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Blood and Marrow transplantation (BMT) is the process of replacement of patient’s bone marrow with healthy stem cells from the donor. BMT has emerged as the standard of care for many genetic disorders and high-risk malignancies which were considered incurable in the recent past. Allogenic BMT is performed using stem cells from an HLA matched donor, while autologous BMT is transfusion of patient’s own stem cells after high dose chemotherapy.

Some of the conditions where allogenic BMT is indicated are haemoglobinopathies like thalassaemia major, sickle cell disease, leukaemia like relapsed ALL, high risk AML, immune deficiencies like severe combined immune deficiencies (SCID), chronic granulomatous disease (CGD), aplastic anaemias like Fanconi anaemia, acquired aplastic anaemia and inherited metabolic disorders like Hurler Syndrome. Autologous BMT is indicated in relapsed/refractory lymphomas, high-risk neuroblastoma etc.

Finding a donor (HLA typing):

The first step in the process of BMT is finding a 10/10 HLA matched donor. Only 25% of children have a fully HLA matched sibling in the family (matched sibling donor). If there is no full HLA matched donor in the family, either a fully HLA matched unrelated donor or a half-matched parent (haploidentical donor) or unrelated cord blood can be preferred as donor of stem cells.

Haploidentical Donor Transplantation:

This procedure uses HLA half-matched (haplotype) donors such as parents or half-matched siblings for allogeneic transplantation. The ability to use haploidentical donors is of special relevance to patients who do not have HLA-matched sibling or unrelated donor options.

Preparing the child and donor for BMT:

Once the donor is identified, both the child and the donor undergo certain blood investigations to be considered fit to undergo BMT. The child/patient is then given a week of chemotherapy and/or radiotherapy to destroy the unhealthy bone marrow and to create space for the new healthy bone marrow to engraft.

Stem cell collection:

Stem cells from matched donors can be collected from peripheral veins through a special apheresis machine or from the bone marrow through harvesting. Stem cell infusion: This is then followed by an intravenous infusion of bone marrow containing the donor stem cells. The new bone marrow then produces healthy blood cells in 2 to 3 weeks (engraftment)

Graft-versus-host disease (GVHD):

Around 20-30% of bone marrow transplanted children can have GVHD where the immune cells of the donor’s bone marrow react against the patient’s own tissues. The disease is either “acute” (usually occurring within 100 days of transplantation) or “chronic” (occurring 100 days after transplantation). Children are treated with immunosuppressant for a period of 6 to 12 months to prevent and treat GVHD.

Protective environment:

The entire transplant unit is equipped with HEPA (high efficiency particulate air) filters to protect against infections and strict aseptic measures are followed throughout the entire hospital stay.

We, at Dr Rela Institute & Medical Centre have a well experienced team of dedicated paediatric haemato-oncologists who offer a comprehensive haematopoietic stem cell transplant service for children with life-threatening benign and malignant haematological disorders.

We follows the protocols at par with internationally renowned centers; hence rendering the best and safest solution to patients who are otherwise extremely vulnerable to life-threatening complications. This state-of-the-art facility is managed by a dedicated team of paediatric haemato-oncologists, bone marrow transplant specialists, Paediatric Nutritionists, infectious Diseases Specialists, Counselors, Pathologists, and staff nurses experienced in this field; and is ably supported by…