Bone Marrow Transplantation in Turkey

Bone marrow transplantation (stem cell-derived transplantation) is a medical procedure aimed at treating serious diseases and blood and immune system disorders, such as leukemia, genetic blood disorders like sickle cell anemia, and hereditary immune system diseases such as bone marrow cancer, lymphoma, and rheumatoid arthritis.

In bone marrow transplantation in Turkey, the affected bone marrow is replaced with healthy bone marrow or stem cells capable of developing into blood-forming cells (red blood cells, white blood cells, and platelets). This donor bone marrow is obtained from a source compatible with the patient, whether from an unrelated donor or from another part of the patient’s own body in cases where healthy bone marrow is available.

The procedure involves administering high doses of chemotherapy and/or radiation to destroy existing cancer cells in the bone marrow, after which the new bone marrow is transplanted. Bone marrow transplantation is performed through a vein and is referred to as non-sibling bone marrow transplantation.

Bone marrow transplantation in Turkey involves the proliferation of new blood cells in the body, thereby restoring normal blood function and immunity. There can be complications from the transplantation, including rejection and side effects from chemotherapy and radiation.

Bone marrow transplantation should be performed in specialized medical centers under the supervision of a qualified and experienced medical team in this field. Before the procedure, the patient should be thoroughly evaluated to determine if this procedure is suitable and effective for their specific medical condition.

How is Bone Marrow Transplantation Performed?

Bone marrow transplantation in Turkey is a procedure in which stem cells produced in the blood are transplanted into the body to replace damaged or diseased bone marrow. In cases where the bone marrow is not functioning or cannot produce enough healthy blood cells, a bone marrow transplant is necessary.

There are two types of bone marrow transplants: autologous and allogeneic. Transplants that use cells from the human body are called autologous transplants, while transplants from a donor are called allogeneic transplants. In this article, we have compiled how to perform both types of transplantation for you.

Autologous Stem Cell Transplantation
Autologous stem cell transplantation uses healthy stem cells in the body to replace damaged or diseased bone marrow. During the stem cell transplant process, using cells from the body has some advantages over using stem cells from another person. For example, in autologous stem cell transplants, there is no compatibility issue between the transplanted cells and the body’s own cells.

Bone marrow transplantation in Turkey can be an option only if the body produces enough healthy bone marrow cells. These cells can be harvested, frozen, and stored for later use. Autologous stem cell transplants are often used in individuals who require high doses of chemotherapy and radiation. Autologous stem cell transplantation helps replace damaged bone marrow.

Autologous stem cell transplants are mainly used to treat the following conditions:

• Hodgkin lymphoma
• Multiple myeloma
• Non-Hodgkin lymphoma
• Plasma cell disorders

Allogeneic Stem Cell Transplantation

Allogeneic stem cell transplantation uses healthy stem cells from a donor to replace damaged or diseased bone marrow. Allogeneic stem cell transplantation is also referred to as allogeneic bone marrow transplantation.

Donors can be family members, acquaintances, or strangers. The cells used in allogeneic stem cell transplantation can be collected from various sites such as:

• Donor’s blood
• Bone marrow in the donor’s pelvis
• Donated umbilical cord blood

Before performing an allogeneic stem cell transplant, high doses of chemotherapy or radiation are administered to destroy diseased cells and prepare the body for the donor cells. Allogeneic stem cell transplantation may be an option for individuals with a variety of diseases, including:

• Acute leukemia
• Adrenal gland disorders
• Severe anemia
• Bone marrow failure syndromes
• Chronic leukemia
• Hemoglobinopathies
• Hodgkin lymphoma
• Immunodeficiencies
• Metabolic errors
• Multiple myeloma
• Myelodysplastic syndrome
• Neuroblastoma
• Non-Hodgkin lymphoma
• Plasma cell disorders
• POEMS syndrome
• Primary amyloidosis

Pre-Transplant Testing and Procedures
Before undergoing a bone marrow transplant, a series of tests and procedures are performed to evaluate the patient’s overall health and ensure they are physically ready for the transplant. The evaluation may take several days or more. Otherwise, the surgeon or radiologist inserts a long, thin tube (catheter) into a large vein in the chest or neck. The catheter typically remains in place throughout the duration of treatment. The transplant team will use this catheter to deliver stem cells, medications, and blood products to the body.

Harvesting Stem Cells for Autologous Transplantation
If a transplant using the patient’s own cells (autologous transplant) is planned, a procedure called apheresis is used to collect stem cells. Before apheresis, a growth factor is injected daily to increase the production of stem cells and transfer stem cells into circulation so they can be harvested.

During apheresis, blood is drawn from a vein and circulated through a special machine. The machine separates the blood into different components, including stem cells. The stem cells are collected and frozen for use during the transplant. The remaining blood is returned to the body.

