The Essential Guide to Bone Marrow Transplant in India

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Bone Marrow Transplant Procedure

A bone marrow transplant (BMT) is a complex medical procedure aimed at replacing damaged or diseased bone marrow with healthy stem cells. This process involves several stages, each crucial to the success of the transplant. Here’s a detailed breakdown of the procedure:

1. Pre-transplant Evaluation

Before the transplant, the patient undergoes a thorough evaluation to ensure they are fit for the procedure. This phase includes:

• Medical History and Physical Examination: A detailed review of the patient's medical history and a physical examination to assess overall health.
• Blood Tests: Comprehensive blood tests to check the patient’s blood cell counts, liver and kidney function, and to screen for infections.
• Imaging Tests: Tests such as X-rays, CT scans, and MRIs to assess the condition of the patient’s organs and detect any abnormalities.
• Bone Marrow Biopsy: A procedure to examine the bone marrow's condition and confirm the diagnosis.
• Psychological Evaluation: Assessment of the patient's mental health to ensure they can cope with the stresses of the transplant process.
• Organ Function Tests: Evaluations of the heart, lungs, and other vital organs to ensure they can withstand the transplant and associated treatments.

2. Donor Selection and Harvesting

Depending on the type of transplant, the source of healthy stem cells can vary:

• Autologous Transplant: The patient's own stem cells are collected and stored for later use.
• Allogeneic Transplant: Stem cells are collected from a compatible donor, often a sibling or unrelated matched donor.
• Umbilical Cord Blood Transplant: Stem cells are collected from the umbilical cord blood of a newborn.

Stem cell harvesting involves:

• Peripheral Blood Stem Cell Collection: The donor is given medication to increase stem cell production, followed by apheresis, where blood is drawn, stem cells are separated, and the remaining blood is returned to the donor.
• Bone Marrow Harvesting: Under general anesthesia, a needle is inserted into the donor’s pelvic bone to extract bone marrow.

3. Conditioning

Conditioning involves preparing the patient’s body to receive the new stem cells. This phase includes:

• High-dose Chemotherapy: Administered to destroy the patient’s diseased bone marrow and to suppress the immune system to prevent rejection of the new stem cells.
• Radiation Therapy: Total body irradiation (TBI) may be used alongside chemotherapy to eradicate any remaining diseased cells and create space for the new stem cells.

4. Transplant Day (Day 0)

On the day of the transplant, healthy stem cells are infused into the patient’s bloodstream through a central venous catheter. This process is similar to a blood transfusion and typically takes several hours. The stem cells then travel to the bone marrow, where they begin to engraft and produce new blood cells.

5. Engraftment and Recovery

Engraftment is the process where the new stem cells settle in the bone marrow and start to produce new blood cells. This phase can last several weeks and involves:

• Close Monitoring: Frequent blood tests and physical exams to monitor the patient’s progress and detect any complications early.
• Supportive Care: Administration of medications to prevent infections, manage side effects, and support overall health.
• Transfusions: Blood and platelet transfusions may be necessary to support the patient until the new marrow begins to function properly.
• Isolation: To reduce the risk of infections, patients are often kept in a sterile environment with limited contact.

6. Post-transplant Care and Long-term Follow-up

Long-term follow-up care is crucial for the success of the transplant and includes:

• Regular Check-ups: Frequent visits to the transplant centre for physical exams, blood tests, and monitoring of organ function.
• Immunosuppressive Therapy: Medications to prevent graft-versus-host disease (GVHD) in allogeneic transplants.
• Infection Prevention: Continued use of antibiotics, antivirals, and antifungals to prevent infections.
• Rehabilitation: Physical therapy and occupational therapy to help regain strength and function.
• Psychosocial Support: Counseling and support groups to help the patient and their family cope with the emotional and psychological aspects of recovery.
• Lifestyle Adjustments: Adopting a healthy lifestyle, including a balanced diet, regular exercise, and avoiding exposure to infections.

