Bone Marrow Transplant: Procedure, Types, Cost & Risks Explained

Introduction

A bone marrow transplant is a life-saving treatment option for a number of blood and immune system disorders. This procedure replaces diseased bone marrow with healthy bone marrow in order to enable the body to provide existing blood cell populations again. If you are a patient considering a bone marrow transplant, it is important you know the transplant process, the types of transplants, the costs, and other risks associated with this life-saving procedure. This blog educates you about these important areas of interest in a straightforward manner.

What Is a Bone Marrow Transplant?

A bone marrow transplant is a medical procedure that replaces diseased bone marrow with healthy hematopoeitic stem cells. Stem cells produce new blood cells, including red blood cells, white blood cells, and platelets, which are all essential for healthy immune systems and oxygen transportation. A transplant may take place after a patient has sustained damage to their bone marrow from diseases such as leukaemia, lymphoma, aplastic anaemia, or even high-dose chemotherapy, or radiation, or those combinations.

Read Also: Things to know about Leukemia: Causes, Diagnosis, and Treatment

Bone Marrow Transplant Procedure

The bone marrow transplant process begins with the patient's preparation through a conditioning phase—high doses of chemotherapy or radiation—to kill diseased cells and suppress the immune system. This step is very important to allow the patient to accept the transplanted cells, because if the immune system is not sufficiently suppressed, the newly transplanted cells will be attacked.

Once conditioning is complete, the patient will receive healthy stem cells via an intravenous (IV) infusion, similar to what may happen with a blood transfusion. The stem cells will then travel to the bone marrow where they will begin to create new blood cells.

Lastly, there is the recovery time that is crucial to the process and will require the patient to remain in the hospital and be checked on regularly. Recovery will take weeks to months and will include careful evaluation for infections or any complications.

Bone Marrow Transplant Types

Bone marrow transplant can be divided into two types:

• Autologous bone marrow transplant: This method involves collecting the patient’s stem cells before treatment and infusing them back into the patient after High Doseg chemotherapy. While there is essentially no rejection risk; autologous bone marrow may not be advisable if some cancer cells remained in the stem cell source.
• Allogeneic bone marrow transplant: The source of the stem cells is from a matched donor (non-target individual may be a family member or unrelated). The risks around potential rejection include the possibility of graft versus host disease (GVHD) when donor stem cells may attack the patient’s tissue.

The type of transplant that follows is based on the disease and patient's health status and donor source.

Bone Marrow Transplant Cost

The cost of a bone marrow transplant can vary widely based on the bone marrow type the process is performed on, the hospital service area, and country of service location. Allogeneic transplant is a more expensive option than autologous bone marrow transplant because additional services are responsible for the support of the donor and donor matching.

On average in India, the hospital cost of a BMT can range from INR 15 lakhs to 30 lakhs and include the BMT process, hospitalization, medications and post- transplant care services may be included in care cost. It is necessary to explore coverage for BMT with health insurance and/or government schemes to reduce out-of-pocket expenses.

Risks and Complications of Bone Marrow Transplant

While a bone marrow transplant may save the life of a patient, there are also major risks and side effects, and patients should have a full understanding of the following:

• Bone marrow transplant infection risk: Infections can be very common and can also be severe in patients because of suppression of the immune system during recovery.
• Graft versus host disease bone marrow transplant: Following an allogeneic transplant, donor graft cells may attack the patient's body and cause skin rash, liver issues, or gastrointestinal problems.
• Bone marrow transplant infertility risk: High-dose chemotherapy or radiation can affect male and female fertility and can sometimes be permanent.
• Other complicating bone marrow transplant factors: Some other complications include bleeding, organ damage, or relapse of the disease.

Bone marrow transplant death rate: The death rate has come down considerably due to increased supportive care, but still varies depending on factors including the patient's age, disease, and relapse.

Bone Marrow Transplant Recovery Time and Success Rate

The recovery period following a bone marrow transplant may be protracted and difficult. The recovery period for a transplant is generally several months. Patients need to be closely monitored during this time to determine if engraftment (growth of new marrow) has occurred and to manage complications.

Success of a bone marrow transplant depends on the patient's condition prior to the transplant, the type of transplant and its source, and once a donor is needed (as in an allogenic transplant) the compatibility of that donor. New techniques and medications used in transplantation have improved outcomes. More and more patients are reaching complete remission after their transplants and also achieving good quality of life after the transplant.

Conclusion

Bone marrow transplants are complex but important treatments that provide hope for many serious blood diseases. Knowledge of the procedure itself, the type of procedure required, the costs involved, and a better understanding of what may happen, including risks, allow patients and families to make informed decisions and can help with preparing for their recovery.

Frequently Asked Questions (FAQ’S)

Q1: What do you pay specifically for in the cost of a bone marrow transplant?
A: The cost of a bone marrow transplant is based on the type of transplant (alogenic or autogenic), the facilities of the hospital that the patient will be transferred to, how many days the patient is in the hospital, the medications required related to the transplant, and the follow up care after transplant. If a donor was required, the hospital will also include that charge in its billing.

Q2: Is a bone marrow transplant dangerous?
A: Bone marrow transplant are dangerous due to the risks of infection, graft versus host disease, infertility (as complication risks) - though doctors will monitor patients closely and early studies would indicate the medical advancements of the past 35 years have reduced mortality risk associated with the transplant from a previous range of 25-30% to a much lower percentage.

Q3: What are the typical side effects after a bone marrow transplant?
A: Side effects can include fatigue, infections, bleeding risk, nausea, graft versus host disease (in the case of allogeneic transplants), and a risk of infertility from the conditioning treatment.

Q4: How long does it take to recover from a bone marrow transplant?
A: Recovery times do vary, but often from about 3 to 6 months or sometimes longer. During this timeframe, patients will require ongoing follow-up visits for monitoring of their immunity and marrow function.

Q5: Which type of bone marrow transplant is better?
A: The type of transplant that is better will depend on the Disease being treated, patient's health and availability of donors. Some patients are candidates for an autologous transplant, which serves as a rescue after very high dose of chemotherapy to kill the disease. an allogeneic transplant may provide a greater chance of cure for certain cancers but also comes with greater risk of complications.