Bone marrow transplantation

Bone marrow transplantation is now a new opportunity to cure complex and even today incurable diseases. The first effectively performed transplant was performed in 1968 in a hospital in the city of Minneapolis USA, a patient with aplastic anemia to a child.

Operations on bone marrow transplantation have since been practiced quite effectively in the treatment of quite complex diseases. Leukemia, lymphoma, breast cancer or ovarian cancer. So in 2007, the American Timothy Brown, thanks to this surgical intervention, was cured not only from leukemia, but also from AIDS. An innovative method of treatment was tried on Brown, which was known throughout the world under the pseudonym "Berlin patient". Today, people are cured of serious ailments by replacing stem cells. Unfortunately, most patients who require transplantation do not always succeed in transplanting cells due to the difficulty of selecting a donor with a compatible transplant material.

The replacement of stem cells is preceded by procedures such as chemotherapy and radiotherapy. After this radical treatment, both harmful and healthy cells of the body are destroyed. It is for this reason that a person undergoing such severe treatment needs stem cell transplantation. There are two types of transplantation, the first one: autologous, when pluripotent SK and the patient's blood are used. And allogeneic, when the material from the donor is used for transplantation.

[1]

Indications for bone marrow transplantation

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

Patients suffering from leukemia or some type of immune deficiency have pluripotent CS that do not work properly. In patients with leukemia, the patient's blood begins to produce a huge number of cells that have not passed through all stages of development. In the case of aplastic anemia, the blood ceases to regenerate the required number of cells. Degraded or immature and substandard cells imperceptibly supersaturate blood vessels and bone marrow, and eventually spread to other organs.

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

Donor for bone marrow transplantation

The donor is selected according to one of three options. Compatible donor - has the most approximate genetic structure of cells. Stem cells taken from such a donor will significantly lower the risk of various deviations associated with the immune system. The best donor is a person with a similar genetics, such as 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 can not be donors because of genetic incompatibility.

A compatible unrelated donor can be any extraneous donor who has consensual genetic material. Many large hospitals have a large donor base, from which it is possible to find a donor with compatibility.

And the third option is an incompatible donor, or an incompatible, unrelated donor. If it is not possible to expect a compatible donor, with an acute course of any serious disease, the patient may be offered pluripotent SCOTs of a partially compatible close relative or an outside donor. In this case, the material for transplantation 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 for each of these health facilities are integrated into the Worldwide Donor Search System (BMDW), headquartered in the Netherlands in Leiden. This international organization coordinates the relevant phenotypic data on HLA - leukocyte antigen of a person in those who are ready to provide their hematopoietic cells or peripheral stem hematopoietic cells.

This is the largest database in the world to date, known since 1988, has an editorial board, which includes one representative from all the donor stem cell banks. The board is convened twice during each year to discuss achievements to agree on further activities. The BMDW is managed by the Europdonor Foundation.

BMDW is a collection of registers of data on stem cell donors and on banks in which peripheral stem-forming hematopoietic cells are present. These voluntary registries provide a centralized and easily accessible, all necessary information for doctors and people who need transplantation.

[2], [3], [4]

Quota for bone marrow transplantation

Is there a specific quota for bone marrow transplantation? Naturally, this is. But in fact, everything is not so simple. Because the state can help not all people in need.

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

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

How are bone marrow transplants done?

To begin with, after the patient has been treated with chemotherapy or radical irradiation, the patient is administered intravenously with the help of a pluripotent SK catheter. Often it is painless and last about an hour. After this, the process of engrafting donors or their cells begins, in order to accelerate the engrafting process, sometimes they use preparations stimulating the work of the hemopoietic organ.

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 also understand the mechanisms of the effect of the transplanted cells. In the process of engrafting, the patient's blood is taken every day for analysis. Neutrophils are used as an indicator. A certain level of their quantity in the blood is needed, if their blood count reaches 500 in the course of three days, this is a positive result and indicates that the replaced pluripotent SC has taken root. For engraftment of stem cells, as a rule, it takes about 21-35 days.

