All About Bone Marrow Transplantation

Patients with certain forms of cancer or other life-threatening diseases are candidates for bone marrow transplantation (BMT). This method uses stem cells, which are extracted from the bone marrow, filtered, and then returned to the patient or to another person. The goal of BMT is to infuse good bone marrow cells into a person after unhealthy bone marrow has been removed. Here is a comprehensive guide about bone marrow transplantation that will teach you all you need to know about the procedure.

What exactly is bone marrow?

First, let us define bone marrow. It is the soft, spongy tissue found within the bones that is rich in stem cells. Pluripotent stem cells are the most primordial of these stem cells (master cells). These stem cells are crucial in bone marrow transplants because they vary from other cells in the following ways:

  • They generate cells that are similar to themselves.
  • They are capable of producing one or more subgroups of mature cells.

Various additional sources of stem cells have also gained favour in the previous decade, as their harvesting is more patient-friendly and provides nearly comparable success rates to bone marrow transplants. Peripheral blood stem cells and cord blood stem cells are examples of this.

What situations necessitate BMT?

The conditions that demand a BMT can be divided into two categories:

Cancerous Diseases

  • Acute Myeloid Leukemia and Lymphoblastic Leukemia
  • Chronic Myeloid and Lymphoblastic  leukemia
  • Non-Hodgkin’s and Hodgkin’s Lymphoma
  • Myelodysplastic Syndrome (MDS)
  • Myeloproliferative Neoplasms, Primary Myelofibrosis, and other conditions
  • Myeloma Multiforme

Non-Cancerous Conditions

  • Aplastic Anaemia
  • Haemoglobinopathies like Thalassemia and Sickle Cell Anaemia
  • Immuno-deficiencies disorders
  • Congenital errors of metabolism
  • Congenital storage disorders

What are the different phases of a BMT?

A bone marrow transplant is a five-stage procedure.

  1. Physical examination: to determine the recipient’s overall health.
  2. Harvesting: the procedure of obtaining stem cells for transplantation.
  3. Conditioning is the process of preparing the body for transplantation.
  4. Stem cell transplantation
  5. Recovery time

Physical Examination of the Body

Routine diagnostic tests are conducted, such as a full haemogram, X-ray, and urinalysis. HLA (Human Leukocyte Antigen) typing and blood grouping are also performed to assess recipient/donor compatibility. This compatibility assessment is critical for lowering the likelihood of transplant rejection.

Autologous Bone Marrow Transplant Cell Harvesting: 

  • Autologous Bone Marrow Transplant:In this form of transplant, the donor is solely the patient. Stem cells are obtained from the patient by bone marrow harvest or apheresis (a method used to collect peripheral blood stem cells), frozen, and then returned to the patient following a comprehensive therapy.
  • Allogeneic Bone Marrow Transplant: In this type of transplant, the donor and recipient have the same HLA type. Stem cells are obtained by bone marrow harvesting or apheresis from a genetically matched donor, usually a sister or brother.

Other potential donors for allogeneic bone marrow transplants include:

  • A relative or parent: When the donor is a parent and the genetic match is at least half identical to the recipient, this is referred to as a haplo-identical match.
  • Transplantation of unrelated bone marrow: Unrelated donors provide genetically matched stem cells or marrow. National bone marrow registries are searched for unrelated donors.
  • Peripheral Blood Stem Cell Transplant: This treatment is more commonly used than bone marrow harvesting since it is less invasive and easier to conduct. Some studies even claim that the stem cell yield from this procedure is larger than that from bone marrow extraction. After four days of taking the essential drugs, the process takes 4-6 hours.Donors are given Granulocyte Colony Stimulating Factor (GCSF) injections for four days to boost stem cell multiplication. The donor’s stem cells are extracted via a technique known as apheresis and delivered intravenously to the recipient.The donor’s stem cells have the ability of stem cell homing, which allows them to travel to the patient’s bone marrow and replace his or her faulty stem cells. This restores the patient’s bone marrow’s capacity to manufacture blood components.
  • Umbilical Cord Blood Transplant: Umbilical cord blood contains a high concentration of stem cells. After the baby is born, cord blood can be extracted from the umbilical cord (a waste byproduct of childbirth) and stored for later use. When compared to adult blood, cord blood contains a larger quantity of stem cells. About 80 to 100 mL of cord blood is taken, and these stem cells are ideal for paediatric transplantation.Before storage and preservation, the cord blood stem cells are typed, numbered, and tested. Cord blood cells are stored in the freezer until they are needed for transplant.

The Patient’s Conditioning

The conditioning method includes (at times) radiation and large doses of chemotherapy. It is done for three reasons:

  • Destroying existing bone marrow cells to create way for donated stem cells
  • Any existing cancer cells must be destroyed.
  • Immune system suppression to reduce the likelihood of donor stem cell rejection

Stem Cell Transplantation

The bone marrow transplant procedure does not entail physically inserting marrow stem cells into the recipient’s marrow, but rather is a delicate and sophisticated blood transfusion approach. The collected stem cells are injected into the circulation through a central venous catheter. These collected stem cells then find their way to the bone marrow via a stem cell trait known as stem cell homing.

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The patient is constantly watched to ensure the transplant’s success. However, there are a few hazards associated with the surgery, including:

Graft versus host disease (GvHD) occurs when transplanted stem cells (“graft”) assault the recipient’s cells (“host”) because they are foreign to the body.

GvHD is classified into two types:

  • Acute GvHD – This happens within the first three months of transplantation.
  • Chronic GvHD – This condition progresses from acute GvHD and can produce symptoms for many years.
  • Infections: As a result of chemotherapy and bone marrow suppression, the body is temporarily unable to create cells needed to fight infections.

Prognosis and long-term survival can vary greatly from patient to patient with any surgery/procedure, such as bone marrow transplantation (BMT). Following a BMT, the patient need ongoing follow-up treatment.

Continuous medical advancements and the performance of a growing number of transplants for a growing range of disorders have considerably improved the result for BMT in adults and children. New processes and strategies for improving treatment regimens and reducing problems and adverse effects of transplantation are continually being developed.

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