is responsible for transporting oxygen throughout the body. Therefore, low levels of haemoglobin results in a decreased supply of oxygen to the cells of the body, making us feel fatigued and weak. The different types of anemia are Aplastic Anaemia, Farconi Anaemia, Haemolytic Anaemia, Pernicious Anaemia, Iron Deficiency Anaemia, Sickle Cell Anaemia and Thalassemia.

Leukemia:

It is a type of cancer that affects the blood and the bone marrow. A cell in the bone marrow undergoes a transformation and turns into a leukaemia cell. Over time, these leukaemia cells suppress the development of normal cells. Leukaemia cancer is a blood disorder which affects the white blood cells. There are 4 types of leukaemia; Acute Myeloid Leukaemia (AML), Chronic Myeloid Anaemia (CML), Acute Lymphoblastic Anaemia (ALL) and Chronic Lymphocytic Anaemia (CLL). The hemato-oncologists at India is well-versed in diagnosing the leukaemia disease accurately and providing an effective leukemia treatment. Some common signs and symptoms of leukaemia include frequent infections, swollen lymph nodes in the neck and armpits, weakness and fatigue, swollen gums, bleeding and bruising easily, red spots on the skin (petechiae), pain in the joints and excessive sweating during nighttime. India has one of the best leukemia treatment centres in India thanks to its potent combination of state-of-the-art facilities and experienced specialists who are capable of tackling the most complex cases of blood cancer.

Hemophilia:

It is an inherited blood disorder in which the blood lacks certain proteins called ”clotting factors”, due to which the blood doesn’t clot properly leading to excessive bleeding.

Thrombosis:

This is an obstruction in the blood vessels due to which the blood supply is adversely affected. If this clot occurs or moves to the brain or lungs, it can be fatal. This is caused due to overactive clotting factors like platelets in the blood. There are two types of thrombosis depending on the location of the clot. Venous thrombosis is when the clot occurs in the veins, while arterial thrombosis is caused by a hardening of the arteries due to deposit of plaque. An arterial thrombosis can result in a heart attack or stroke.

Lymphoma:

It is a type of cancer that affects the body’s lymph system. The lymph system consists of lymph nodes and vessels that move lymph fluids throughout the body. These lymph fluids contain white blood cells which fight infections. There are two types of lymphoma: Hodgkin’s lymphoma and non-Hodgkin’s lymphoma. People who are affected by HIV or who are taking anti-rejection medicines after an organ transplant, and those who have undergone radiation therapy treatments are at a greater risk of developing this condition.

Myeloma:

It is a type of blood cancer which is related to lymphoma and leukaemia. In this condition, the plasma cells that produce infection-fighting antibodies multiply rapidly and release excess immunoglobulin into the blood, causing irreparable damage to the organs.

Bone Marrow Transplantation:

Hospitals in India possesses the required facilities in terms of both skilled manpower as well as premium infrastructure to perform bone marrow transplant with an aim to provide the best treatment for all kinds of blood cancers. We have skilled surgeons who are experts in performing the two types of BMT; autologous BMT and allogeneic BMT. In the former method, the stem cells are sourced from the patient themselves and is performed if the person has a healthy bone marrow. In the latter method, the stem cells are collected from a donor who must be a close genetic match. The donor can be a sibling or an unrelated person.

Stem Cell Transplant:

This involves injecting healthy stem cells into the body to replace diseased or damaged stem cells. These may become damaged due to exposure to chemotherapy or radiation therapy. BMT and Haematology care is an excellent and thorough service to treat all types of blood disorders and cancers.

What are Haematopoietic stem cells?

Hematopoietic stem cells (HSCs) are the stem cells that give rise to other blood cells. This process is called haematopoiesis. This process occurs in the red bone marrow, in the core of most bones. In embryonic development, the red bone marrow is derived from the layer of the embryo called the mesoderm.These includes autologous and allogeneic transplants in children and adults including matched unrelated and haplo identical transplants with and without T cell depletion

The conditions which necessitate a Hematopoietic stem cell transplant can be broadly classified into 2 groups and below are the few examples:

Cancerous diseases

• Acute Myeloid Leukemia

• Acute lymphoblastic leukemia

• Chronic myeloid leukemia in blast crisis/accelerated phase

• Relapsed/Refractory Hodgkin’s and Non-hodgkin’s Lymphoma

• Myelodysplastic Syndrome

• Myeloproliferative Neoplasms, Primary Myelofibrosis etc.

• Multiple Myeloma

Non-Cancerous conditions

• Severe aplastic Anaemia

• Haemoglobinopathies such as Thalassemia major and Sickle Cell Anaemia

• Immunodeficiency disorders like severe combined immunodeficiency, Chronic granulomatous disease, leucocyte adhesion deficiency

• Inborn errors of metabolism

• Hereditary storage disorders like Gauchers disease, Niemann–Pick disease

• Autoimmune disorders ,multiple sclerosis

Type of Hematopoietic stem cell transplants Autologous stem cell transplants

Hematopoietic stem cells are taken from the patient either by bone marrow harvest or apheresis for collection of peripheral blood stem cells, cryopreserved and then given back to the patient after high dose chemotherapy.

