Bone marrow transplant

Bone marrow transplantation is currently a new opportunity to cure complex and hitherto incurable diseases. The first successful transplantation was performed in 1968 in a hospital in the city of Minneapolis, USA, to a child with aplastic anemia.

Bone marrow transplants have since been used quite effectively in the treatment of fairly complex diseases. Leukemia, lymphoma, breast cancer, or ovarian cancer. In 2007, American Timothy Brown was cured not only of leukemia but also of AIDS thanks to this surgical intervention. The innovative treatment method was tested on Brown, who was known to the world under the pseudonym "the Berlin patient." Today, people are cured of serious illnesses thanks to the replacement of stem cells. Unfortunately, most patients who require transplantation are not always able to transplant cells due to the difficulties of selecting a donor with compatible transplantable material.

Stem cell replacement is preceded by such procedures as chemotherapy and radiotherapy. After this radical treatment, both harmful and healthy cells of the body are destroyed. That is why a person who has undergone such harsh treatment needs a stem cell transplant. There are two types of transplantation, the first: autologous, when pluripotent SCs and the patient's own blood are used. And allogeneic, when material from a donor is used for transplantation.

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Indications for bone marrow transplantation

Indications for bone marrow transplantation are relevant for patients suffering from hematological, oncological or a number of hereditary diseases. Timely indications are also important for patients with acute chronic leukemia, lymphomas, various types of anemia, neuroblastomas and various types of combined immunodeficiency.

Patients suffering from leukemia or any type of immune deficiency have pluripotent stem cells that do not work properly. In patients with leukemia, the blood of the patient begins to produce a huge number of cells that have not passed all stages of development. In the case of aplastic anemia, the blood stops regenerating the required number of cells. Degraded or immature and poor-quality cells imperceptibly oversaturate the vessels and bone marrow, and over time, they spread to other organs.

In order to stop the growth and kill the harmful cells, extremely radical treatments such as chemotherapy or radiotherapy are necessary. Unfortunately, during these radical procedures, both the diseased and healthy cellular elements die. And so the dead cells of the hematopoietic organ are replaced by healthy pluripotent SCs either from the patient himself or from a compatible donor.

Bone marrow transplant donor

The donor is selected according to one of three options. A compatible donor has the closest possible genetic structure of cells. Stem cells taken from such a donor will significantly reduce the risk of all sorts of deviations associated with the immune system. The best donor is a person with similar genetics, such as a blood brother or sister, other relatives. A transplant taken from such a close relative has a 25% chance of genetic compatibility. Unfortunately, in most cases, parents and children cannot be donors due to genetic incompatibility.

A compatible unrelated donor can be any outside donor with compatible genetic material. Many large hospitals have a large donor database from which it is possible to find a compatible donor.

And the third option is an incompatible related donor or an incompatible unrelated donor. If it is impossible to wait for a compatible donor, in the case of an acute course of some serious disease, the patient may be offered pluripotent SCs of a partially compatible close relative or an outside donor. In this case, the transplant material is subjected to a special preparatory process in order to reduce the chances of rejection of the transplanted cells by the patient's body.

The donor databases of each of these medical institutions are combined into the Bone Marrow Donors Worldwide (BMDW), headquartered in Leiden, Holland. This international organization coordinates the relevant phenotypic data on HLA – human leukocyte antigen – in people who are willing to donate their hematopoietic cells or peripheral hematopoietic stem cell elements.

This database, currently the largest in the world and known since 1988, has an editorial board consisting of one representative from each stem cell donor bank. The board meets twice a year to discuss achievements and agree on future activities. BMDW is managed by the Europdonor Foundation.

BMDW is a collection of registries of data on stem cell donors and banks of peripheral hematopoietic stem cells. These registries, united on a voluntary basis, provide centralized and easily accessible information for doctors and people who need transplants.

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Bone marrow transplant quota

Is there a certain quota for bone marrow transplantation? Of course, there is. But in reality, everything is not so simple. Because the state can help far from all people in need.

The quota allows you to get help in the best clinic for free. At the same time, everything is done using high technology and medical procedures. But, unfortunately, the number of people is limited. The operation is expensive and the state is simply not able to help everyone. Basically, quotas are awarded to children. Because not many young parents can find such a sum for the operation. And in general, the search for a donor and a charitable organization takes a long time. But people with such a diagnosis cannot wait.