Operation of bone marrow transplantation

The operation of bone marrow transplantation 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 kill cancer cells, but the healthy pluripotent SC of the patient is also killed in the process. The above procedures for the replacement of stem cells are called - the preparatory regime. This regime lasts for as long as the specific patient's disease and the recommendations of its treating doctor require.

Then a patient is placed in a vein (on the neck) a catheter, through which drugs, cellular elements of blood will be injected and blood will be taken for analysis. Two days after radiotherapy or chemotherapy, a surgical procedure is performed, during which the stem cells are injected intravenously.

After the replacement of stem cells, for 2 to 4 weeks, the hematopoiesis cells should be implanted. During this period, the patient is injected with antibiotics that will help cope with the infection and make a transfusion of platelets in order to avoid bleeding. Patients who have undergone transplantation from an unrelated or related but incompatible donor require drugs that will help minimize the rejection of transplanted stem cells by the body.

After SC transplantation, patients may experience a feeling of weakness, 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 abnormalities. As a rule, the staff of the hospital is competent enough and is able to create the most comfortable conditions for overcoming such difficulties. And of course one of the important aspects that will lead a patient to an early recovery is the attention and involvement of the patient's relatives and friends.

Bone marrow transplantation with HIV

A bone marrow transplant with HIV from a healthy donor will allow the recipient to be cured of this disease. In order to implement 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 communicating with the cellular elements of the human brain.

Before the procedure, the recipient must undergo radiation and drug therapy. This will destroy your own pluripotent SC. Medicines against the HIV infection itself are not accepted. After 20 months from the date of the operation, a study is being conducted. As a rule, the recipient is completely healthy. Moreover, he does not carry the HIV virus in the blood, the organ of hematopoiesis and other organs and tissues. Simply put, in all the tanks, where it can be.

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

[5], [6], [7], [8], [9]

Bone marrow transplantation in leukemia

Often it is used in cases of acute myeloblastic leukemia and relapses of acute leukemia. To carry out the operation, a complete clinical-hematologic remission is necessary. Before the procedure itself, a course of chemotherapy is conducted, often in combination with radiotherapy. This will completely destroy leukemia cells in the body.

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

The method involves the transplantation of stem cells, the source of which can be either a hemopoietic organ or the blood of a patient or a donor. If it is a question of isotransplantation, then an odnoyaytsovy twin can act as a donor. In allotransplantation, even a relative. At autotransplantation itself is a patient.

If it is a question of lymphoproliferative diseases, then autotransplantation of SC of blood is often used. This method has been universally recognized in the treatment of resistant lymphomas and relapses.

[10], [11], [12]

Bone marrow transplantation in children

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

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

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

If the donor hemopoiesis was obtained from an identical twin, the transplantation in this case is called the allogeneic. In this case, the brain must correspond genetically to the patient's own brain. To identify compatibility, special blood tests are performed.

[13], [14], [15]

Bone marrow transplantation

Sometimes one operation is not enough. So, the organ of hematopoiesis may not settle down in a new place. In this case, a second operation is performed.

It is no different from ordinary transplantation, only now it is called re-transplantation. Before performing this procedure, a diagnosis is performed. After all, it is necessary to determine why the body of hemopoiesis could not take root for the first time.

After all the procedures have been completed, you can proceed with the re-operation. This time, a person is subjected to more thorough research. Because it is necessary to understand why this happened and not to allow another relapse.

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

[16], [17], [18]

Contraindications to bone marrow transplantation

Contraindications, in the first place, create acute infectious diseases, such as HIV, hepatitis B and hepatitis C, syphilis, all kinds of immune system disorders, as well as pregnancy. It is not recommended to replace stem cells with weak physically and elderly patients, and is strictly contraindicated in patients with severe internal diseases. Contraindications can also create long-term therapy with the use of antibiotics or hormonal drugs.

