Bone Marrow Transplant for Aplastic Anemia

Aplastic Anemia Bone Marrow Transplant​

Aplastic anemia is a pathological state characterized with low production of blood cells by the bone marrow. It is particularly important to mention that bone marrow transplantation or BMT also known as stem cell transplant can be considered as a curative treatment plan for a severe aplastic anemia.

Types of Bone Marrow Transplants

Allogeneic Stem Cell Transplant

• Stem cells are harvested from a matched source such as the siblings or unrelated donors can be used.
• This procedure entails treating the patient with chemotherapy and or radiotherapy that kill diseased bone marrow before the transplant.
• It entails receiving healthy stem cells to produce healthy blood cells since the faulty ones cause the ailment.

Autologous Stem Cell Transplant 

• This involves the use of the patient’s own stem cells, but this is rare in aplastic anemia since the marrow is already incompetent.

Bone Marrow Transplant Procedure for Aplastic Anemia​

Pre-Transplant Evaluation

Before the transplant, the steps the patient has to go through include:

• Investigations (Lab tests and scans) (to ensure that the patient is not having other illnesses).
• Bone marrow biopsy (to establish the extent of the disease for patients diagnosed with aplastic anemia).
• HLA typing (to find a matched donor).
• Blood tests that include heart, lungs, liver, kidney functions.
• Infection screening (to prevent complications).

Finding a Donor

• Best match: A sibling with the same HLA type.
• Other option is a matched unrelated donor that can be found in a donor registry.

Conditioning (Pre-Transplant Treatment)

Again, the patient undergoes chemotherapy ± radiation in order to:

• Destroy the faulty bone marrow.
• Suspended the immune response to a certain extent (to avoid rejection).
• Rejuvenate the older samples from which new stem cells are required.

Stem Cell Infusion (Transplant Day)

• Recipient’s compatible healthy stem cells are then given to the patient through a process known as infusion, which is similar to the process used in blood transfusion.
• It gets to the bone marrow where beginning of the next blood cell formation takes place.

Engraftment (Recovery Phase)

• Blood is formed in the bone marrow and it requires 2-4 weeks for new blood cells to circulate in the bloodstream.
• Blood counts are monitored daily.

Supportive care includes:

• Blood transfusions.
• Antibiotics (to prevent infections).
• Preventive medicines for graft-versus-host disease

Post-Transplant Care

• They get admitted in the isolation wards with necessary infection prevention measures in place.
• 6- to 12-month follow-ups for reintroduction of immunity levels.
• It may require immunosuppressive therapy for up to some months.

Aplastic Anemia Treatment Options​

Aplastic anemia is a severe disease that is characterized by different pathological changes when the bone marrow fails to produce enough red blood cells. The necessity and type of treatment depend on the stage, the patient’s age and the availability of the donor.

Supportive Care (For Mild Cases or While Awaiting Treatment)

• Blood Transfusion – to treat low red blood cell (RBC) and platelet counts
• Iron chelation therapy – As a result of frequent transfusion, there are chances of getting high levels of iron.
• The given drugs include antibiotics and antifungals needed to avoid infections as a result of low white blood cell count 

Immunosuppressive Therapy (IST) (For Severe Cases without a Suitable Donor)

• Suitable for patients above 40 years of age or if there is no matched related donor available.

Common IST Medications:

• Anti-thymocyte globulin (ATG) – an agent that reduces the activity of immune cells which is damaging the bone marrow.
• Some immunosuppressive drugs are as follows: Cyclosporine (CsA) – It can be used to act as a bone marrow stimulant.
• Eltrombopag (Promacta®) – Stimulates platelet and blood cell production.
• Response Rate: 60-70% patients improve.
• Some disadvantages include: It may not be a permanent treatment method, and clients may sometimes revert to the problem.

Bone Marrow Transplant 

Best for:

• Young patients (under 40).
• Patients with a matched sibling donor have a better result in comparison with unrelated donor transplant 

Procedure:

• High-dose chemotherapy ± radiation to destroy faulty marrow.
• This is healthy donor stem cells are used to replace the damaged immune system.
• Success Rate: 70-90% transplants are mostly done when the stem cells are extracted from a matched sibling donor.
• Some of the various risks include graft rejection, infection, and graft versus host disease (GVHD).

Growth Factors (Limited usage in certain cases)

• Erythropoietin (EPO) & G-CSF (Filgrastim) – Stimulate blood cell production in certain cases.
• Used when: The patient has a mild case or requires some assistance even after finishing the course of medication.

Survival Rate of Bone Marrow Transplant in Aplastic Anemia​

The survival rate of BMT in patients with aplastic anemia depends on the stem cell donor, age and other complications arising after the transplant.

Survival Rates Based on Donor Type

• Matched Sibling Donor (MSD) 70-90%
• Matched Unrelated Donor (MUD) 50-70%
• Haploidentical (Half-Matched) Donor 30-60%
• Umbilical Cord Blood Transplant 30-50% (rarely used)

Factors Affecting Cost of Bone Marrow Transplant for Aplastic Anemia​

The cost of a bone marrow transplant (BMT) for aplastic anemia varies widely based on several factors:

Type of Transplant

• Donor-Related Expenses
• Hospital & Country of Treatment
• Pre-Transplant Workup & Conditioning
• Post-Transplant Medications & Follow-up

Aplastic Anemia Stem Cell Transplant​​

In severe aplastic anemia, one of the possible treatments is stem cell transplant or bone marrow transplant (SCT/BMT). This is transplantation of healthy stem cells obtained from a donor to the bone marrow that has been affected in order to correct the production of blood cells.

