Bone Marrow Transplantation

At our center, where treatment is delivered by a multidisciplinary team, patients with malignant and benign diseases are offered the most attentive care and treatment options. Our specialist psychologist provides patients with the psychological support they need before and after transplantation. A pharmacist works at our center to ensure the proper storage and preparation of chemotherapy and other medications.

Patients with blood disorders such as multiple myeloma (a malignant bone marrow disease of plasma cells), lymphoma (a hematologic cancer of the lymph nodes), acute leukemia (blood cancer), chronic leukemia and aplastic anemia can apply to our center for autologous and allogeneic transplantation. Hisar Hospital Intercontinental, which serves more than 1,000 patients from 30 different countries every year, aims through its Bone Marrow and Stem Cell Transplantation Center to meet the bone marrow transplant needs of patients not only from Türkiye but from many countries around the world.

What Are Bone Marrow and Hematopoietic Stem Cells?

Bone marrow is the tissue inside the bones where blood cells and stem cells are found. Stem cells produce ‘red blood cells, white blood cells and platelets’.

What Is a Bone Marrow Transplant?

In certain malignant or benign diseases of the blood, lymph nodes and bone marrow, it allows us to give patients sufficient, curative doses of medication. When high-dose medication is given, the patient’s body cannot produce blood cells for a long time. During this period, patients may lose their lives due to bleeding and infection. A bone marrow transplant shortens this period and enables patients to recover.

Where are stem cells obtained from in a bone marrow transplant?

• From the bone marrow,

• From the blood,

• From the umbilical cord.

There are three types of bone marrow transplant:

Allogeneic transplant: A transplant performed with stem cells taken from the patient’s tissue-matched siblings, family members or matched unrelated donors.
Autologous transplant: A transplant in which the patient’s own stem cells are collected and later returned to the patient.
Syngeneic transplant: A transplant performed with stem cells taken from the patient’s identical twin.

How Is an Autologous Bone Marrow Transplant Performed?

First, the patient is given appropriate treatment to eliminate the disease. In the next stage, to prevent the disease from recurring, certain medications are given and the stem cells are collected and frozen. The patient then receives high-dose drug therapy to destroy the remaining diseased cells. After the high-dose therapy, the stored healthy stem cells are transferred back to the patient.

Are there risks with an autologous transplant?

Patients usually tolerate the treatment well. Because the stem cells are taken from the patients themselves, serious problems are very rare in this group. Due to the high-dose medications, problems such as nausea, vomiting, diarrhea and hair loss may occur, which usually resolve after treatment.

How Is an Allogeneic Bone Marrow Transplant Performed?

First, the patient is given appropriate treatment to eliminate the disease. Stem cells are collected from a tissue-matched sibling or unrelated donor. Meanwhile, the patient receives high-dose drug therapy to destroy the remaining diseased cells. The cells collected from the donor are then given to the patient. There is no risk for the sibling or unrelated donor who donates the stem cells. The process is similar to donating blood at a blood bank. Because the donated stem cells are replaced in the body within a short time, no illness or disorder occurs.

Are there risks with an allogeneic transplant?

Because completely healthy stem cells are transplanted, the risk of the disease recurring is very low. Even if the sibling is a full tissue match, the immune systems may not be compatible with each other. The donor’s immune cells may react against the organs of the person receiving the stem cells. ‘Graft Versus Host’ disease, which affects the liver, skin and intestines, may develop. This condition must be treated.

How are stem cells collected?

Although they can be taken from the bone marrow, this is rarely done today. Currently, stem cells are collected with ‘apheresis’ devices through the veins in the arm or via a catheter placed in a vein in the neck. Stem cells are collected without putting the patient or donor to sleep.

Why are stem cells frozen in a bone marrow transplant?

Harvested bone marrow stem cells can be given immediately or frozen and stored for use when needed. Freezing is carried out at a minimum of -80 °C. When stored at this temperature, the cell is preserved in a suspended state without losing any of its abilities, so that all its functions remain healthy. When the stem cell is thawed, the cell’s system resumes working where it left off. Stem cells are generally stored at -196 °C. This technique is called cryopreservation. With this technique, stem cells can be stored for many years.

How are peripheral blood stem cells obtained for transplantation?

This is currently the most commonly used stem cell collection method in the world. Stem cells circulating in the donor’s blood are collected using a method called apheresis. It is similar to donating blood at a blood bank. The stem cells of the donor or patient are collected in the apheresis unit. Depending on the person, the procedure takes 2-4 hours. After the collected stem cells are counted, they are frozen until they are given to the recipient. Apheresis may rarely cause side effects such as temporary fainting, chills, numbness of the lips and cramps in the hands.

What happens after the stem cells are transplanted into the patient?

After entering the bloodstream, the stem cells settle in the bone marrow to produce white blood cells, red blood cells and platelets. They begin producing blood within 2-4 weeks after the transplant. Full recovery of the immune system depends on the type of transplant. The recovery process is completed within a few months for autologous transplant recipients and within 1-2 years for allogeneic transplant patients.

In which patients is a bone marrow transplant performed?

• 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: Thalassemias

What is life like after a bone marrow transplant?

After discharge from the hospital, recovery continues for 1 year in patients who had an allogeneic transplant and for 2-4 months in those who had an autologous transplant. After the transplant, the patient cannot return to full-time work for 6 months. The patient may feel very weak during the first few weeks; during this period they should get up and walk around the house. At discharge, the patient is given detailed information about precautions regarding food and drink, follow-up appointment times, check-ups and what to do.

Which tests are performed on patients and stem cell donors before the transplant?

Patients and donors undergo blood, urine, lung, heart, liver, hepatitis and infection tests. The decision is made based on the results. Any problems found during the patient’s dental examination, such as cavities, are treated. Patients are examined particularly for lung and heart diseases. Any liver-related problems are resolved. The patient’s psychological suitability is assessed. Necessary supportive treatments are provided. The patient is informed about stem cell transplantation. After the patient gives their consent, treatment is started according to their disease and condition.

How are stem cells collected?

A catheter is placed in the patient or donor. Chemotherapy, which releases stem cells from the bone marrow into the bloodstream, or medications that cause them to multiply rapidly, are given. At the appropriate time, stem cells are collected from the patient or donor using apheresis devices, which recognize and separate them.