Bone Marrow Transplant In India

Bone Marrow Transplantation, as simple as it sounds is nowhere near as simple. There are a number of factors that play a key role when it comes to bone marrow transplantation. 

In the year 2005, 1540 patients went through bone marrow transplantation performed in only six different transplantation centres. While the numbers may sound a little less, we are talking about data from 14 years ago. The number has increased by a warping number. Lifestyle changes, population increase and the reach of Indian medical facility are some of the reasons for the increased number of patients. Not to forget, the influx of foreign patients that come to India for affordable medical services. 

With high tech medical technology and increasing infrastructure, India has become one of the top countries when it comes to serving medical tourism. Due to the new reforms in medical technology and research, the success rate for BMT has been higher as compared to what it was a few years back.

From early 2000 to 2019, India has started spending a lot more on the health care sector than it used to ten years back. The rise in the medical facility, high-tech pieces of equipment, trained professionals, dedicated infrastructure has made India a leading name in the healthcare industry. 

Bone marrow transplantation is one of the treatments that the Indian Hospital and healthcare industry are well known for.  With more than a billion population and having to deal with thousands of patients every year suffering from some sort of blood cancer, dedicated hospitals are working with thousands of patients every year who are waiting or going through BMT.

Now, there are a  lot of things to consider before going through bone marrow transplantation. Doctors consultation and proper diagnosis is a must before go make any decision. There is a reason why it is suggested only in a life-threatening situation. It is in no way a cheap process. Diagnosis and treatment both are quite expensive. The process will include haematologists, oncologists, radiologists, laboratory technicians, doctors and nurses not to forget the infrastructure. 

Let us try to understand it in detail:

What is bone marrow transplantation?

It’s a medical treatment which replaces unhealthy or genetically defective bone marrow cells with healthy ones. Bone marrow is present tissue inside of bones, they contain stem cells. Stem cells mature into different types of blood cells, including RBC, WBC and platelets. Any defect in bone marrow genetically or otherwise can cause a number of problems, such as low count of RBC causing anaemia. Low count of WBC or platelets. Each one comes with its own set of complication.

You may think blood transfusion can be a solution, to some extent it can be but not in extreme cases. The average lifespan of a red blood cell is 100-120 days and white blood cell is 4 days, so, a patient suffering from leukaemia or any type of blood cancer would need a blood transfusion pretty regularly. Also, if cancer goes severe, transfusion the whole body’s blood is near to impossible. To cure the problem healthy bone marrow is transplanted in their body either through a donor or from their own body.

Who receives bone marrow transplantation?

Patients with a certain type of cancers such as leukaemia, where the bone marrow makes abnormal white blood cells. Or myeloproliferative disorder where the bone marrow makes too many white blood cells. Or aplastic anaemia where the marrow does not make RBC. Lymphoma and thalassemia are some other types of disorders which can be cured by bone marrow transplantation over time.

This is the list of all the diseases where bone marrow transplant might be needed:

  • Acute Leukemia
  • Aplastic anaemia
  • adrenoleukodystrophy
  • Bone marrow failure syndrome
  • Chronic leukaemia 
  • Hodgkin’s Lymphoma
  • Hemoglobinopathies
  • Inborn errors of metabolism
  • Myelodysplastic Syndrome
  • Multiple Myeloma
  • Non-Hodgkin’s Lymphoma
  • Neuroblastoma
  • POEMS syndrome
  • Plasma Cell Disorders
  • Primary amyloidosis

How does bone marrow transplantation work?

Firstly, there are two types of bone marrow transplantation:

Autologous BMT– Healthy bone marrow cells are removed from your body and stored in the freezer. The bone marrow is then later put back into you after removing unhealthy ones from your body by radiation or chemotherapy. This is usually done in patients suffering from blood cancer where you still have healthy bone marrow left. For genetic problems such as thalassemia or sickle cell anaemia, Autologous BMT is not possible. 

Allogeneic BMT– Stem cells received from a donor is given to the patient. This process comes with a bit of complication as the patient’s genes have to match with the donor. A brother, sister or some other close blood relative is a good match for such transfusion. 

The actual process of BMT shouldn’t take more than 24 hours. But the preparation might take weeks. 

There is another one which is gaining popularity. 

Umbilical cord blood transplant: In this process, the stem cells from a newborn baby’s umbilical cord is taken right after birth. The stem cells from a newborn’s umbilical cord are very immature and are a good match to be used as a stem cell in bone marrow transplantation. The stem cells recovered in the process is pretty less and takes the Patient a long time to recover. 

After the stem cell is collected from the patient or donor, the patient has to go through ration or chemotherapy to get rid of unhealthy stem cells.  The session can be quite intense and take a long time. Only doctors can tell when is the right time to transfusion.

The transfusion is usually given via a large vein. It looks quite similar to blood. The cells move through your bloodstream and eventually settle down to your blood marrow. There, they start to grow, divide and start to make red blood cells, white blood cells and platelets. It can take several days for the stem cells to start making fresh blood.

What are some of the complications?

Most people don’t suffer any complications or minimum complications there are cases of severe complications as well.

Here is the list of some complication

Graft-versus-host disease for Allogeneic transplant) – In this scenario, the donor cells develop an immune system that sees your body as foreign and attacks them.

Stem cell failure – the new stem cells refuse to work and eventually die.

Organ Damage – the stem cell may produce some kind of immune disorder where they start damaging a particular organ.

Infections, Cataracts, Infertility, new cancer are some other complications.

Success Rate –In a study conducted in Apollo Cancer Hospital, from the year 2007 to 2012, 50 patients were studied who went through bone marrow transplant. They were studied for 39 months. 77% of the cases were noted to be successful. This was back in early 2000 when the health industry hadn’t risen up as it is today. Now, with better services the success rate has gone to about 85%.

How are stem cells are harvested:

For autologous BMT, the patient has to go through several rounds of chemotherapy and radiation to get rid of bad stem cells, so, the patient is left with only good stem cells. The stem cell is then extracted. It is a minor surgery. With a metal probe, under general anaesthesia, the bone marrow is extracted. The bone marrow is usually taken from the back of both hips. 

In Leukapheresis, the donor is given several shots through a course of a few days so the bone marrow moves from bone marrow to bloodstream. The bloodstream usually does not have an abundance of stem cells already present, specific drugs bring them in the bloodstream. The stem cell rich blood is then removed by IV, it is then processed to separate the stem cell in the lab and then transfused into the patient. This is a long process tests both yours and your donor’s patience.

So, How much does all of this costs?

Bone marrow transplantation can costs up to 800,000 $ in countries like US and UK. Maybe, a little less in the UK but still a lot. Whereas, a bone marrow transplantation in India will cost you around 25 or 30 Lakh rupees which when converted to dollars comes around to 50,000 $, even starts from $10,999 in some clinics. That is 63 per cent less. In Turkey, it will cost you, $49,999. In Germany, $225,000. Some countries that might offer you the treatment at the same price but the health care infrastructure and experience of the professionals are nowhere near as good as India’s. 

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