Stem Cell Harvesting for Allogeneic Transplantation
In the process of transplantation using stem cells from a donor (allogeneic transplantation), a suitable donor is searched for, and upon finding one, stem cell harvesting procedures are performed. Stem cells can come from the donor’s blood or bone marrow. The transplant team decides which is best based on the patient’s condition.

Another type of allogeneic transplant uses stem cells from umbilical cord blood (cord blood transplantation). Mothers can choose to donate the umbilical cord after giving birth to their child. The blood from these cords is frozen and stored in a cord blood bank until needed for bone marrow transplantation.

The Conditioning Process

After completing the pre-transplant tests and procedures, a process known as conditioning begins. During conditioning, chemotherapy or radiation is given to provide the following conditions:

• Destruction of cancer cells
• Suppression of the immune system
• Preparation of the bone marrow for the new stem cells

The conditioning regimen depends on a number of factors, such as the disease, general health, and the type of planned transplantation.

What Happens During the Bone Marrow Transplant Procedure?

After the bone marrow transplant process is complete. On the day of the transplant, the stem cells are administered to the body through the catheter. The transplant procedure is painless, and the patient is not asleep during the process.

What Happens After Bone Marrow Transplantation?

When the new stem cells enter the body, they migrate from the blood to the bone marrow. Over time, they multiply and begin to form new, healthy blood cells. While the number of blood cells in the body typically takes a few weeks to return to normal, it may take longer for some individuals.

It is important to closely monitor the patient’s condition in the days and weeks following bone marrow transplantation. For this, several blood tests and similar examinations can be performed on the patient. Complications such as nausea and diarrhea may occur, and medications may be needed to treat them.

After bone marrow transplantation, careful medical care is required. In the event of an infection or other complications, hospitalization for several days or sometimes longer may be necessary.

The patient may need periodic transfusions of red blood cells and platelets until the bone marrow starts producing enough healthy cells on its own.

Even months or years after the transplant, patients may be more susceptible to infections or other complications. Regular follow-up appointments for life are needed to monitor for late complications.

Things to Consider After Transplantation
If the bone marrow transplant uses stem cells from a donor (allogeneic transplant), doctors may prescribe medications that reduce immune system reactions (immunosuppressive drugs) to prevent graft-versus-host disease (GVHD). The immune system takes time to recover after transplantation. During this time, medications may also be given to prevent infections.

After bone marrow transplantation, dietary adjustments may be necessary to stay healthy and prevent excessive weight gain. A nutritionist and other members of the transplant team work with the patient to develop a healthy meal plan that meets their needs and complements their lifestyle. Some recommendations may include:

• Following food safety instructions to prevent foodborne infections
• Eating a variety of healthy foods, including vegetables, fruits, whole grains, lean meats and poultry, fish, legumes, and healthy fats like olive oil
• Limiting salt intake
• Reducing alcohol consumption
• Avoiding grapefruit and grapefruit juice due to their effects on a range of immunosuppressive medications (calcineurin inhibitors)
• Engaging in regular physical activity after bone marrow transplantation, which helps control weight, strengthen bones, increase endurance, strengthen muscles, and maintain heart health.

It is also crucial to take steps to prevent cancer after transplantation. It is essential to avoid smoking, use sunscreen outdoors, and have regular cancer screenings by a doctor.

Outcomes of Bone Marrow Transplantation

Bone marrow transplantation can cure some diseases and alleviate others. Some individuals complete bone marrow transplants with few side effects and complications. Others may face a significant number of difficult issues in the short and long term. The severity of side effects and the success of the transplantation can vary from person to person and can sometimes be difficult to predict before transplantation.

It can be frustrating when significant difficulties arise during the transplantation process. However, it may be helpful to remember that many people have gone through a very tough time in the transplantation process but ultimately succeeded in their transplants and returned to normal activities with a good quality of life.

Success Rates of Bone Marrow Transplantation
The success rate of bone marrow transplantation depends on several factors, including the type of disease being treated, the type of transplantation (autologous or from a donor), the patient’s health status, and the degree of compatibility of the cells taken from the donor with the patient. However, in general, the success rates are as follows:

• Autologous Bone Marrow Transplantation: In this type, the patient’s own cells are used. The success rate is high, reaching about 70-90%, especially in cancer cases such as lymphoma or multiple myeloma. This type is used when the disease is stable, and the bone marrow cells are returned after high-dose chemotherapy.
• Allogeneic Bone Marrow Transplantation: The success rate depends on the degree of tissue compatibility between the donor and the patient. If the donor is a close relative (like a sibling), the rate is about 60-80%. If the donor is not a close relative but tissue-compatible, the success rate may be slightly lower.
• Medical Conditions: Some diseases treated with bone marrow transplantation, such as leukemia or thalassemia, may have varying success rates depending on the stage at which the disease is detected. For example, in cases of acute leukemia, if the disease is detected early, the success rate is higher compared to advanced stages.
• Other Factors:
  • Patient Age: Younger individuals usually have higher success rates.
  • Overall Health: Patients in generally good health have higher success rates compared to those with other diseases or complications.
  • Complications: Conditions like graft-versus-host disease (GVHD), which may occur after transplantation from a donor, can affect the success rates. This condition can be partially controlled with medications, but in some cases, it may lead to long-term complications.