In such cases, the state comes to the rescue. As a rule, the procedure is fully paid for by families who are not able to pay for the treatment at all. But if you look at the cost of the operation, no one has such an opportunity.

How is a bone marrow transplant done?

First, after the patient has undergone treatment with chemotherapy or radical radiation, the patient is injected intravenously with pluripotent stem cells using a catheter. This is often painless and lasts about an hour. After this, the process of engraftment of donor or own cells begins; in order to speed up the engraftment process, drugs that stimulate the hematopoietic organ are sometimes used.

If you want to know how bone marrow transplantation is done, you will need to understand what processes occur in the body after its transplantation, and you should also understand the mechanisms of action of transplanted cells. During the engraftment process, the patient's blood is taken for analysis every day. Neutrophils are used as an indicator. A certain level of their number in the blood is required, if their indicator in the blood reaches 500 within three days, then this is a positive result and indicates that the replaced pluripotent SCs have engrafted. As a rule, about 21-35 days are required for the engraftment of stem cells.

Bone marrow transplant surgery

Bone marrow transplant surgery is preceded by powerful radiotherapy or intensive chemotherapy of the patient, sometimes both of these elements of treatment are practiced together. These procedures are used to destroy cancer cells, but in the process, they also kill the patient's healthy pluripotent stem cells. The above procedures for replacing stem cells are called the preparatory regimen. This regimen lasts as long as the patient's specific disease and the recommendations of his or her attending physician require.

Next, a catheter is inserted into a vein (in the neck) of the patient, through which drugs and blood cells will be administered and blood will be taken for analysis. Two days after radiotherapy or chemotherapy, surgery is performed, during which stem cells are administered intravenously.

After replacing the stem cells, it takes 2 to 4 weeks for the hematopoietic organ cells to take root. During this period, the patient is given antibiotics to help fight the infection and platelet transfusions to avoid bleeding. Patients who have undergone transplantation from an unrelated or related but incompatible donor require medications that will help minimize the body's rejection of the transplanted stem cells.

After stem cell transplantation, patients may feel weak, in some cases bleeding may occur, liver dysfunction, nausea, small ulcers may appear in the mouth, in rare cases there is a possibility of developing small mental deviations. As a rule, the hospital staff is quite competent and is able to create the most comfortable conditions for overcoming such difficulties. And naturally, one of the important aspects that will lead the patient to a speedy recovery is the attention and participation of the patient's relatives and friends.

Bone Marrow Transplant for HIV

A bone marrow transplant from a healthy donor for HIV will cure the recipient of this disease. In order to carry out this procedure, it is necessary to select a donor with a special genetic mutation. It occurs only in 3% of Europeans. This makes such a person susceptible to all known strains of HIV. This mutation affects the structure of the CCR5 receptor, thus preventing the "virus" from contacting the cellular elements of the human brain.

Before the procedure itself, the recipient must undergo a course of radiation and drug therapy. This will destroy their own pluripotent SCs. Medicines against HIV infection itself are not taken. A study is conducted 20 months after the operation. As a rule, the recipient is completely healthy. Moreover, he does not carry the HIV virus in the blood, hematopoietic organ and other organs and tissues. Simply put, in all the reservoirs where it can be.

This surgical intervention is associated with a high risk of infectious complications. It is quite possible that the achieved result may contribute to the development of a new direction in the field of gene therapy of HIV infection.

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Bone Marrow Transplant for Leukemia

It is often used in cases of acute myeloblastic leukemia and relapses of acute leukemia. In order to perform the operation, complete clinical and hematological remission is necessary. Before the procedure itself, a course of chemotherapy is administered, often in combination with radiation therapy. This will completely destroy leukemic cells in the body.

The sensitivity of lymphomas to chemotherapy is directly dependent on the dose, even during relapses. The chance of achieving remission is mainly given by high-dose chemotherapy, as well as it, but in combination with whole-body irradiation. True, in this case, such an approach is fraught with deep and prolonged suppression of hematopoiesis.

The method involves transplantation of stem cells, the source of which can be either a hematopoietic organ or the patient's or donor's blood. If we are talking about isotransplantation, then the donor can be an identical twin. In case of allotransplantation, even a relative. In case of autotransplantation, the patient himself.

When it comes to lymphoproliferative diseases, autotransplantation of blood stem cells is often used. This method has received universal recognition in the treatment of resistant lymphomas and relapses.

