Cancer Hospitals in India have oncology units comprising surgical oncology, medical and radiation therapy as well as the crucial Bone Marrow Transplantation (BMT). The BMT (Bone Marrow Transplant) unit with high pressure hipa filters has helped achieve a very high success rate in the various types of transplantation.
Beginning in early 1983, bone marrow transplantation (BMT) hospitals in India have undergone slow but steady growth. With about 50% disease-free survival in acute myeloid leukaemia and aplastic anaemia and 90% survival in thalassemia major, the results are encouraging. However, the outcome in chronic myeloid leukemia so far has been poor.
Cord Blood Transplant and Mismatched Allogeneic Stem Cell Transplant have been performed successfully in hospitals in India, a feat that is remarkable and significant, considering the fact that the treatment costs one-tenth of what it does in the west. Special surgeons are available for individual organs. Plastic surgeons of repute provide treatment for head and neck cancer, breast cancer and other malignancies. Facilities offered at these hospitals in India include tele-therapy which includes simulation work stations to ensure high precision and safety during treatment at the 18 MV linear accelerator or telecobalt machines, brachy therapy and 3-D planning systems. In orthopedics, the Ilizarov technique is practiced for the treatment of limb deformities, limb shortening and disfiguration.
Hospitals in India treating Bone Marrow Transplants are; Apollo Hospitals (Chennai), Indraprastha Apollo Hospital (New Delhi) and Manipal Hospital (Bangalore).
Definition of Bone Marrow
The bone marrow-the sponge-like tissue found in the center of certain bones-contains stem cells that are the precursors of white blood cells, red blood cells, and platelets. These blood cells are vital for normal body functions, such as oxygen transport, defense against infection and disease, and clotting. Blood cells have a limited lifespan and are constantly being replaced; therefore, healthy stem cells are vital.
In association with certain diseases, stem cells may produce too many, too few, or otherwise abnormal blood cells. Also, medical treatments may destroy stem cells or alter blood cell production. The resultant blood cell abnormalities can be life threatening.
Bone marrow transplantation involves extracting bone marrow containing normal stem cells from a healthy donor, and transferring it to a recipient whose body cannot manufacture proper quantities of normal blood cells. The goal of the transplant is to rebuild the recipient's blood cells and immune system and hopefully cure the underlying ailment.
Purpose of Bone Marrow
A person's red blood cells, white blood cells, and platelets may be destroyed or may be abnormal due to disease. Also, certain medical therapies, particularly chemotherapy or radiation treatment, may destroy a person's stem cells. The consequence to a person's health is severe. Under normal circumstances, red blood cells carry oxygen throughout the body and remove carbon dioxide from the body's tissues. White blood cells form the cornerstone of the body's immune system and defend it against infection. Platelets limit bleeding by enabling the blood to clot if a blood vessel is damaged.
A bone marrow transplant is used to rebuild the body's capacity to produce these blood cells and bring their numbers to normal levels. Illnesses that may be treated with a bone marrow transplant include both cancerous and noncancerous diseases.
Cancerous diseases may or may not specifically involve blood cells; but, cancer treatment can destroy the body's ability to manufacture new blood cells. Bone marrow transplantation may be used in conjunction with additional treatments, such as chemotherapy, for various types of leukemia, Hodgkin's disease, lymphoma, breast and ovarian cancer, and other cancers. Noncancerous diseases for which bone marrow transplantation can be a treatment option include aplastic anemia, sickle cell disease, thalassemia, and severe immunodeficiency.
Precautions of Bone Marrow Transplantation at Hospitals in India
Bone marrow transplants are not for everyone. Transplants are accompanied by a risk of infection, transplant rejection by the recipient's immune system, and other complications. The procedure has a lower success rate the greater the recipient's age. Complications are exacerbated for people whose health is already seriously impaired as in late-stage cancers. Therefore, a person's age or state of health may prohibit use of a bone marrow transplant. The typical cut-off age for a transplant ranges from 40 to 55 years; however, a person's general health is usually the more important factor.
