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Haematology and Bone Marrow Transplant

HCG’s haematology and bone marrow transplantation department houses experienced and skilled haematologists and BMT experts.

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Overview

The haematology and bone marrow transplantation department at HCG comprises experienced and skilled haematologists and BMT experts who specialise in the diagnosis, treatment and management of a broad spectrum of benign and malignant disorders of blood and bone marrow.

treatment and management

Benign Haematological Disorders:

1. Red Blood Cell (RBC) Disorders: The key function of red blood cells is to carry oxygen and the disorders that affect these cells are termed red blood cell disorders. Sickle cell anaemia, aplastic anaemia and thalassaemia are common red blood cell disorders.

2. White Blood Cell (WBC) Disorders: The key function of WBC is to regulate the body’s immune system. WBC disorders are caused by abnormal white blood cells, also known as leukocytes. WBC disorders are characterised by either very high or very low WBC numbers. Neutropenia and MDS are two major white blood cell diseases.

3. Platelet Disorders: The primary function of platelets is to support wound healing. Platelet disorders are characterised by either very high or very low numbers of platelets. ITP and dengue are two important platelet disorders.

4. Bleeding Disorders: Bleeding disorders are caused due to multiple factors. When an injury occurs, the blood does not clot, and this can lead to a multitude of health complications. Haemophilia is one of the bleeding disorders.

5. Clotting Disorders: Clotting disorders happen when blood clots unexpectedly in the veins and arteries. This affects the blood flow and functioning of the organs. Deep vein thrombosis happens when the clot occurs in the legs, and pulmonary embolism happens when the clot happens in the lungs.

Malignant Haematological Disorders/Blood Cancers:

1. Leukaemia: Leukaemia happens when bone marrow starts making abnormal white blood cells in excess quantities. These abnormal cells later enter into the bloodstream. Important leukaemia types include acute myeloid leukaemia (AML), acute lymphocytic leukaemia (ALL), chronic myeloid leukaemia (CML) and chronic lymphocytic leukaemia (CLL).

2. Lymphoma: Lymphoma starts in infection-fighting cells and is largely seen arising in the lymph nodes, spleen, thymus, bone marrow. More than 60+ types of lymphoma are identified; nevertheless, it is broadly classified into two types – Hodgkin’s Lymphoma & Non-Hodgkin’s Lymphoma.

3. Myeloma: Myeloma is a type of blood malignancy that arises from plasma cells. This cancer largely affects and damages the bones, immune system, kidneys and red blood cells. Multiple Myeloma is the most common type of myeloma.

Early detection and timely treatment play a significant role in the successful management of blood malignancies. It’s critical to diagnose and classify the disease correctly with the help of high-end specific tests.

Chemotherapy, radiation therapy and bone marrow transplantation are the common treatment methods used to treat blood cancers.

However, bone marrow transplantation is largely preferred as a curative option when the patient is at a high risk of relapse.

Bone Marrow Transplant

Stem cell transplant or bone marrow transplant is a medical procedure that replaces the destroyed or damaged bone marrow cells or stem cells with healthy bone marrow cells.

It involves the extraction of healthy stem cells, filtration and transferring them back to the donor itself (Auto Transplant) or to another individual, who is called the recipient/ donor (Allogeneic Transplant)

Why is Stem Cell Transplant required?

The goal of stem cell/ bone marrow transplant is to treat many diseases and a few types of cancer successfully. For some diseases, a stem cell/bone marrow transplant serves as the only potential cure.

A stem cell/bone marrow transplant becomes necessary when:

  • The existing bone marrow cells are damaged, destroyed or not functioning optimally due to health conditions such as aplastic anaemia, leukaemia, etc. A bone marrow transplantation in this case helps patients have a healthy, functioning marrow.
  • The immune system needs to be regenerated to fight the existing or residual cancers that could not be treated completely with radiation or chemotherapy.
  • The patient suffers from a health condition that affects the production of bone marrow cells or other serious immune system illnesses.
  • The normal functioning of the immune system is to be restored after high doses of chemotherapy and radiation that are given to treat malignant health conditions. This transplant, which is known as rescue, replaces the damaged bone marrow with the healthy bone marrow. This is commonly performed in diseases like lymphoma and neuroblastoma.

Types

Bone marrow transplant is categorised depending on the source of the healthy stem cells. In other words, the classification is made based on who the donor is. There are three types of bone marrow transplant:

1. Autologous Bone Marrow Transplant: As the name says, during an autologous bone marrow transplant, the patient is itself the donor. The stem cells are carefully extracted before the patient receives high-dose radiation or chemotherapy and are stored in the freezer. After the chemotherapy or radiotherapy, the stem cells are put back into the patient’s body, where they start producing normal blood cells.

2. Allogeneic Bone Marrow Transplant: The term “allo” means different. During an allogeneic bone marrow transplant, the stem cells are extracted from another individual, known as the donor, based on his/her HLA type (genetic match). The HLA type of the donor’s stem cells should match with the HLA type of the recipient’s. Allogeneic bone marrow transplant is further classified into two subtypes:

  • a. Related Donor Bone Marrow Transplant: In this type of transplant, the donor is picked among siblings, parents or children and transplant is initiated after confirming the HLA type matches. When the donor’s genetic make-up matches the recipient’s genetic make-up at least by 50%, it is called a haploidentical / half-matched transplant.
  • b. Unrelated Donor Bone Marrow Transplant: Unrelated donor or matched unrelated donor (MUD) is someone who is unrelated to the patient but has an HLA type that matches with that of the patient’s. Unrelated donors are found through bone marrow registries.