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Bone marrow transplantation in children

Bone marrow transplantation in children is used in cases where the patient suffers from leukemia. Moreover, this method is also used for aplastic anemia, multiple myeloma, and immune system disorders.

When pluripotent SCs begin to function somewhat incorrectly, thereby provoking an excessive amount of defective or immature cells, leukemia develops. If, on the contrary, the brain sharply reduces their production, this leads to the development of aplastic anemia.

Immature blood cells completely fill the hematopoietic organ and vessels. Thus, they displace normal cellular elements and spread to other tissues and organs. To correct the situation and destroy excess cells, they resort to chemotherapy or radiotherapy. Such treatment can damage not only defective, but also healthy cellular elements of the brain. If the transplant is successful, the transplanted organ will begin to produce normal blood cells.

If the donor hematopoietic organ was obtained from an identical twin, then the transplantation in this case is called allogeneic. In this case, the brain must genetically match the patient's own brain. To determine compatibility, special blood tests are performed.

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Repeat bone marrow transplant

Sometimes one operation is not enough. For example, the hematopoietic organ may not take root in a new place. In this case, a second operation is performed.

It is no different from a regular transplant, only it is called retransplantation. Before performing this procedure, diagnostics are carried out. After all, it is necessary to determine why the hematopoietic organ could not take root the first time.

After all procedures are completed, a second operation can be performed. This time, the person undergoes a more thorough examination. Because it is necessary to understand why this happened and to prevent another relapse.

The operation itself is complicated. But much in this case depends on the patient's efforts. If he carefully follows all the doctor's recommendations, then relapse can be avoided.

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Contraindications to bone marrow transplantation

Contraindications are primarily caused by acute infectious diseases such as HIV, hepatitis B and hepatitis C, syphilis, all kinds of immune system disorders, and pregnancy. Stem cell replacement surgery is not recommended for physically weak and elderly patients, and is strictly contraindicated for patients suffering from severe diseases of internal organs. Contraindications may also be caused by long-term therapy with antibiotics or hormonal drugs.

Contraindications to stem cell donation include the donor having an autoimmune or infectious disease. The presence of any of the diseases is easily determined by a mandatory comprehensive medical examination of the donor.

But today, the most serious obstacle to the stem cell replacement procedure remains the incompatibility of the donor and the patient. There is a very small chance of finding a suitable and compatible donor for transplantation. Often, donor material is taken either from the patient himself or from his physiologically compatible relatives.

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Consequences of bone marrow transplant

Are there any negative consequences of bone marrow transplantation? Sometimes there is an acute reaction to the transplant. The fact is that a person's age is a risk factor for this complication. In this case, the skin, liver and intestines can also be affected. Large rashes appear on the skin, mainly on the back and chest. This can lead to suppuration and necrosis.

In this case, local treatment is prescribed, which includes the use of ointments with prednisolone. If we talk about liver damage, they manifest themselves almost immediately. These phenomena are based on degeneration of the bile ducts. Damage to the gastrointestinal tract leads to constant diarrhea with pain and blood impurities. Treatment is carried out using antimicrobial therapy and increased immunosuppression. In more complex forms, damage to the lacrimal and salivary glands, as well as the esophagus, may occur.

Suppression of one's own hematopoietic organ can provoke immune deficiency. Therefore, the body becomes quite susceptible to various infections. It is necessary to undergo a course of recovery. Otherwise, cytomegalovirus infection may manifest itself. Which leads to the development of pneumonia and death.

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Rehabilitation after bone marrow transplant

After a bone marrow transplant, there is a long recovery period. Thus, the new hematopoietic organ may need a year to begin to function fully. During this time, patients must always be in touch. Because infections or complications may arise that must be dealt with.

Life after transplantation can be both disturbing and joyful. Because there is a feeling of complete freedom. From now on, a person is healthy and can do everything he wants. Many patients say that their quality of life has significantly improved after transplantation.

But despite the new opportunities, there is always a fear that the disease will return. Therefore, after the procedure, it is always worth monitoring your own health. Especially in the first year, because the body needs a long time to recover and nothing should interfere with this process.

Where do bone marrow transplants take place?

In fact, many clinics in Russia, Ukraine, Germany and Israel are engaged in this type of “work”.

Naturally, it would be much more convenient if the procedure was performed near the person's place of residence. But in most cases, you have to go abroad. Because it is a rather complicated operation that requires specialized intervention. Naturally, specialists are everywhere, but you also need an equipped clinic for this. Therefore, whether you like it or not, people go to another country. After all, this is the only way to save a person and give him a chance for further recovery.