Even in the absence of complications, the transplant and associated treatments are hard on the recipient. Bone marrow transplants are debilitating. A person's ability to withstand the rigors of the transplant is a key consideration in deciding to use this treatment.
Types of Bone Marrow Transplantation at Hospitals in India
Autologous and Allogeneic Transplants
Two important requirements for a bone marrow transplant are the donor and the recipient. Sometimes, the donor and the recipient may be the same person. This type of transplant is called an autologous transplant. It is typically used in cases in which a person's bone marrow is generally healthy but will be destroyed due to medical treatment for diseases such as breast cancer and Hodgkin's disease. Most bone marrow transplants are autologous. If a person's bone marrow is unsuitable for an autologous transplant, the bone marrow must be derived from another person in an allogeneic transplant.
Allogeneic transplants are more complicated because of proteins called human lymphocyte antigens (HLA) that are on the surface of bone marrow cells. If the donor and the recipient have very dissimilar antigens, the recipient's immune system regards the donor's bone marrow cells as invaders and launches a destructive attack against them. Such an attack negates any benefits offered by the transplant.
HLA Matching before Bone Marrow Transplant at Hospitals in India
There are only five major HLA classes or types-designated HLA-A,-B, -C,-D, and class III-but much variation within the groupings. For example, HLA-A from one individual may be similar to, but not the same as, HLA-A in another individual; such a situation can render a transplant from one to the other impossible.
HLA matching is more likely if the donor and recipient are related, particularly if they are siblings; however, an unrelated donor may be a potential match. Only in rare cases is matching HLA types between two people not an issue: if the recipient has an identical twin. Identical twins carry the same genes; therefore, the same antigens. A bone marrow transplant between identical twins is called a syngeneic transplant.
New Advancements in Bone Marrow Transplantation at Hospitals in India
Haploidentical Allogeneic BMT for patients without donors
Haploidentical Allogeneic peripheral blood stem cell transplant offers an innovative option for patients who cannot be suitably matched with a family member, or who do not have an unrelated donor readily available for transplant.
This technique makes it possible to use partially matched family members as donors.
In this new procedure, peripheral blood stem cells are collected from the donor, and depleted of T cell lymphocytes known to cause graft-versus-host disease. The first treatment phase for the patient includes chemotherapy, immunosuppressive drugs, and radiation. Transplant specialists can then infuse the prepared cells from the donor into the patient's body. This transplant method allows physicians to select a partially matched donor from the patient's family whose white blood cells will act as natural killer cells against the leukemic cells of the patient.
Procedure In Bone Marrow Transplantation at Hospitals in India
The bone marrow extraction, or harvest, is the same whether for an autologous or allogeneic transplant. Harvesting is done under general anesthesia (i.e., the donor sleeps through the procedure), and discomfort is usually minimal afterwards. Bone marrow is drawn from the iliac crest (the part of the hip bone to either side of the lower back) with a special needle and a syringe. Several punctures are usually necessary to collect the needed amount of bone marrow, approximately 1-2 quarts (0.9-1.91). (This amount is only a small percentage of the total bone marrow and is typically replaced within four weeks.) The donor remains at the hospital for 24-48 hours and can resume normal activities within a few days.
If the bone marrow is meant for an autologous transplant, it is stored at -112 to -320°F (-80 to -196°C) until it is needed. Bone marrow for an allogeneic transplant is sometimes treated to remove the donor's T cells (a type of white blood cell) or to remove ABO (blood type) antigens; otherwise, it is transplanted without modification.
The bone marrow is administered to the recipient via a catheter (a narrow, flexible tube) inserted into a large vein in the chest. From the bloodstream, it migrates to the cavities within the bones where bone marrow is normally stored. If the transplant is successful, the bone marrow begins to produce normal blood cells once it is in place, or engrafted.
Cost implication in Bone Marrow Transplantation
Bone marrow transplantation is an expensive procedure. (Bone marrow donors are volunteers and do not pay for any part of the procedure.) Insurance companies and health maintenance organizations (HMOs) may not cover the costs.
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