3. Umbilical Cord Blood Transplant: During an umbilical cord blood transplant, the stem cells are collected from the umbilical cord at the time of the childbirth. These stem cells are tested, typed and stored until they are used for transplantation.

Diseases That Can be Treated with BMT

Malignant Diseases:

  • Multiple Myeloma
  • Relapsed Hodgkin’s Lymphoma
  • Relapsed Non-Hodgkin’s Lymphoma (NHL)
  • Neuroblastoma
  • Relapsed Ewing’s Sarcoma
  • Metastatic Ewing’s Sarcoma
  • Medulloblastoma and other Brain Tumours
  • Metastatic Germ Cell Tumours
  • Myelodysplastic Syndromes (MDS)
  • Acute Myeloid Lymphoma (AML)
  • Acute Lymphocytic Leukaemia (ALL)
  • Chronic Myelogenous Leukaemia (CML)
  • Refractory Lymphoma
  • Myeloproliferative Neoplasms (MPN)

Non-Malignant Diseases:

  • Severe Autoimmune Diseases
  • Multiple Sclerosis
  • Aplastic Anaemia
  • Thalassaemia
  • Severe Immunodeficiency Disorders 
  • Inherited Metabolic Disorders

Frequently Asked Questions

1. Are all blood disorders genetic?

No, not all blood disorders are genetic. However, certain blood disorders are transferred from parents to their children. Examples: thalassaemia, sickle cell anaemia, haemophilia, aplastic anaemia, etc.

2. Is there a cure for sickle cell anaemia?

Sickle cell anaemia is generally treated with blood transfusions and stem cell transplant. Stem cell transplant serves as a potential cure for sickle cell anaemia.

However, the patient needs to discuss all the treatment options available with the specialists and make informed health decisions.

3. What is the best treatment for blood cancer?

Common treatment methods used to treat blood cancers are chemotherapy, radiation therapy and stem cell transplant. Chemotherapy uses anticancer drugs that stop the growth of cancer cells within the body. Radiation therapy is also used to destroy the cancer cells within the body. The last treatment method is the stem cell transplant, which is the curative approach towards blood cancers. During stem cell transplantation, existing bone marrow cells are replaced with healthy bone marrow cells received from a donor.

4. What is HLA typing?

Human Leukocyte Antigen (HLA) typing is a genetic test used to find a match for bone marrow and cord blood transplants. HLA is a type of protein or marker that is found on most of the cells in the body.

A close match between the recipient’s and donor’s HLA markers is essential for the bone marrow or cord marrow transplant to be successful.

5. Who can be an ideal stem cell donor?

Siblings are the best possible donors for stem cell donation as in about 30% of the cases, the brothers and sisters serve as a good match for the patient.

If there is trouble with having an HLA-matched sibling, then the next choice is the patient’s parents or children, where there is a possibility of a half-matched HLA. Since half of the HLA markers come from mother and another half from the father, the chances of other family members being a match are highly unlikely.

6. How to find a donor outside the family member?

When there is no suitable donor available within the family, the stem cells are to be received by an unrelated donor. In this case, the stem cells are procured from a domestic or international registry.

HCG – The Specialist in Cancer Care is tied up with all major national and international bone marrow registries to perform a quick search for the suitable donor and facilitate the transplant.

Usually, it takes two working days to find out whether or not any suitable donor match is available in the registry.

7. Is there any cost involved in preliminary donor search from the registry?

No, there are no charges for preliminary donor search. However, when the suitable donor is found, the patient has to bear the charges for the stem cell procurement. This fee shall be paid to the donor registry.

8. Does the donor have to be of the same blood group as the patient?

No, the patient and the donor do not have to be of the same blood group. There are about 6-10 major HLA markers that should match for a transplant to be successful. If these markers match, the transplant can be performed even between the donor and recipient of different blood groups.

9. Are pieces of bone removed during the transplant?

No, the bone pieces are not removed during a bone marrow transplant. The stem cells from the donors are collected through peripheral blood stem cell (PBSC) donation, wherein the blood is drawn through an IV and is passed through a machine that separates stem cells from other blood components. The remaining blood components are given back to the donor immediately, and the stem cells are given to the recipient.

10. Are stem cell donations done via surgery?

Around 90% of the donations are made through the non-surgical method of peripheral blood stem cell (PBSC) donation. The blood is drawn intravenously and passed through a machine called Apheresis that separates stem cells from other blood components, which are later transferred back to the donor, and the stem cells are transfused to the recipient.

Another method to collect the stem cells is the bone marrow harvest. During this procedure, the stem cells are collected by placing the needle into the soft centre of the bone, where the marrow lies. Hip bones and sternum are the common sites of bone marrow harvesting. Although this procedure is performed in an operation theatre, there is no surgery involved here.

11. Is stem cell donation bad for the donor’s health?

Stem cell donation does not cause any serious problems among donors. Not more than five percent of the donor’s marrow is harvested, and therefore, the donors need not worry about their immune system being affected. These stem cells replace themselves within 4-6 weeks.

12. How should a donor prepare himself for the transplantation?

The potential donor is made to undergo several tests to assess her health and genetic make-up, especially the HLA type. Once the HLA type is matched, the stem cells will be either collected through bone marrow harvest or peripheral blood stem cell donation – the latter is being more commonly used now.

The donor will be given growth factor injection 2-3 days before the donation. The donor will also be asked to get hospitalised for 1-3 days.

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