In Cooperstown, New York, in 1956 a relatively unknown name in the medical world perfected a process that, has since, saved the lives of thousands. It was Dr. E. Donnall Thomas that, in that year, successfully transplanted bone marrow from one healthy twin to the other suffering from leukemia.
The medical procedure pioneered by Dr. E. Donnall Thomas is now used routinely by doctors across the world to treat patients with a variety of blood disorders, not just leukemia. Effective bone marrow transplants are also undertaken for sufferers of anemia and numerous other inherited disorders of the immune system.
Prior to the innovation of bone marrow transplantation, patients could not be treated via chemotherapy. This was because the doses of chemotherapy and radiation required to kill the cancerous cells, also killed off the healthy cells in the bone marrow. However, with bone marrow transplants, the healthy cells that are destroyed by the high levels of chemotherapy and radiation can be replaced by those from a suitable donor.
The science of bone marrow transplantation has not ceased in its evolution since 1956. Today it is a very specialist area of modern medicine with dedicated bone marrow transplant centers throughout the world. One of the most advanced of these is theBone Marrow and Stem Cell Transplantation Center at Samitivej Hospital.
This dedicated center is now one of the world’s leading centers for bone marrow transplants. It is at the cutting edge of new and progressive techniques and procedural evolution that has resulted in an enviable level of success in treating bone marrow and immune system disorders.
Globally, the patient survival rate exceeding one year following a bone marrow transplant is currently 68%. For the same period, The Canadian Cancer Society reports that up to 70% of patients will survive past one year. The figure for Europe is 88%, whilst the Bone Marrow and Stem Cell Transplantation Center at Samitivej Hospital has a survival rate of 96%.
Couple these impressive statistics with a mortality rate in infants with thalassemia, following Haploidentical Stem Cell Transplant treatment, at 0%, it is easy to see that Samitivej Hospital’s Bone Marrow and Stem Cell Transplantation Center has become a world leader.
The center, sited at Samitivej’s Srinakarin Hospital and began treating patients in September of 2004. Staffed by highly trained medical professionals using state of the art equipment, the center is now a world leader. The facility meets and surpasses international standards and boasts a Positive Pressure Room designed to combat and prevent infection. This includes those receiving high levels of chemotherapy. These rooms are all fitted with HEPA (high efficiency particulate air) filtration.
Types of Bone Marrow Donor
Allogeneic Transplant is a procedure where a patient is given healthy stem cells from a suitable donor. This is done to replace the patient’s own cells which have been damaged following treatment of high level chemotherapy or radiation.
Healthy stem cells are extracted from the healthy blood or bone marrow from a related donor which is not an identical twin, commonly a brother or sister. Cells can also be harvested from a non-related donor that has similar genetics to the patient.
Haploidentical-related donors are usually the mother or father of the patients. These donors will require a minimum of a 50% genetic match to the stem cell recipient. Donor selection is done with HLA (human platelet alloantigens) matching. Additionally, unrelated donor matching can be done with registered donors from worldwide donor lists.
Haploidentical Bone Marrow Transplantation
Initially, a full assessment of the patient’s disease is undertaken. Then HLA (human leukocyte antigens) screening is done for the patient and the donor. Also, prior to any transplantation therapy the patient and donor will undergo a comprehensive health study. This will include any historical kidney or liver disease, other chronic conditions, any infections and medications currently prescribed.
Transplantation can then begin. Firstly, conditioning chemotherapy is administered. This is done to eradicate or reduce the bone marrow and lymph nodes where the cancerous cells develop. Then harvesting of stem cells from the donor takes place and can be transferred to the patient.
Finally, for a period of between 2 and 4 weeks, the patient will be monitored to assess the efficacy of the new cells functional performance. The 3 steps of the transplant procedure would typically take a month. Transplantation will be followed by post-procedural checks every 1 or 2 weeks for around 3 months. Following that, less frequent monitoring will be required for up to 2 years.
Prevention and Treatment of GvHD
GvHD, or, graft versus host disease is a very real risk following any form of transplantation, with the prevention and treatment being referred to as Photopheresis. This treatment for GvHD is an entirely non-invasive and painless procedure specifically designed to stimulate the immune system which aids in fighting disease. Samitivej Hospital’s Bone Marrow and Stem Cell Transplantation Center has successfully used this treatment on patients as young as 2 years old.
The procedure entails blood being drawn from the patient. The white blood cells are separated from the red cells and are then mixed with the medication, they are then exposed to ultra violet light. Each photopheresis procedure takes 3 to 4 hours and each patient will undergo several of these procedures for up to 12 weeks. The exact number of procedures will be determined by the nature of the patient’s disease.
It is also worth noting that the Samitivej Hospital Bone Marrow and Stem Cell Transplantation Center is the only dedicated facility in the Asia Pacific Region with specialist photopheresis equipment that can treat children as young as 2 years and with a body weight as little as 10 kilos.
There are some side effects associated with photopheresis. These are likely to include tingling or numbness in the fingers and lips. Cramps and a feeling of being lightheaded are also common. Some more serious side effects are a fever and a drop in blood pressure. Medication can be prescribed to counter the negative side effects of the treatment.
Following photopheresis treatment there are some simple lifestyle adjustments patients can make as precautionary steps in order to minimize possible side effects. Avoiding direct sunlight is advisable. Patients should also use sunscreen with at least an SPA factor of 50 and wear quality UVA sunglasses.
Bone marrow and stem cell transplantation continues to evolve through science and technology. The Bone Marrow and Stem Cell Transplantation Center at Samitivej Hospital will continue to keep itself at the forefront of treatment and procedural advances. With its unrivaled levels of successful treatment in this area of medicine, there is no better place for bone marrow and stem cell transplant treatment.