Bone Marrow Transplant Treatment Cost in India

?Inside the human bone, there are a soft, spongy and fatty tissue present which is responsible for the production of red blood cells, (role: oxygenation and nutrients distribution in the body), white blood cells (immunity), and platelets (responsible for blood clotting).

Damaged bone marrow as a result of chemotherapy, infection or disease is replaced in a bone marrow transplant. This is done by blood stem cell transplantation where the healthy blood cells travel to the marrow and produce new blood cells as well as promote the new marrow’s growth.

This bone marrow also houses the hematopoietic stem cells or HSCs which are the immature blood-forming stem cells. Most cells can make their own copies and get differentiated into other functional cells. But stem cells are unspecialized and are capable of multiplying via cell division and differentiate into mature blood cells or remain as stem cells. The HSC present in the marrow is capable of making new blood cells all throughout the lifespan.

So a bone marrow transplant replaces the damaged stem cells with healthy ones which help the body to make enough white blood cells, red blood cells and platelets to avoid various bleeding disorders, anemia, and infection. There is the best bone marrow transplant surgery done in India.

Healthy stem cells can be received from a donor or they may be produced from the patient’s own body.  So before chemotherapy radiation, these stem cells will be harvested and grown. These healthy cells will be kept in store and used late during transplantation.

Based on the above there are two kinds of transplants namely:

Autologous stem cell transplants: In this kind of transplant, own stem cells are used.  In this case, the cells are collected from the patient’s body before they are about to undergo damaging therapy. The healthy and harvested stem cells are introduced back to the body after the treatment is over. But this technique cannot be used if the patient does not house healthy stem cells in the body. But if this can be done then it reduces the chances of many other complications.

Allogeneic transplants: in this case stem cells are collected from a donor. The donor identified must be a very close match to the patient genetically. This can be done by browsing through a donor registry or a compatible relative can be a good choice.

The donor cells, when introduced to the patients’ body can trigger false alarms which can make the immune system attack the new cells and treat them as foreign harmful bodies. For this, the patient is put on medications to suppress their immune system. The risk of this is that the patient is being exposed to illness due to a weakened immune system.

The success of the above is highly dependent on how well the donor cells found a match with the patient’s body type.

A bone marrow transplant can be the treatment option for the following clinical conditions:

Leukemia and lymphomas: Under this category the following disorders of blood can be considered with bone marrow transplant treatment. Here the lymphatic system is affected with cancer.

• Acute myelogenous leukemia.

• Acute lymphoblastic leukemia.

• Chronic myelogenous leukemia.

• Chronic lymphocytic leukemia.

• Juvenile myelomonocytic leukemia.

• Hodgkin lymphoma.

• Non Hodgkin Lymphoma.

Some of the symptoms would include shortness of breath, unaccounted weight loss and swellings in the lymphatic nodes.

Bone marrow disorders: This is the second kind of condition where a bone marrow transplant is required, where the bone marrow fails to function properly.

• Fanconi anaemia.

• Paroxysmal nocturnal haemoglobinura.

• Severe aplastic anaemia.

• Pure red cell aplasia.

• Amegakaryocytosis/congenital thrombocytopenia.

Symptoms include paleness in complexion, weakness and nausea, general fatigue in doing anything.

Inherited immune system disorders:  This is a rare condition where during birth infants are born with such immunity disorders.

• Severe combined immunodeficiency.

• Wiskott- Aldrich Syndrome.

Symptoms include bloody diarrhoea, eczema, skin and oral mucosa appearing in the first years of birth.

Haemoglobinopathies:  A disorder where the red blood cells do not function properly.

• Sickle cell diseases.

• Beta thalassemia major.

Symptoms include low oxygen in blood, dizziness, blood in urine and general weakness and fatigue.

Inherited metabolic disorders: These kinds of diseases show their manifestation from infantile stage to early teens and can be life threatening requiring bone marrow transplant.

• Krabbe disease (GLD)

• Hurler syndrome

• Adrenoleukodustrophy

• Myelodysplatic syndromes

• Metachromatic leukodystrophy

• Multiple myeloma

• Myleodysplastic syndromes

Most common diagnosis of the above conditions are done through blood tests to understand the count, and function of the blood cells and biopsy of any affected tissue to understand the nature of the cancer.

When stem cell transplant surgeon thinks the patient is ready to have a transplant, a series of events will be rolled into motion. The whole process is similar to the transfusion of blood.

If the patient is about to have an allogeneic transplant, then bone marrow cells will be harvested from a donor a day before the procedure. And if the patient’s own cells are used then it will be retrieved from the stem cells.

Cells can be collected in two ways:

During the harvesting of bone marrow cells: these are collected through a needle from both the hip bones when the patient is under anesthetic where he or she does not have any sense.

In the next step called leukapheresis, a donor is helped with five shots to assist the stem cells to move from the bone marrow into the bloodstream. Thereafter the blood is drawn through an intravenous line and the white blood cells are separated from the stem cells with the help of a machine.

In the upper right portion of the chest of the patient, a central venous catheter which is like a needle is introduced. This makes a pathway for the flow of the new stem cells into the heart in the form of fluid. The stem cells will now be pumped to be distributed throughout the body. They will finally reach the bone marrow by traveling through the blood and begin to grow there.

Since the bone marrow transplantation takes place over this session, the port is left undisturbed in the patient’s body. With many sessions, the chances of the new stem cells to integrate with the rest of the body increases. This process is called engraftment.

Nutrients, blood transfusions, and liquids are also received via this port. Medications are required at this stage to keep infection away and allow the healthy growth of the new marrow. At this juncture, the patient will be closely monitored for any kind of undesirable complications.

With breakthroughs achieved in the treatment of blood disorders, more and more valuable innovations are coming up. One such alternative to bone marrow transplant is Nicord treatment, where cells collected from the blood of the umbilical cord is cultured making use of a technology based platform called NAM. Here the highly functional stem, progenitor and dendritic cells are developed to overcome the difficulty of not seeking suitable donors in the treatment for bone marrow transplants. This medication has now been approved by the FDA.

Bone marrow transplant can be a very complex treatment since the patient needs to be prepared for the whole cycle mentally. So before the treatment starts, it is advised to the patient to understand the timelines, consequences (recovery period and quality of life with children bearing capacities), stem cell transplant success rate and aftercare required for the treatment.  The patient should share all previous history of clinical condition with his or her healthcare provider and try to find if there are other suitable alternatives to this treatment which can be considered.

Depending on the damage that is being addressed by the bone marrow transplant the recovery period in influenced. In some cases, patients are kept under observation for several weeks to monitor the production of healthy blood cells and check for any damage caused in any of the healthy organs as a result of the transplant. Hence the average length of stay for bone marrow transplant can be 3 to 6 weeks.

It might take an year to get back to normal life and even after that the treatment provider will continue to monitor the health of the patient. Diet will be significantly changed by total elimination of red meat, alcohol, and reduction of sugary and too much spicy and salty food. More concentration will be given on vegetables and whole grains for the recovery.

Patients will also be advised to manage fatigue and note down any huge abnormality to doctor and maintain a very balanced and non stressed lifestyle.

Bone marrow transplant cost can be really inexpensive in India compared to any other medical tourism destinations across the globe. It ranges from $18000 to $32000 depending on the kind of transplant that is recommended.