Oncology & Bone Marrow Transplant

Oncology is a branch of medicine that deals with the prevention, diagnosis and treatment of cancers. Sub branches include Surgical Oncology,Medical Oncology,Radiation Oncology,Nuclear Medicine,Palliative medicine and Rehabilitative medicine.
Cancer being a complex disease  requires highly specialized techniques for diagnosis – like CT, MRI, PET-CT, Onco-histopathology, Molecular and Genomic Testing etc.. and a wide range of interventions – including surgery, radiation therapy, chemotherapy,targeted therapy and immunotherapy.

In our partner hospitals, decisions on treating individual cancers are often managed through discussion on multi-disciplinary cancer conferences, commonly known as Tumor Boards where medical oncologists,surgical oncologists,radiation oncologists, pathologists,radiologists and organ specific experts meet to find the best possible management for an individual patient considering the physical, social, psychological, emotional and financial status of the patient. It is very important for oncologists to be updated on the latest advancements in oncology, as changes in management of cancer are paradigm.

Our partner hospitals and doctors follow globally recognized standards of care for treatment of the cancer of brain, head & neck, breast, lung, gastrointestinal tract,hepatobiliary & pancreatic, genitourinary tract, hematolymphoid, musculoskeletal system, pediatric cancers etc. They are equipped to deal with illness, whether the cancer is in early stage or metastasized.

FAQ’s on Bone marrow transplant

What is Bone marrow transplant?

Bone marrow transplant is also known as hematopoietic stem cell transplant. Hematopoietic stem cells create the major lineages in blood -the red blood cells, white blood cells and platelets.

In the treatment of some cancers an effective regimen has to be used which can be harmful to the hematopoietic system. The hematopoietic system gets hit as a bystander. Additionally, instances like in treatment of leukemia’s where we want to target the hematopoietic system itself. The stem cell transplant is either done as a curative measure or to replenish the hematopoietic system.

What are the types of Bone marrow transplant?

Allogenic – Stem cells are obtained from another person. The matching is done by HLA testing.The Donor can be related to the patient or unrelated. The donor stem cells obtained can either have a complete match or incomplete match. Generally, the chances of stem cell acceptance are more and complications are less in a complete match.

Autologous- Here the patient’s own stem cells are utilized. Prior to myeloabalative regimen(Chemotherapy with or without radiation) the stem cells are collected and stored(cryopreserved). They are replenished after the myeloabalative regimen.

How are hematopoietic stem cells obtained?

Hematopoietic Stem cells can be obtained from the donor’s blood through a procedure known as stem cell apheresis which is similar to an extended blood donation. The procedure of stem cell apheresis is performed after using certain drugs which stimulate the stem cells to migrate more vigorously from the bone marrow. Hematopoietic stem cells can also be obtained from bone marrow aspirate.

Diseases are treated by stem cell/bone marrow transplant –

Hematological

Leukemias- Acute lymphoblastic leukemia(ALL), Acute myeloid leukemia (AML) etc..

Dysplastic Syndromes of Marrow- Myelodysplastic syndrome (MDS),

Bone marrow failures- Aplastic Anemia

Sickle Cell Disease, Thalassemia

Immune deficiencies Disorders

Storage Disorders etc…

Solid tumours– following High dose chemotherapy for

Neuroblastoma

Lymphomas

Primitive neuroectodermal tumor (PNET)

Germ Cell tumors etc…

What are the complications of BMT?

 During the course of transplant and post-transplant a few complications can occur. The most commonly affected are the immune system, GI system, kidneys, liver, skin and mucosa.

Mucositis –  The oral and gut mucosae are one of those tissues which are normally being constantly replaced .Hence post myeloabalative regimen, it is one of those tissues which gets targeted and as a result ulcers are formed. The mucosites usually recovers 2- 3 weeks post the myeloabalative regimen.

Infections – Post myeloabalative regimen the hematopoietic system is affected and the blood counts reduce including the white blood cells. During the period of reduced WBC counts there is a susceptibility for infections. This is the reason for isolating the patients during transplant.

Graft-Versus-Host Disease (GVHD) – This may occur in Allogenic transplants. GVHD is caused when the T-Cells(Immune cells) derived from the donor recognize and react to the recipient as a foreign entity. GVHD can affect the skin, liver, gastro intestinal system. The effects can be anywhere from mild to life-threatening. GVHD may occur during the immediate transplant period or later after the transplant. Medications are started during the conditioning regimen to prevent this complication and continued post-transplant. These medications can render the immune system weak, hence post transplant it’s imperative to maintain a good degree of hygiene.

Thrombotic Microangiopathy (TMA) and Veno-Occlusive Disease (VOD)- These complications are less frequently encountered. In TMA there is inflammation of the small blood vessels and can result in clots . This can affect the vessels of kidney leading to kidney injury. The Heart, Lungs and gastrointestinal system may also be affected.In VOD usually the major venous return from the liver is occluded leading to liver dysfunction and in severe cases liver failure can occur.

What are the survival rates for patients undergoing stem cell/bone marrow transplant?

The survival rates vary. The rate of survival depends on the nature of disease, age of the patient additional co-morbidities and other factors. Generally, survival rates are better in Autologous transplant than in Allogenic transplant. Ipso facto success rates are better in a fully HLA matched transplant than an unmatched, unrelated transplant

Duration of stay during transplant?

The length of stay at a bone marrow transplant unit depends on the type of transplant. Usually in autologous transplant 3- 4 weeks of stay is required and the length of stay in allogenic transplant varies between 4- 6 weeks, if no intervening complications ensue.

Costs (approx)

BMT (Autologous) – $ 18000 – 30000
BMT  (Allogenic – Full Match) – $ 30000- 55000
BMT (Haplo identical ) –  $ 45000 – 60000