Costs of Bone Marrow Transplantation
The costs of bone marrow transplantation vary significantly and depend on several factors, including geographical location, medical center, type of health insurance, and the complexity and specific requirements of the patient’s condition.

In general, the costs of bone marrow transplantation can be substantial. These costs may include medical tests, pre-operative medical evaluations, necessary preparations, hospital and surgical fees, anesthesia costs, blood tests and medications, and post-operative medical follow-ups.

Additionally, there may be extra costs related to the bone marrow donor, such as travel and accommodation expenses, as well as tests. The costs of bone marrow transplantation may range from $35,000 to $65,000 depending on the patient’s condition and the procedures followed, and sometimes they can reach up to $100,000.

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How Long Does Bone Marrow Transplantation Take?

The duration of the bone marrow transplantation procedure varies based on several factors, including the type of disease, the patient’s condition, donor compatibility, and hospital arrangements. Generally, bone marrow transplantation can take several days or weeks.

The first part of the process requires patient preparation, which includes medical tests and an evaluation of the patient’s general health. A schedule for medical tests, laboratory analyses, imaging tests, and other necessary examinations is organized.

The actual bone marrow transplantation procedure typically takes a few hours. During this, the bone marrow is collected from the donor and transplanted into the recipient’s body via a vein. General anesthesia may be required for the recipient during this process.

After the procedure, the patient may be hospitalized for a short period for monitoring and care. Overall, full recovery and return to daily life may take some time, depending on the patient’s recovery and adaptation to the new bone marrow.

The supervising medical team must provide more accurate details about the expected duration of the bone marrow transplantation procedure and the length of hospital stay based on the individual patient’s condition and treatment plan.

Types of Bone Marrow Transplantation:

• Autologous Bone Marrow Transplantation: In this type, the bone marrow is collected from the patient themselves. The bone marrow is often harvested before starting high-dose chemotherapy or radiation treatment and is then frozen for later use. After treatment, the frozen bone marrow is reintroduced into the patient’s body to restore bone marrow function.
• Allogeneic Bone Marrow Transplantation: In this type, bone marrow is collected from a compatible donor. The compatibility between the recipient and donor is determined based on matching tissue characteristics, such as the HLA tissue typing system. The donor’s bone marrow is used to transplant into the patient’s body after administering specific treatments to destroy cancerous or affected cells.

Bone marrow transplantation must be carefully coordinated to ensure donor-recipient compatibility and to minimize the risk of immune rejection and other complications. Allogeneic bone marrow transplantation may be necessary in cases where autologous bone marrow is unavailable or when the disease significantly impacts the bone marrow.

When is Bone Marrow Transplantation Performed?

Bone marrow transplantation is performed when the bone marrow is affected by a serious disease or health issue negatively impacting its function. Bone marrow transplantation is considered when other treatments have proven ineffective in addressing the disease, or when there is a need to replace the affected bone marrow with new marrow.

Here are some conditions that may necessitate bone marrow transplantation:

• Leukemia: Such as leukemia, lymphoma, and other bone marrow tumors.
• Hematological disorders: Such as sickle cell anemia, thalassemia, and Crigler-Najjar syndrome.
• Immune system disorders: Such as lupus, severe rheumatoid arthritis, and other conditions affecting bone marrow function and immunity.

The decision to proceed with bone marrow transplantation is based on the medical team’s assessment of the patient’s condition, test results, and disease progression. The optimal timing for transplantation is determined based on the patient’s needs, the availability of a compatible donor, and the overall health status of the patient.

Is Bone Marrow Transplantation Dangerous?

Yes, bone marrow transplantation is considered a specialized surgical procedure and carries some risks and challenges. Here are some specific aspects to consider:

• Procedure Complications: Complications may occur during or after the procedure, such as wound infections, bleeding, blood clots, bone marrow toxicity, organ toxicity, and others.
• Graft Rejection: The patient’s immune system may mount an immune response against the transplanted bone marrow, leading to rejection. This requires the use of immunosuppressive medications to prevent immune reactions against the transplanted marrow.
• Long-term Complications: After the procedure, patients may experience long-term complications such as weakened immune systems, endocrine problems, infertility issues in males, and growth and development problems in children.
• Side Effects of Treatment: The chemotherapy received before transplantation may cause side effects such as hair loss, nausea, vomiting, and effects on the digestive and nervous systems.

However, the benefits of bone marrow transplantation should be weighed against the potential risks. The success rate and possible risks depend on the patient’s condition, donor compatibility, and the choice of the medical center involved. Adequate support and care must be provided to the patient throughout the procedure and recovery.

We Wish You Healthy Days.