Patients often go to Germany, Ukraine, Israel, Belarus and Russia. There are specialized clinics that perform such complex operations. The most important argument when choosing a place to perform the procedure is not only high-class clinics, but also the cost of the operation itself.

In Ukraine, bone marrow transplantation can be done at the Kiev Transplantation Center. The center began its work in 2000, and during its existence, over 200 transplants have been performed there.

The availability of the most modern medical instruments and equipment ensures the implementation of a wide range of procedures for allogeneic and autologous transplantation, as well as resuscitation, intensive care and hemodialysis.

In order to minimize the likelihood of developing infectious complications in patients with immune depression in the period after transplantation, the 12 transplant blocks and the operating room of the department use "clean room" technology. 100% air purity with the help of special climate control systems is ensured by initially preventing the penetration of harmful microorganisms, rather than eliminating them, already present in the room, by traditional means of antiseptic wet cleaning and UV irradiation.

Bone marrow transplantation in Israel can be performed in many medical institutions, one of which is the Moshe Sharett Institute of Oncology in Jerusalem. The research institute is part of the Hadassah Medical Center as one of its divisions. High-quality treatment of various oncological diseases is ensured by the use of the most advanced medical methods and technologies known at present.

The Hadassah center has its own donor bank, and the fast and effective search for a donor or recipient is facilitated by close ties and cooperation with many similar organizations, both within the country and abroad. The department has a device that allows for the atraumatic collection of lymphocytes and SCs for transplantation (apheresis). A cryo-bank provides long-term storage of such cellular material for further use after radiation and chemotherapy.

The registry of potential blood organ donors in Germany numbers over 5 million people, making it the largest in the world. Every year it receives more than 25,000 applications, the vast majority from citizens of other countries.

You can carry out such a procedure with all the necessary preparatory and mediating activities by using the services of the Berlin company GLORISMED.

The high level of professional training of specialists ensures that medical care in this area is at the highest level. A program of rehabilitation measures is also provided, taking into account the individual characteristics and condition of each specific patient. The use of various physiotherapeutic methods, manual, sports and art therapy, consultations regarding a healthy lifestyle, optimization of nutrition and diet are offered.

Bone Marrow Transplant in Russia

There are several medical institutions in this country that specialize in such operations. There are about 13 departments licensed for transplantation. This procedure is performed by highly qualified hematologists, oncologists, transfusiologists, etc.

One of the largest departments is the Raisa Gorbacheva Center at St. Petersburg State Medical University. Even fairly complex surgeries are performed here. This is really more of a department that specializes in this problem.

There is another clinic called "ON Clinic", it also deals with diagnostics of the disease and bone marrow transplantation. It is a fairly young medical center, but nevertheless, it has managed to establish itself.

It is also worth paying attention to the clinical center of children's hematology, oncology and immunology named after Dmitry Rogachev. This is a clinic with many years of experience. Which helps to fight the current situation, both adults and children.

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Bone Marrow Transplant in Germany

It is in this country that some of the best clinics performing this type of surgery are located.

Patients from abroad are admitted to various clinics. Thus, the most popular of them are the Heine Clinic in Dusseldorf, the university clinics of Münster and many others. The University Center Hamburg-Eppendorf is highly valued.

In fact, there are quite a few good medical centers in Germany. Highly qualified specialists work here. They will diagnose the disease, the procedures that are necessary before the operation and the procedure itself. In total, there are about 11 specialized clinics in Germany. All these centers have certificates from the International Society of Cell Therapy.

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Bone Marrow Transplant in Israel

There are many hospitals in this country that specialize in performing such operations.

Experimental operations are carried out annually, after which this technology allows saving lives with new and previously incurable diagnoses. In Israeli clinics, the percentage of patients who have successfully undergone bone marrow transplantation is constantly increasing.

Thanks to new scientific discoveries, the latest technologies and drugs that have proven themselves in this area are used. It has become possible to perform transplants from related donors, even with incomplete compatibility.

All these procedures are performed by the Hadassah Ein Kerem Medical Center in Jerusalem – Department of Transplantation and Cancer Immunotherapy, the Shemer Medical Center in Haifa based at the Bnei Zion Hospital, and the Rabin Clinic. But this is not the entire list. In fact, this surgical intervention is performed in 8 clinics. Some of which are not very expensive.

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