Before embarking on signing up for a bone marrow transplant or bone marrow donation, one needs to be fully aware of the pros and cons. There are numerous myths about bone marrow transplants, but here is an attempt to help with clearing up some of them and sharing some facts about them.
What is bone marrow transplantation?
Bone marrow is the soft spongy tissue in your body that contains the hematopoietic stem cells, which are stem cells that become blood cells– red blood cells (RBCs), white blood cells (WBCs), and platelets. All these blood cells play a critical role in your body. RBCs carry oxygen throughout your body, WBCs are part of your immune system, and platelets form clots when bleeding and help stop it.
Bone marrow transplantation is a treatment where healthy stem cells get transplanted into your bone marrow or your blood. These healthy replacement cells can come from your own body or a donor. Bone marrow transplantation is also referred to as stem cell transplantation. Patients suffering from life-threatening diseases like lymphoma, leukemia, and other forms of cancer could be treated with stem cell transplantation.
How many types of stem cell transplantation are there?
There are two types of bone marrow donation possible:
- Autologous transplant– Stem cells needed for an autologous transplant come from your own body – usually done before starting cancer treatment. This is because cancer treatment like chemotherapy and radiation therapy kills all types of cells, including stem cells. After the treatment, the stem cells are then replaced in your body.
- Allogeneic transplant– Stem cells needed for an allogeneic transplant come from another person called a donor.
The bone marrow transplant cost in India is high for both types. In both these cases, the order is the same. After you are advised of bone marrow transplantation, the process includes:
- Collecting replacement stem cells
- Patient preparation for the transplant
- Bone marrow transplantation
- Recovery
All the steps are very complex and expensive, so proper advice and guidance have to be taken at every step by consulting your physician and the insurance company.
Who can donate bone marrow?
Myth: Only a family member can make a stem cell donation.
Fact: Stem cells from a parent, child, brother, or sister are not always a perfect match for a patient’s HLA (human leukocyte antigen) type. The best treatment approach is when healthy stem cells are collected for a donation from another person who has the best match.
- Although the HLA is inherited from your parents, the likelihood of finding a marker match with a family member is only 25-30%. So most stem cell transplants to cure cancers and other incurable diseases are donated by other donors.
- A donor can be anyone who is in good health.
- The best age band to be a stem cell donor is 18-44 years, as outcomes are more successful in this age band.
- Bone marrow donors must be able to give informed consent.
- Like all organ donation, stem cell donation is also voluntary, so before the donation process, an ‘Intent to Donate’ form has to be signed.
What is the bone marrow donation process?
When a donor match is successful, stem cells can be donated in two ways-
- The bone marrow, a surgical procedure, has to be done in a hospital operating room. It could take 1.5-2 hours, where an incision has to be made in the hip bone, and the marrow has to be taken from there.
- Peripheral blood stem cells (PBSC) – A non-surgical procedure that can take a few hours over 1 or 2 days, as in the case of donating platelets.
Some guidelines for bone marrow donation:
- Bone marrow transplant cost in India can be expensive anywhere from 15 to 40 lacs and so should be included in the medical insurance plan.
- The donor could show some side effects after the procedure. Common ones are lower back pain and continued ache, stiffness while walking, fatigue, bleeding at the collection site.
- Usually, the donor will receive general or spinal anesthesia before the procedure, so there is always some risk, and hence the transplantation cost.
- Recovery from a bone marrow transplant can take a long time. In the initial recovery phase, it’s critical to take all precautions as the patient’s already low immune system can be further compromised.
- Proper medication is to be taken to reduce the risk of infection as it is common to get some infection after a bone marrow transplant.
- A transplant will require enough time for recovery, so it’s good to have a caregiver identified before bone marrow transplantation.
- Constant interaction with your doctor is needed to understand the side effects and what to look out for.
- A transplant is successful only when the blood count levels come to safe levels– red blood cells, white blood cells, and platelets– all have to show marked improvement. This increase is one way to know if bone marrow transplantation was a success.
Keeping in mind the bone marrow transplant cost in India which is high, and the risk of bone marrow transplantation, good consultation and supervision are needed at every step. For the transplant to be a success, therefore, a lot of preparation, both mentally and physically, has to be done both for the donor as well as for the patient.
