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About Service
FAQ's
WHAT IS STEM CELL TRANSPLANTATION/BONEMARROW TRANSPLANTATION?

Hematopoetic stem cell transplant is the transfer of healthy blood forming cells from the donor to the recipient to cure or control certain medical conditions. Unlike solid organ transplants (liver, kidney), bone marrow transplant is not a surgical procedure.

WHAT ARE STEM CELLS?

The Stem cells can be described as the “seed cells” of the body, as they

  • Can produce cells identical to themselves (replenish themselves)
  • Have the capacity to produce one or more subsets of mature cells (form new cell/tissues).
SOURCES OF STEM CELLS
  • Bone marrow- bonemarrow is the spongy tissue found in the medullary cavity of the bone, which is rich in stem cells.
  • Peripheral blood stem cells-Bobnemarrow stem cells can be mobilized from bone marrow to peripheral blood with medications, and its becoming preferred mode of stem cell collection
  • Cord blood another source of stem cells, collected and stored at the time of birth.
CONDITIONS REQUIRING STEM CELL TRANSPLANT (SCT)

The Conditions requiring stem cell transplant can be divided into two broad groups:

  1. Cancer/ malignant conditions
  • Relapsed or high-risk blood cancer (leukemia)
  • Relapsed or stage IV solid tumours (lymphoma, neuroblastoma, ewing’s sarcoma)
  • Myeloproliferative disorders,Myelodysplastic syndromes
  1. Non-malignant conditions
  • Transfusion dependent anemia like Thalassemia major, sickle cell anemia etc.
  • Bone marrow failure syndromes (constitutional/Idiopathic Aplastic anemia)
  • Primary immunodeficiency disorders
  • Metabolic diseases (inborn errors of metabolism) and storage disorders.
  • Certain Genetic disorders/Neurological conditions like Adrenoleukodystrophy
TYPES OF SCT

Autologous- Here, the patient’s own stem cells are harvested and stored. Then, after giving intensive treatment to control the disease, these cells are re-infused into the patient as a rescue procedure. It is used mainly in Stage IV (high risk) or relapsed solid tumours.

Allogenic- Here, healthy cells are collected from a donor and transfused into the patient to form new cells in the patient. Based on the donor used, Allogenic SCT can be of the following types:

  • Matched Sibling transplant (MSD)- HLA matched brother or sister is the donor. This is the best option with the highest success rate.
  • Matched unrelated donor (MUD)- A HLA matched but unrelated person is the donor. Nowadays, many Stem cell registries are being maintained to aid in finding unrelated donors in case sibling isn’t there or is not a match.
  • Haploidentical- Where either of the parents is the donor. In recent times, success rate with Haplo SCT has been steadily increasing.
  • Mismatched sibling donor (MMSD)r mismatched unrelated donor (MMUD)- rarely used.

Syngenic – where your twin is your donor, provided they are disease free

STAGES OF SCT

After diagnosis of the condition requiring SCT in a child, next step is identification of the donor. For this, HLA typing of the child and the prospective donor(s) needs to be done for matching. Once the donor is selected, SCT involves the following stages-

  • Donor and recipient clinical examination and laboratory work up.
  • Harvesting and storing the stem cells from the donor.
  • Conditioning- Preparing the body of the recipient for the transplant.
  • Transplanting the stem cells
  • Recovery period
PRE-TRANSPLANT WORK UP

Routine diagnostic tests such as complete hemogram, biochemistry,X-ray,2DECHO , urinalysis and Screening for viral infections is done. Also, Human Leukocyte Antigen(HLA) typing and blood grouping are done to assess recipient/donor compatibility. This assessment of compatibility is essential to reduce risk of rejection of transplant.

HARVESTING THE STEM CELLS

The stem cells are collected either from the bone marrow or the peripheral blood of the donor. Donors are given Inj G CSF to increase the number of stem cells prior to the collection in case the source of stem cells peripheral blood. Sometimes, stored cord can be used as the source of stem cells. Though none of the collection methods cause any harm to the donor, peripheral blood stem cell collection by apheresis is gaining popularity as it is less invasive and cumbersome to the donor, without the requirement of anaesthesia and with good success rate as bone marrow SCT.

The collected stem cells are stored by cryopreservation.

CONDITIONING

The conditioning process is done for three reasons:

  • Destruction of the existing bone marrow cells to make room for the transplanted stem cells
  • Destruction of any existing cancer cells
  • To suppress the immune system of the recipient to decrease chances of rejection of donorstem cells.

It carried out by giving intensive chemotherapy with or without radiation. 

TRANSPLANTATION OF STEM CELLS

It is not a surgical procedure, rather a delicate and careful transfusion of the collected stem cells into the recipient via a central venous catheter. These stem cells then home in to the bone marrow of the recipient and starts proliferating after some time.

POST TRANSPLANT RECOVERY

After transplantation, the child must be under constant observation with intensive supportive care. Continuous monitoring is required to identify and manage any complications arising. Even with all the precautions, SCT does involve few risks, chief of which are

  • GVHD (Graft Vs Host disease)-In this disease, the transplanted stem cells (“graft”) attack the recipients cells (“host”) asthey are considered alien to the body.There are two types of GvHD:

Acute GvHD – Occurs during the first three months following the transplant.

Chronic GvHD – Develops from acute GvHD and can cause symptoms for many years.

  • Infections- risk of infections is high as the recipient’s immunity is very low during this process. With strict aseptic precautions and isolation, aggressive use of antibiotics and antifungals, proper nursing care etc this complication can be combated.
  • Graft rejection- the recipients body may reject the donor cells. This can be controlled by the optimum use of immune suppressives in the recipient after the transplant.

It usually takes 3 to 4 weeks for the recovery  after SCT.

BONE MARROW TRANSPLANT UNIT AT RAINBOW CHILDREN’S HOSPITAL
  • HEPA filters(High Effiency Particulate Air Module) to maintain positive oressure and to fuilter particles
  • Pass box to ensure aseptic transfer of objects in to BMT room
  • Laminar Hood for aseptic preparation of medications
  • One to one nursing care, Round the clock doctor cover to ensure safety and good outcomes
  • RO water for all purpose usage
  • In house blood bank facility
Details of 1 st BMT done at Rainbow childrens hospital

Born in a middle class farmer family in Suryapet, little J is the first child of his parents. At 11 months of age unfortunately he developed significant dullness, vomiting and fever at 10 months age. He was brought to Rainbow Children’s hospital for treatment and was diagnosed with brain tumour in  MRI scan. He got operated for same in July 2017 and  It was a poorly differentiated Grade IV medulloblastoma tumour . Given his age, and and local spread to surrounding meninges it is a high risk tumour.

As he was very young, Radiation therapy could not be given post surgery. Post Surgery MRI revealed residual tumour along with spinal meningeal enhancement  (?metastasis). In view of the high risk nature of the child’s disease, parents were counselled regarding the chances of cure and survival of the child.He was started on chemotherapy under the care of Dr Sirisha Rani, Sr Consultant in Pediatric Hematology Oncology, rainbow childrens hospital, Banjara hills. After 5 cycles of chemotherapy, repeat MRI showed complete clearance of the tumour and spinal meningeal enhancement.

Following this good response it was decided to consolidate his tumour remission with High dose chemotherapy followed by Autologous stem cell transplantation. The transplantation was carried out in the state of the art Bone marrow transplantation unit (BMTU) at Rainbow Children’s hospital Banjara hills. During the conditioning as well as post transplantation, he was closely monitored. With high clinical acumen, timely use of prophylactic antibiotics and excellent nursing care his course was smooth without any major complications and he was successfully discharged.

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