What is bone marrow?
Bone marrow is the soft and spongy material found inside bones.
Bone marrow transplantation makes it possible to replace a sick or damaged marrow with healthy marrow, capable of producing normal blood cells.
In bone marrow diseases, bone marrow stem cells function defectively, producing too many immature blood cells (as in the case of leukaemia) or an insufficient number of cells (as in the case of medullary aplasia). Immature or deficient cells interfere with the production of healthy cells, accumulate in the bloodstream and can invade tissues.
Large doses of chemotherapy and radiation (Total Body Irradiation or TBI) are required to destroy abnormal bone marrow and blood cells. However, these therapies destroy not only diseased cells but also healthy cells in the bone marrow.
The marrow of a donor or, in some cases, that of the patient himself, taken before the therapies and treated appropriately, allows restoring the normal functions of production of blood cells.
Even the therapies used to fight other forms of cancer, which do not affect the bone marrow if in high doses, can damage the patient’s bone marrow.
In this case, the bone marrow is taken from the patient before the therapies, preserved and reinfused at the end of the treatments that could damage it.
What is bone marrow transplantation?
Bone marrow transplantation is not a surgical operation.
Bone marrow transplantation consists of two distinct phases – the first, during which the patient undergoes chemotherapy and/or radiotherapy, has the purpose of destroying all the marrow cells of the patient himself (including obviously the sick ones) and the second consists in administering to the patient, by transfusion, the healthy bone marrow is taken from a donor (or eventually the patient himself, previously).
At this point, the medullary cells are able to find a way to reach their rightful place, which is the cavity of the bones, where they begin to work by producing blood cells. In a period typically varying between one and two weeks after the transplant, we begin to see the first results, with the appearance, in the blood circulation, of healthy cells.
However, despite this apparent simplicity, bone marrow transplantation is a complicated biological procedure, which may also present some risks to the patient’s life.
The phase in which the new marrow is perfused to the patient is only the culmination of the whole procedure. Precise preparation is necessary before the actual transplantation. Afterwards, a long journey to healing will begin.
The transplant heals a large number of patients. Healing must, therefore, be the end with which the transplant is faced. Not only that, but bone marrow transplantation is the only transplant that can lead to healing not maintained by medicines. While, in fact, in organ transplants, immunosuppressive therapy is foreseen for the rest of life, in bone marrow transplantation healing can be definitive, without the need for constant immunosuppressive treatment.
In recent years, progress in this field has been enormous in all respects – bone marrow donation, the source of stem cells, indications for transplantation and above all the reduction of mortality.
What types of cancer can be treated with bone marrow and peripheral stem transplants?
Bone marrow and peripheral stem transplantation are mainly used in the treatment of leukaemia and lymphomas. They are useful especially if leukaemia or lymphoma is in remission phase, that is if the manifestations and symptoms of the tumour had disappeared.
These two types of transplants are also used to treat other cancers, for example
- Neuroblastoma (a tumour that develops in unripe nerve cells and affects mainly newborns and children),
- Multiple myelomas.
Researchers are still evaluating the efficacy of bone marrow, and peripheral stem cell transplants and clinical trials (research) are underway regarding the treatment of different types of cancer.
Bone marrow transplant cost in India
Cost of bone marrow transplant in India varies widely depending on the procedure chosen.
Autologous transplant costs between INR 15 lakhs and 18 lakhs or USD 21,000 and 25,000. Cost of allogeneic transplant is about twice this. However event at USD 30,000, it is a tenth of the cost in the US where similar operations are performed. In a few state-run hospitals that offer bone marrow transplants, it costs within INR 10 lakhs or USD 14,000. It is a life-saving treatment and at the cutting edge of cancer therapy which contributes to its high cost.