Bone Marrow Transplant – How hard is it to find a bone marrow match?

A Bone marrow transplant is a medical procedure to replace damaged or destroyed bone marrow with someone else’s or from your own body healthy blood cells. This helps your body to make RBC, WBC and platelets to avoid bleeding, infections or anemia. A bone marrow can be destroyed because of infection, chemotherapy or by any chronic disease. This procedure involves transplanting new stem cells and promoting growth of new blood cells in the body. This is also known as stem cell transplant. 

Bone marrow transplant cost in India ranges from 15 lakhs to 40 lakhs INR.  

What is HLA – Human leukocyte antigen:

The Human Leukocyte Antigen (HLA) is a cluster of genes that are responsible for the major proteins of the histocompatibility complex (MHC), called antigens, found in the human body’s cell membrane of leukocytes. HLA are proteins or markers found in the cells of the body. The function of HLA is the regulation of the immune system whether cellular in humans or humoral. It is a vital component in the human body in the vertebrate genome in respect to infection and autoimmunity. It helps the body to distinguish the body’s own protein from foreign invaders’ proteins such as bacteria or viruses.  

HLA matching & its importance before transplant:

For a successful outcome of bone marrow transplant, it is vital for HLA to match meaning there has to be a close match between a donor’s HLA and patients HLA. Researchers say that donors should match at least 6 HLA markers. Matching of HLA boosts the growth of healthy blood cells and also reduces the risk of post transplant risk mainly graft-versus-host-disease (GVHD). 

Based on research, there is one in four chances of patients’ blood cells matching their own siblings or relatives. Only 30% of patients could find a HLA matched donor in their immediate family. For the remaining 70% patients who need a transplant, HLA matched bone marrow from other donor’s is suggested.  

Selecting the best donor for a patient:

While selecting the most suitable donor for a patient, the doctor will consider factors such as age, gender, body weight, blood type, health condition, number of pregnancies (in case of female donor) or if the donor tests positive for a common virus called CMV. 

For instance, 

  • A donor matches the patient on 10/10 
  • A female with no pregnancy is considered. 
  • If there are more than one donor, then the younger donor will be selected after considering his/her health condition and prior exposure to common viruses. 

Hence, the doctor will select the donor on basic level evaluation such as blood tests, physical examination and medical history. Special blood tests such as HLA tests may also be needed.  

Eligibility criteria to select a donor: 

You could be a healthy donor for a bone marrow transplant if you meet the following eligibility criteria: 

  • Healthy individuals between the age of 18 to 60 years falls under the category of ‘ideal candidates’ for bone marrow transplant. 
  • To qualify for bone marrow transplant donor, the ideal body mass index (BMI) limit is 40 kg/m2.
  • People with health conditions such as blood disorder, infection, chronic heart disease, chronic lung disease, chronic diabetes, autoimmune diseases and mental illness are not eligible to donate stem cells. 
  • Pregnant women cannot become a donor until the full delivery is completed.  

How hard is it to find a bone marrow match?

Research has found that, for patients looking for a bone marrow match, the likelihood of a suitable match is as high as 91% to 99%. Most candidates for bone marrow transplant will find a suitable match from the donor’s registry. Even hard to find matches can find suitable donor matches from stem cell banks drawn from umbilical cord blood donations. For almost all patients, there is some sort of product available to match their needs. 

Patients suffering from blood related cancers such as lymphoma or leukemia require bone marrow transplant to help survive their cancer treatment. The transplant is performed after radiation and chemotherapy. Bone marrow transplant cost in India starts from USD 17,000.

Researcher says that donation from close relatives is the best possible option, but only 30% of patients get access to such donors. The majority has to rely on banked stem cells and donor registry. Bone marrow transplant success rate in India has increased considerably.

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