Contraindications to the donation of stem cells, is the disease of the donor autoimmune or infectious disease. The presence of any of the diseases is easily determined by compulsory medical comprehensive examination of the donor.

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

[19], [20], [21], [22],

Consequences of bone marrow transplantation

Can there be any negative consequences of bone marrow transplantation? Sometimes there is an acute reaction to the transplant. The fact is that the age of a person is a risk factor for this complication. In this case, the skin, liver and intestines can also be affected. On the skin, there are large eruptions, mainly on the back and chest. This can lead to suppuration, as well as necrosis.

In this case, local treatment is prescribed, which includes the use of ointments with prednisolone. If we talk about liver damage, then they manifest themselves almost immediately. At the heart of these phenomena is the degeneration of the bile ducts. Lesion of the digestive tract leads to constant diarrhea with pain and impurities of blood. Treatment is carried out with the help of antimicrobial therapy and increased immunosuppression. In more complex forms, lesions of the lacrimal and salivary glands, as well as the esophagus, may appear.

The oppression of one's own organ of hematopoiesis can provoke insufficiency of immunity. Therefore, the body becomes quite susceptible to various infections. It is necessary to conduct a recovery course. Otherwise, cytomegalovirus infection may manifest itself. Which leads to the development of pneumonia and lethal outcome.

[23], [24], [25], [26], [27], [28]

Rehabilitation after bone marrow transplantation

After a bone marrow transplantation, a long recovery period occurs. So, for a new hematopoietic organ it may take a year for it to start functioning fully. Throughout this time, patients should always be in touch. Because there may be infections or complications that need to be addressed.

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

But, despite the new opportunities, there is always a fear that the disease will return. Therefore, after the procedure, it is always worthwhile to monitor your own health. Especially in the first year, because the body needs a long time to recover and this process should not interfere.

Where are bone marrow transplants done?

In fact, this type of "work" is engaged in many clinics in Russia, Ukraine, Germany and Israel.

Naturally, it would be much more convenient if the procedure was performed near the place of residence of a person. But in most cases it is necessary to go abroad. Because this is a rather complicated operation that requires specialized intervention. Naturally, experts are everywhere, but you need a well-equipped clinic for this. Therefore, do not free will, people go to another country. It's only in this way that you can save a person and give him a chance for further recovery.

Often patients are sent to Germany, Ukraine, Israel, Belarus and Russia. There are specialized clinics that perform such complicated operations. Not only high-quality clinics become the most important argument in choosing the location of the procedure, but also the cost of the operation itself.

In Ukraine, bone marrow transplantation can be done at the Kiev Transplant Center. The Center started its activity in 2000, and during its existence more than 200 transplantations were performed in it.

The availability of the most modern medical instruments and equipment provides an entire range of activities for alogenic and autologous transplantation, as well as resuscitation, intensive care and hemodialysis.

In order to minimize the probability of developing infectious-type complications in patients with immune depression during the period after transplantation, the technology of "clean rooms" takes place in 12 transplantation units and the operating room of the department. 100% air purity with the help of special climate control systems is provided due to the initial prevention of penetration of harmful microorganisms, and not their elimination, already present in the room, by traditional means of antiseptic wet cleaning and UV irradiation.

Bone marrow transplantation in Israel can be done in a variety of medical institutions, one of which is the Institute of Oncology. Moshe Charette in Jerusalem. Research Institute as one of the units is part of the medical center "Hadassah". The qualitative treatment of a variety of oncological diseases ensures the application of the most progressive medical techniques and technologies known at the present time.

The Hadassah Center has its own donor bank, and a fast and effective search for a donor or recipient is facilitated by close communication and cooperation with many similar organizations, both domestically and abroad. In the department there is a device that allows atraumatic method (apheresis) to collect lymphocytes and SC for transplantation. Long-term storage of such a cellular material for use in the future, after radiation and chemotherapy provides a cryo-bank.