The entire process, from pre-transplant evaluation to long-term follow-up, requires close coordination between the patient, their family, and a multidisciplinary team of healthcare professionals to ensure the best possible outcome.

Bone Marrow Transplant Doctors in India

1. Dr. Rahul Bhargava

Position: Director - Blood Disorders and Bone Marrow Transplant

Consults at:

• Fortis Memorial Research Institute, Gurgaon
• Fortis Hospital, Noida

Ratings: 5.0

Surgeries: 800

Experience: 15 years

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About

Dr Rahul Bhargava is renowned for being the first Indian doctor to popularize stem cell transplants in multiple sclerosis. With over 400 successful transplants, he is considered one of the best stem cell transplant experts in Delhi and Gurgaon. His vision of creating the first integrated centre of excellence in haematology, paediatric haematology, and stem cell transplant has been realized at Fortis Memorial Research Institute. Dr. Bhargava is also actively involved in community awareness around blood disorders.

Areas of Interest

• Benign Haematology and Haematology
• Paediatric Hematoncology
• Matched Sibling, Unrelated, and Haploidentical Transplants
• Hematopathology and Molecular Haematology

Previous Experience:

• MBBS and MD in Medicine from Bhopal, Madhya Pradesh
• Senior Resident in the Department of Haematology and Stem Cell Transplant at CMC Vellore
• DM graduate from AIIMS, New Delhi
• Established the first stem cell transplant centre at Medanta the Medicity, Gurgaon, completing 100 transplants in 2 years
• Head of Haematology at Artemis, where he performed the first haploidentical transplant in Gurgaon

2. Dr. Revathi Raj

Specialization: Hematologist and Pediatrician

Experience: 31 years

Consults at:

• Apollo Cancer Centres, Chennai

Education:

• MBBS from Madras University, Chennai, India (1991)
• Diploma in Child Health (DCH) from The Tamil Nadu Dr. M.G.R. Medical University (TNMGRMU) (1993)
• FRC.PATH. (U.K.) from The Royal College of Pathologists (2008)

Professional Memberships:

• Indian Medical Association (IMA)

Services Offered: Blood transfusion, stem cell transplantation, wellness screening, haemophilia care, lymphatic drainage, bone marrow transplant, eosinophilia treatment, thalassemia care, and chelation therapy.

Dr. Revathi Raj is a highly experienced haematologist and paediatrician, with over three decades of practice. She provides specialized care in bone marrow transplants and various other treatments related to haematology and paediatrics at Apollo Cancer Centres in Chennai.

Bone Marrow Transplant Hospitals in India

1. Apollo Hospitals, Chennai:

Bone Marrow Transplant Cost in India

Generally, the cost of a bone marrow transplant in India ranges from ₹15,00,000 to ₹40,00,000 (approximately USD 18,000 to $48,000).

Factors Affecting Cost:

1. Type of Transplant: There are two main types:

• Autologous: Using your bone marrow.
• Allogeneic: Using bone marrow from a donor. Allogeneic transplants are typically more expensive.

2. Hospital Facilities: The reputation and amenities offered by the hospital can impact the cost.

3. Donor Search & Matching: If an allogeneic transplant is needed, the cost of searching for and matching a donor can add to the overall bill.

4. Post-operative Care: The extent of aftercare needed, including medications and potential complications, can influence the total cost.

Recommendations:

To get a more accurate estimate for your specific situation, it's advisable to:

• Contact Hospitals Directly: Reach out to hospitals you're considering to get a quote based on your specific condition and transplant type.

Bone Marrow Transplant Success Rate in India

Success rates for bone marrow transplants in India depend on several factors:

• General Range: Success rates in India generally range between 60% and 80%.

• Type of Transplant: Autologous transplants often have slightly higher success rates than allogeneic transplants.
• Patient's Age & Health: A younger patient with a good overall health condition generally has a better prognosis.
• Underlying Condition: The success rate can vary depending on the disease being treated with the transplant.
• Hospital & Doctor Experience: A well-established hospital with experienced doctors specializing in BMT can significantly influence success rates.

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