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Haematology &
Bone Marrow Transplantation Department


  • Introduction Benign Haematological Disorders Malignant Haematological Disorders Bone Marrow Transplant Frequently Asked Questions
Introduction

HCG’s haematology and bone marrow transplantation department is a well-equipped unit of experienced and skilled haematologists and BMT experts who are specialised in the diagnosis and management of a wide range of benign and malignant disorders of blood and bone marrow.

9

Centers largest network BMT Centers

12

consultants and 60 nurses - Largest team of trained specialists

1200

Successful BMTs


All BMT Room with separate HEPA filters.

0.3 mm filtered positive airflow with 12 air exchanges per hour.

MDT for all complicated and BMT patients

Benign Haematological Disorders:

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Red Blood Cell (RBC) Disorders:

Red blood cell disorders are those that affect the red blood cells, whose key function is to carry oxygen to various parts of the body. Common red blood cell disorders include Sickle Cell Anaemia, Aplastic Anaemia and Thalassaemia.
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White Blood Cell (WBC) Disorders:

WBC disorders are associated with the abnormality of white blood cells or leukocytes, which control the body’s immune system. In WBC disorders, the white blood cells are either very high or very low in number. Major white blood cell disorders include Neutropenia and MDS .
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Platelet Disorders:

Platelets have a significant role in homeostasis and wound healing. In the case of platelet disorders, either the number of platelets increases or decreases or the functioning of the platelets is affected. Some of the major platelet disorders include ITP and Dengue.
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Bleeding Disorders:

In the case of bleeding disorders, when an injury occurs, the blood does not clot, which will eventually lead to various complications ranging from mild to severe. Haemophilia is one of the common bleeding disorders.
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Clotting Disorders: 

In the case of clotting disorders, the blood clots unexpectedly in the veins and arteries and affects the blood flow and functioning of the organs. If the clot occurs in legs, it is known as Deep Vein Thrombosis (DVT) and if it occurs in the lungs, it is known as Pulmonary Embolism.

Malignant Haematological Disorders/Blood Cancers: 

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Leukaemia:

Leukaemia is a form of blood cancer wherein the bone marrow makes many white blood cells that aren’t normal and produces too many which get into the bloodstream. Major types of leukaemia are AML, ALL, CML & CLL.
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Lymphoma:

This cancer begins in infection-fighting cells and is largely present in the lymph nodes, spleen, thymus, bone marrow. There are over 60+ types of lymphoma; however, it is broadly classified into two types - Hodgkin’s Lymphoma & Non-Hodgkin’s Lymphoma. 
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Myeloma:

Myeloma occurs in plasma cells, a type of white blood cell. This cancer affects and damages the bones, immune system, kidneys and red blood cell. Multiple Myeloma is the most common type of myeloma.  
  1. Early detection and timely treatment are important for successful blood cancer treatment. It’s critical to diagnose and classify the disease correctly with the help of high-end specific tests. 
  2. Chemotherapy, radiation therapy and bone marrow transplantation are the common treatment methods used to treat blood cancers. 
  3. 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 

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. (Allogenic 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:

  1. 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. 
  2. The immune system needs to be regenerated to fight the existing or residual cancers that could not be treated completely with radiation or chemotherapy. 
  3. The patient suffers from a health condition that affects the production of bone marrow cells or other serious immune system illnesses.
  4. 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 of Bone Marrow Transplant

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:

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. 
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 2 subtypes:

1) 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 .

2) 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.
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.

Bone Marrow Transplant is Suitable for:

  1. Multiple Myeloma
  2. Relapsed Hodgkin’s Lymphoma
  3. Relapsed Non-Hodgkin’s Lymphoma (NHL)
  4. Neuroblastoma
  5. Relapsed Ewing’s Sarcoma
  6. Metastatic Ewing’s Sarcoma
  7. Medulloblastoma and other Brain Tumours
  8. Metastatic Germ Cell Tumours
  9. Myelodysplastic Syndromes (MDS)
  10. Acute Myeloid Lymphoma (AML)
  11. Acute Lymphocytic Leukaemia (ALL)
  12. Chronic Myelogenous Leukaemia (CML)
  13. Refractory Lymphoma
  14. Myeloproliferative Neoplasms (MPN)
  1. Severe Autoimmune Diseases
  2. Multiple Sclerosis
  3. Aplastic Anaemia
  4. Thalassaemia
  5. Severe Immunodeficiency Disorders 
  6. Inherited Metabolic Disorders

Frequently Asked Questions on Blood Disorders and Bone Marrow Transplant

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.

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.

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.

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.

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.

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 registry to perform a quick search for the suitable donor and facilitate the transplant.

Usually, it takes 2 working days to find out whether or not any suitable donor match is available in 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.
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.
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. 

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.

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.

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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