Recovery after Bone Marrow Transplant for Aplastic Anemia​

The recovery after BMT for aplastic anemia is not very short and may take anywhere from a few months to one year. Close monitoring of patient ensuring that bodily complications arising due to the attack on the immune system are addressed.

Phases of Recovery

1st Month: Hospital Stay & Early Recovery

• There is one key focus; it is engraftment, the time when new stem cells begin to manufacture blood cells.
• The patients are confined to a sterile isolation area to reduce the chances of contracting an illness.
• Blood tests involving WBC, RBC, and platelets count are taken daily to check the body’s status.
• Engraftment occurs within 2-4 weeks post-transplant.
• Common side effects: Fatigue, nausea, diarrhea, mouth sores.

1-6 Months: Immune System Recovery

• The primary points of emphasis in this section are how infections and GVHD can be avoided or minimized.
• Immune system is still compromised, therefore; infection control measures should be strictly implemented.
• Patients require products related to immunosuppressive drugs like Cyclosporine and Tacrolimus.
• Patient may still need blood transfusions.
• Dietary Restrictions: Do not take raw foods, milk and any food that has not been pasteurized and meat that is not well-done.

6-12 Months: Gradual Return to Normal Activities

• Major areas: Reducing medication, rebuilding strength
• The body regains total functionality of the immune system.
• Vaccinations are resumed when the patient is about one year old after transplantation.
• Tiredness decreases, but a person may feel still tired.

Risks of Bone Marrow Transplant in Aplastic Anemia Patients​

Severe aplastic anemia may be treated by a procedure known as bone marrow transplant (BMT), although this procedure has certain risks:

• Graft Failure
• Infections
• Graft-versus-Host Disease
• Organ Damage
• Secondary Cancers
• Infertility & Hormonal Imbalances
• Chronic Fatigue & Psychological Effects

Aplastic Anemia Bone Marrow Transplant Success Stories​

Mr. Daniel Mwangi from Kenya Successfully Receives Bone Marrow Transplant for Aplastic Anemia in India

• Patient Name: Mr. Daniel Mwangi
• Age: 32 years
• Gender: Male
• Country of Origin: Kenya
• Doctor Name: Dr. Sandeep K. Agarwal
• Hospital Name: Fortis Memorial Research Institute, Gurgaon
• Treatment: Immunosuppressive Therapy followed by Bone Marrow Transplant (Unrelated Donor)

A 32-year-old man, Mr. Daniel Mwangi from Kenya who earlier received treatment in his country but his conditions deteriorated due to a severe aplastic anemia. He went to Fortis Memorial Research Institute at Gurgaon for check-up where Dr. Sandeep K Agarwal examined him and went for HLA matching to find out the correct donor for him.

After immunosuppression, the procedure to perform a bone marrow transplant was done using stem cell from a unrelated donor for Mr. Mwangi. His body finally engrafted, and proper care in the post-transplant period is merely aimed at preventing infection. The international patient services of GetWellGo proved useful in co-ordinating the operations and made a follow up to the patients.

Following this treatment, he was discharged and went back to Kenya and up to now, his blood count is stable and he’s in good health as he resumed working and went back to normalcy after the hospital stay for three months.

This case illustrates that early diagnosis is valuable as well as the quality of the healthcare that is offered to the patients from different parts of the world in India.

Eligibility Criteria for Bone Marrow Transplant in Aplastic Anemia

The eligibility criteria for a patient to undergo BMT in patients with aplastic anemia involve several factors, which include the state of the disease, the general health of the individual, and the availability of donor match. Here are the common guidelines:

• Severity of Aplastic Anemia
• Age Criteria
• Donor Availability
• Response to Other Treatments
• Overall Health and Organ Function
• Absence of Secondary Malignancies
• Psychological & Emotional Health

Bone Marrow Transplant Centers for Aplastic Anemia​

• Fortis Memorial Research Institute, Gurgaon
• Apollo Hospitals, Delhi
• Max Super Speciality Hospital, Delhi
• Medanta-The Medicity, Gurgaon

Pediatric Aplastic Anemia Bone Marrow Transplant

Pediatric Aplastic Anemia Bone Marrow Transplant could be considered curative for children with Severe Aplastic Anemia and Very Severe Aplastic Anemia. Aplastic anemia is a medical condition that is characterized by the inability of the bone marrow in the body to produce enough blood cells such as red blood cells, white blood cells, and platelets. In cases where children cannot respond to other therapies such as immunosuppressive therapy, then the only treatment that stands a better chance of curing the child is the bone marrow transplant.

Why Choose GetWellGo for Bone Marrow Transplant for Aplastic Anemia?

GetWellGo is regarded as a leading supplier of healthcare services. We help our foreign clients choose the best treatment locations that suit their needs both financially and medically.

We offer:

• Complete transparency
• Fair costs.
• 24 hour availability.
• Medical E-visas
• Online consultation from recognized Indian experts.
• Assistance in selecting India's top hospitals for bone marrow transplant.
• Expert oncologist with a strong track record of success
• Assistance during and after the course of treatment.
• Language Support
• Travel and Accommodation Services
• Case manager assigned to every patient to provide seamless support in and out of the hospital like appointment booking
• Local SIM Cards
• Currency Exchange
• Arranging Patient’s local food