20 inpatient beds are available in the center, where a physician team consisting of a professor and a specialist experienced in stem cell transplant from the field of hematology and a biologist experienced in apheresis and stem cell freezing, nurses and other experienced healthcare personnel work.
All rooms are single and equipped with world class HEPA filters that ensure the clean air free of all dust and microorganisms. All diet types are provided to patients in our center, especially the neutropenic diet (sterilized from microorganisms); they are continuously supervised by an experienced dietitian regarding content and quality standards.
Our psychologist provides the patients with necessary psychological support before and after the transplant. A pharmacist also works in our center and supervises drug storage and preparation for chemotherapy and other medical applications.
What are Bone marrow and Hematopoietic Stem Cell?
Bone marrow is a place inside the bone that contains blood and stem cells. Stem cells create red blood cells, white blood cells and platelets.
What is Bone Marrow Transplantation?
It enables administration of drugs at sufficient and therapeutic doses for certain malignant or benign blood, lymph node and bone marrow diseases. When drugs are administered at high doses, blood cells cannot be produced in patients’ body for a long time. The patients can lose their lives due to bleeding or infection during this time. Bone marrow transplantation shortens this time and enables recovery of the patients.
Where are the stem cells harvested in bone marrow transplantation?
- Bone marrow,
- Umbilical cord.
There are three types of bone marrow transplantation:
Allogeneic transplantation: Blood cells are collected from patient’s siblings, family members or unrelated donors with match tissue groups.
Autologous transplantation: Stem cells are collected from the patients themselves.
Syngeneic transplantation: Stem cells are obtained from the patient’s identical twin and transplanted.
How Is Autologous Bone Marrow Transplantation Performed?
The patient is primarily given an appropriate treatment to eliminate the disease. In the next stage, certain medications are administered to prevent recurrence of the disease; stem cells are harvested and frozen. Then, high-dose medication treatment is started to destroy the remaining cells of the disease. Following high-dose medication therapy, the stored stem cells are transferred to the patient.
Are there risks of autologous transplantation?
The treatment is generally well tolerated by the patients. Since stem cells are obtained from the patient’s own body, life threatening problems are rarely seen in this patient group. High-dose medication may cause nausea, vomiting, diarrhea and hair loss, but they can be managed after the treatment is completed.
How Is Allogeneic Bone Marrow Transplantation Performed?
The patient is primarily given an appropriate treatment to eliminate the disease. Stem cells are harvested from the patient’s sibling or unrelated donor with match tissue groups. Meanwhile, high-dose medication treatment is started to destroy the remaining cells of the disease. Next, the donor cells are transferred to the patient. The procedure poses no risk for the donor sibling or unrelated donor. The procedure is similar to donating blood in blood bank. Since the harvested stem cells are replaced in a short time, no disease or disorder is seen.
Are there risks of allogeneic transplantation?
As completely healthy stem cells are transplanted, the risk of recurrence is very low. Even if the tissue groups are completely matching, immune systems may not be compatible. The immune cells of the donor may react to the organs of the recipient. ‘Graft Versus Host’ disease may develop that causes disorders in liver, skin and intestines. This condition should be treated.
How are stem cells harvested?
The stem cells can be collected from bone marrow, although this method is rarely used today. Stem cells are still harvested from blood vessels of arm or with ‘apheresis’ devices by inserting a catheter to the blood vessel in the neck. Stem cells are harvested without anesthetizing the patient or the donor.
Which tests are done for patients and stem cell donors before transplantation?
Blood tests, urine tests and lung, heart, liver, jaundice and infection tests are done for patients and donors. Decision is made depending on results of these tests and examinations. In case of problems, such as caries, are noted in dental examination, they are treated. Investigations are especially focused on lung and heart diseases. Liver problems are solved. Psychological condition of the patient is investigated for the eligibility. Necessary supportive treatments are given. The patient is informed about stem cell transplantation. After the patient voluntarily consents to the procedure, treatment is started according to the disease and overall health of the patient.
How are stem cells harvested?
A catheter is inserted to the patient or the donor. Chemotherapy agents that mobilize stem cells from the bone marrow to the peripheral circulation or drugs that ensures quick proliferation thereof are administered. Stem cells are harvested from the patient or the donor with devices called apheresis that identifies the stem cells at the suitable time.
Why are stem cells frozen in bone marrow transplantation?
The harvested stem cells can be immediately transferred or they are stored to be used when necessary. Freezing procedure is performed in at least -80°C. When the cells are stored at this temperature, they are preserved in healthy form without losing any native function. When the stem cell is thawed, the system of the cell continues its functions. The cells are usually stored in -196°C. This technique is called cryopreservation. Stem cells can be stored for many years with this technique.
How are peripheral blood stem cells harvested for transplantation?
It is still the most common stem cell harvesting method around the world. Stem cells in circulating blood of the donor are collected with a method called apheresis. The procedure is similar to donating blood in blood banks. Stem cells of the donor or the patient are collected in the apheresis unit. The procedure takes around 2-4 hours depending on the personal factors. After the collected stem cells are counted, they are frozen until the transplantation. Apheresis can rarely cause side-effects such as fainting, chilling, numbness in lips and cramps in hands.
What happens after stem cells are transplanted?
Stem cells reside in bone marrow to produce white blood cells, red blood cells and platelets after they enter into the blood circulation. The cells start producing blood within 2 to 4 weeks after the transplantation. Complete recovery of the immune system depends on the type of transplantation. The recovery process is completed within several months for recipients of autologous transplantation while it takes 1 to 2 years for recipients of allogeneic transplantation.
For which patients is the bone marrow transplanted?
- Acute Myeloblastic Leukemia
- Acute Lymphoblastic Leukemia
- Non-Hodgkin Lymphoma
- Hodgkin Lymphoma
- Multiple Myeloma
- Myelodysplastic Syndrome
- Chronic Myelocytic Leukemia
- Aplastic Anemia
- Paroxysmal Nocturnal Hemoglobinuria
- Primary Amyloidosis
- Hereditary Diseases: Thalassemia
How about the life of patients after bone marrow transplantation?
After being discharged from the hospital, the recovery period continues for 1 year in allogeneic transplant patients and 2 to 4 months in autologous transplant patients. The patients cannot return to full-time work for 6 months after the transplantation. The patients may suffer severe fatigue in the first couple of weeks; they should stand up and walk around the house. The patients are informed in detail about their diet, follow-up visit intervals, follow-up examinations and other necessary actions before they are discharged.