It is indicated in following conditions

• Multiple myeloma

• Relapsed/Refractory Hodgkin’s and Non-hodgkin’s Lymphoma

• Paediatric solid tumors like Metastatic Neuroblastoma ,relapsed/refractory germ cell tumors, metastatic Ewings sarcoma

• Tandem transplants for Paediatric high grade brain tumors like Medulloblastoma, Atypicalrhabdoidteratoidtumors etc.

Allogeneic stem cell transplants

Hematopoietic stem cells are taken from the healthy donor either by bone marrow harvest or apheresis for collection of peripheral blood stem cells.

There are various types of donors used for HSCT

Matched sibling donor (MSD):

Haematopoietic stem cells are taken from a genetically matched donor (6/6 or 10/10), usually a brother or sister. This type of MSD can be found only in 25-30 % of cases.

Matched unrelated donor (MUD):

As only 30 % of patients who require a stem cell transplant finds a matched sibling donor, for the rest 70 % of cases we have to search for a donor either in Indian or international recognised stem cell registries. If patient finds a 10/10 (or 9/10 in specific conditions) donor, we will approach concerned registries to get stem cells.

Haploidentical Donors :

A haplo-identical match is when the donor is a parent and the genetic match is at least half identical to the recipient. As many patients don’t have a MSD or MUD, haplo identical hematopoietic stem cell transplants are indicated in such cases. It can be done carried out either by giving post-transplant cyclophosphamide or various T cell depletion techniques like TCR alpha/beta, CD 19 or CD 45 RA depletion.

Umbilical cord blood transplant:

Either matched 6/6 or mismatched 5/6 (or 4/6 in specific conditions) unrelated cord blood cells can be used as source of stem cells for transplants(Either single or double units).

How is stem cell transplantation done? Assessment of Patient and Donor:

We first assess patients to confirm that they will benefit from stem cell transplantation. Several tests are also done to ensure that the patient is fit to undergo the treatment. If an allogeneic transplantation is being planned then we test the patient's brothers, sisters and if required, parents to find an HLAmatched donor within the family. If there is no HLAmatched donor in the family then we assess if the patient will benefit from receiving stem cells from an unrelated donor. An international donor search is then initiated and if such a donor is found, then a matched unrelated transplant (MUD) is done. We also ensure that the donor is fit to donate stem cells.

Process of Stem Cell Transplantation:

The patient is then admitted to our BMT unit for the 'conditioning regimen' which prepares his bone marrow space for transplantation. The donor stem cells are harvested either form the bone marrow or the peripheral blood. These stem cells are then infused in to the patient's veins, just like a blood transfusion is given. The patient does not have to undergo any surgery. The patient is then monitored for complications such as infections and these are treated, if they occur. Once the patients are stable and the new bone marrow starts producing blood cells (usually within 2-3 weeks) they are discharged and are followed up in the day-care and the out-patient department usually for 2-4 months to detect any new complication.

What are the usual complications of stem cell transplantation? Infections:

In the first few weeks after transplantation, patients are at a risk of infections. To decrease the risk of infections patients are kept isolated in rooms where the air is filtered to prevent fungal infections (HEPA filter). They are given food with a low bacterial load. We monitor patients for infection and attempt to treat these promptly and effectively.

GVHD: (Graft versus host disease)

In allogeneic stem cell transplantation patients are given medicines such as Methotrexate and Cyclosporine to prevent the donor cells from attacking the patient's organs, this condition is called as Graft Versus Host Disease (GVHD). Some patients will nevertheless develop GVHD and in most of these we are able to control it. Some patients may develop GVHD which persists after the first 100 days since transplantation and then they are said to have chronicGraft Versus Host Disease (cGVHD).

Rejection:

Occasionally the donor stem cells may be rejected by the patient's body and then we try to support them with transfusions and antibiotics. Some of these patients might benefit from a second stem cell transplantation.

Does stem cell donation harm the donor?

Stem cell donation is generally considered to be a safe procedure. The majority (more than 98.5%) of donors, who donate bone marrow, feel completely recovered within a few weeks. A small percentage (1.34%) of donors experience a serious complication due to anaesthesia or damage to bone, nerve or muscle in their hip region. The risk of side effects of anaesthesia during marrow donation is similar to that during other surgical procedures. Serious side effects of anaesthesia are rare. Common side effects of general anaesthesia include sore throat (caused by the breathing tube) or mild nausea and vomiting. Common side effects of regional anaesthesia are a decrease in blood pressure and a headache after the procedure. For donors who give stem cells from the peripheral blood, less than 1% experience a serious side effect from the donation process. We take all the necessary precautions to ensure the safety and wellbeing of the donor.