The register of potential donors of the hemopoietic organ in Germany has more than 5 million people, making it the most numerous in the world. Each year, it receives more than 25,000 applications, in the overwhelming majority from citizens of other states.

To carry out such a procedure with all the necessary preparatory and mediating measures, you can use the services of the Berlin company GLORISMED.

High level of professional training of specialists determines the medical service in this matter at the highest level. A program of rehabilitation measures is also envisaged, taking into account the individual characteristics and condition of each individual patient. The application of various physiotherapy techniques, manual, sports and art therapy, consultations on a healthy lifestyle, optimization of diet and diet are suggested.

Bone marrow transplantation in Russia

In this country there are several medical institutions that specialize in such operations. In total, there are about 13 offices with licenses for transplantation. This procedure is performed by high-class doctors, hematologists, oncologists, transfusiology, etc.

One of the largest departments is SPbSMU Center names Raisa Gorbacheva. Even complicated operations are carried out here. It really is more of an office that specializes in this issue.

There is another clinic called "ON Clinic", it also deals with the diagnosis of the disease and bone marrow transplantation. This is a fairly young medical center, but, nevertheless, he managed to prove himself.

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

[29], [30], [31]

Bone marrow transplantation in Moscow

The bone marrow transplantation in Moscow is carried out in the clinic "ON Clinic". This is one of the new medical centers that is part of the global network. Here, any kinds of operations are conducted only with the use of the latest technologies. Professionally trained personnel is fully responsible for the work. Doctors are constantly being trained abroad and are familiar with all the latest developments.

The Institute of Hematology, which is located in Moscow, also deals with this procedure. There are good specialists who will prepare a person for the operation and will hold it qualitatively.

There are also small clinics that deal with this procedure. But it is better to give preference to truly professional medical institutions. Among them are the largest center of SPbSMU Center names Raisa Gorbacheva. Real professionals work here, who will conduct the necessary preparations, diagnostics and make the operation.

[32], [33], [34]

Bone marrow transplantation in Germany

It is in this country that some of their best clinics are located, performing this kind of operations.

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

In fact, Germany has quite a few good medical centers. Highly qualified specialists work here. They will conduct the diagnosis of 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 of the international society of cellular therapy.

[35], [36], [37], [38], [39]

Bone marrow transplantation in Ukraine

Bone marrow transplantation in Ukraine from year to year becomes one of the claimed procedures. Often the list of patients is replenished by children. It is they who are exposed to this phenomenon.

So, in Ukraine the operation is carried out only in the 4 largest clinics. These include the Kiev Transplantation Center, Transplantation Center in Okhmatdete. In addition, a similar procedure is carried out at the National Cancer Institute and the Donetsk Institute of Urgent and Rehabilitation Surgery. V. Gusaka. The last center is one of the largest in Ukraine. Each of these clinics is competent in the issue of transplantation.

These clinics are famous for their professionalism. Doctors who perform this complex procedure are constantly being interned abroad. They are familiar with all the latest technologies used in these areas.

[40], [41], [42], [43]

Bone marrow transplantation in Israel

In this country there are many hospitals that specialize in carrying out such operations.

Every year, experimental operations are performed, after which this technology allows saving lives with new and previously incurable diagnoses. In the clinics of Israel, the percentage of patients who successfully performed bone marrow transplantation is constantly increasing.

Thanks to new scientific discoveries, the newest technologies and preparations are used which have proved themselves to be positively recommended in this field. There was an opportunity to conduct transplantation from related donors, even with incomplete compatibility.

All these procedures are carried out by the Hadassah Ein Kerem Medical Center in Jerusalem - the Department of Cancer Transplantation and Immunotherapy, the Shemer Medical Center in Haifa on the basis of the Bnei Zion Hospital, and the Rabin Clinic, but this is not the whole list. In fact, this surgical intervention is carried out in 8 clinics, some of which are not very expensive.

