⁠Bone Marrow Transplant

⁠Bone Marrow Transplant (Stem cell transplant)

Stem cell transplant (SCT) is an advanced therapeutic procedure which is utilized for treating various haematological diseases like thalassemia, aplastic anemia, primary immunodeficiency and haematological malignancies like leukemias, lymphomas and myeloma.

Previously stem cell transplant was known as bone marrow transplant because the source of donor stem cells was bone marrow. Nowadays various other sources like peripheral blood and cord blood are also used to procure stem cells for transplantation. Historically during the Second World War, after atomic bomb blasts in Japan, the survivors had permanent bone marrow aplasia. That time, Dr. Donnel Thomas had started working on puppies for performing bone marrow transplant experiments and later he started this procedure in humans and made a major breakthrough for which he was awarded Nobel Prize in Medicine in 1991.

SCT is of 2 types

• 1) Autologous SCT- Patient’s own stem cells are used for transplant.
• 2) Allogeneic SCT- Stem cells are procured from a donor, other than the patient.

Who can be a donor?

For a successful SCT, HLA matching between the donor and recipient is a must. The donor is usually a HLA matched sibling. It is very rare to get a matched family donor other than the sibling. For cases where siblings do not match, there are certain international and national registries which keep records of HLA of voluntary donors like NMDP from USA, DKMS from Germany, DATRI from India etc. If match is found with any of the volunteer, allogeneic SCT can be performed with that individual which is called Matched Unrelated Donor transplant (MUD transplant). The success of Allogeneic SCT is 70-80% depending upon the diagnosis and underlying condition of the patient. For autologous SCT, the success rate is more than 90%.

Nowadays Haploidentical transplant (half matched transplant) is performed in patients with desperate illness which can be cured only by SCT, with a success rate of 40-50%.

FAQs about SCT

1) Can stem cells be used for cardiac, neurological and other chronic illness?

Use of SCT is permitted only for hematopoietic illnesses by law. Any procedure other than this is accounted as experimental and not therapeutic. The regenerative medicine is at experimental stage and routine offering of such modalities for problems like multiple sclerosis, cerebral palsy, diabetes mellitus, cardiomyopathies, osteoarthritis, etc. is unethical and should be highly discouraged. ICMR has given guidelines for use of hematopoietic stem cells in a rational manner.

2) Should preservation of cord blood stem cells be routinely offered?

Private cord blood banking with storage of cord blood as medical insurance for the baby and family is highly discouraged by various international societies (Pediatrics, gynecological and hematological). The reason is that the chances that the cells will be needed are very less. Also, the dose and volume of cord blood stem cells is a major limiting factor if the patient’s weight is more than 20kg. Also the idea that regenerative medicine will be in therapeutics in near further and various organs will be regenerated, is a remote reality as of now. However, public cord blood banking is very useful and has to be promoted for social causes but not for personal utilization.

3) Can Stem cell donation cause harm to donor?

Stem cell donation is a very safe procedure so chances of donor having any problem due to donation are less than 1%.

4) What is the cost of SCT?

It depends on the type of SCT and diagnosis. Autologous SCT costs approximately 5-6 lacs rupees. Matched family donor transplant cost varies from 10 to 15 lacs. In case of MUD transplant depending upon the country from which the stem cells are procured the cost varies from 25 to 40 lacs. The cost is one tenth compared to the West but it is still prohibitive for many of our patients. With the support of various charitable organizations, this can still be performed for needy patients.