[44], [45], [46], [47]

Bone marrow transplantation in Belarus

 By the level of development of transplantology, this country is famous for its good results. Annually, about 100 operations are performed, which really help people.

To date, Belarus is ahead of all former USSR countries in terms of the number of operations conducted. The procedure is carried out in the 9th clinical hospital of Minsk and RNPC of children's oncology and hematology. These are two cents that conduct this complex procedure. Professional doctors will help prepare a person for this and carry out the operation at a high level.

Transplantation is a great progress to date. Because a few years ago it was impossible to help patients with this disease. Now, transplantation is used to treat a number of diseases. New technologies do not stand still, and it allows coping with many serious problems.

[48]

Bone marrow transplantation in Minsk

Bone marrow transplantation in Minsk is carried out in the Center of Hematology and Transplantation on the basis of the 9th city clinical hospital. To date, this clinic has become a member of the European Association of Transplantation Centers.

This clinic is the only one in the territory of the capital of Belarus. It is in demand because it performs one of the most complicated operations. After all, transplantation is a huge progress in the field of working with hematopoietic SC. And in general, today, thanks to this procedure, you can cope with many serious diseases.

This is a new leap in medicine that allows people to give a chance to live a new life. Before the operation, a number of activities are carried out to identify the problem itself, to diagnose it and to choose the method of performing the procedure.

[49], [50], [51]

Cost of bone marrow transplantation

The cost of surgical intervention varies in very high ranges. After all, finding a donor and conducting the procedure itself is not so simple. In many cases, this takes a long time. Situations are different. Therefore, sometimes it is necessary not only to wait a long time for the donor, but also to conduct a lot of activities before the operation itself.

The cost depends entirely on the complexity of the operation. Naturally, the total amount includes the qualification of the clinic and the professionalism of doctors. Much depends on the country where the operation itself is conducted. So, in Moscow such a procedure can cost from 650 thousand rubles to 3 million. In St. Petersburg, the price fluctuates in the area of 2 million rubles.

As for the far abroad, in Germany the operation costs 100 000 - 210 000 thousand euro. Everything depends on the work itself and the procedure is complicated. In Israel, the cost of surgical intervention with a related donor fluctuates around 170 thousand dollars, with non-related reaches 240 thousand dollars.

[52], [53], [54], [55],

How much does the bone marrow transplant cost?

It should, immediately stipulate that the procedure is expensive. The price affects a lot. So, the first thing is the specialization of clinics and the location of its location. Because Israeli and German medical centers are the most expensive. Here the cost of the operation varies around 200 000 thousand euros. But, despite this, the clinics are really the best of its kind.

The price is affected by the professionalism of the doctor, but this is reflected minimally. Much depends on the complexity of the procedure itself. So, the cost depends on the relationship of the donor. In Russia, the operation will be worth about 3 million rubles. In addition, even consultations before the procedure are paid.

But when it comes to saving a person's life, the price does not play a special role. It is not fictitious. The cost of the operation is due to its complexity.

Reviews about bone marrow transplantation

Reviews about bone marrow transplantation are mostly positive. But to be based only on them is not worth it. It is necessary to pay attention to the fact, where the operation was performed. Because much depends on the competence of the blade and doctors.

Especially popular are the clinics in Israel. Because here there is not only the latest equipment, but also specialists who know how to handle it. Considering the responses of people about these or other medical centers, it is worth considering the complexity of the operation itself. Without fatalities, unfortunately can not do. Therefore, you need to pay attention to the quality of the operation. Often, such a procedure helps to get rid of the disease once and for all. It is important during the rehabilitation process to follow all the recommendations of the doctor and not to disappear from his field of activity. In any case, do not give up. If you believe with all your heart that the procedure will help, so it will be.