Bone marrow�is a spongy-like substance found inside our large bones and is made up of hematopoietic stem cells. It is these cells that are transplanted to the patient during a transplant. Hematopoietic stem cells grow up to become white blood cells, red blood cells and platelets. The bone marrow is a location where these cells grow and are stored until they are needed.

White blood cells also called�leukocytes�are the body's defense mechanisms, the Red blood cells called as erythrocytes carry oxygen from the lungs to the rest of the body and return carbon dioxide to the lungs as waste. Platelets help the body form blood clots in the event of a cut or bruise.

Allogeneic

Transplanted cells coming from a donor like a sibling, a relative, or someone unrelated to the patient (the cells can even come from umbilical cord blood) are known as Allogeneic cells. In the case of an identical twin of the patient, the transplant is called syngeneic and is essentially like an autologous transplant.

The cells must be "matched" to the patient, which is done by�human leukocyte antigen (HLA) testing. The HLA type is made up of 6 antigens: 3 are inherited from the mother, and 3 are inherited from the father. Doctors usually look first to a family member for a match. Siblings from the same parents have a 25% chance of matching each other, but if no siblings match, that patient's parents or children can be tested. A donor may "match" the patient in 6 out of 6, 5 out of 6, or 4 out of 6 antigens. Those who do not have a family match can go in for the same through a donor match program from external sources.

Initially the cells were taken directly from the bone marrow and that was how the name "Bone marrow transplant originated".

The procedure is done in an operating room. The patient is anesthetized and positioned face down. Long needles are inserted into the hip bones and the bone marrow is pulled out using a syringe. This is then poured through a special column that separates out the desired stem cells. The other mature red and white blood cells and platelets are re-infused into the donor. This procedure will be repeated till the required quantity is obtained. These cells are then frozen in a special preservative (called Dimethyl sulfoxide or DMSO) to protect them from "freezer burn" until they are used. The donor still has plenty of cells to produce blood cells for him or herself.

A second method of collecting stem cells currently being used in clinical trials for allogeneic transplants involves giving the donor a medication called�granulocyte colony stimulating factor, or GCSF, which causes the stem cells to be released from the bone marrow and into the blood stream. A test is done to determine how many cells are circulating in the blood stream. Once the desired level is reached the donor is taken to the pheresis department at the hospital to have the cells removed. The cells can be removed using either a catheter in the chest wall or 2 large intravenous (IV) catheters, one placed in each arm. Blood is taken out of the donor, circulated through the pheresis machine to remove the stem cells, and then the rest of the blood is returned to the patient. The cells would be frozen in the same DMSO preservative mentioned earlier for the bone marrow. Calcium loss which occurs would be supplemented with tablets.

The diseases treated with an allogenic transplant are;

Leukemias, Lymphomas, Multiple Myeloma, Severe Aplastic Anemia, and Sickle Cell Disease, are the diseases that are treated using this method.

Before the treatment chemotherapy is given before the cells are transplanted into the patient. It helps destroy the patient's marrow and immune system so that it does not attack the donor's cells, and cause them to fail. It also destroys any remaining cancer cells in the body. It also helps to make room for the new bone marrow.

A transplant is done to replace the bone marrow is affected by the disease, as in leukemias and aplastic anemia,� and on the hope to cure the patient by replacing the diseased marrow with the healthy one from the donor. In similar cases, a much higher dose of chemotherapy is used to treat the cancer, which would also kill the patient's bone marrow. The patient is then replaced with the donor's healthy marrow. One very important part of all allogeneic transplants is called the "graft versus tumor effect" where the donor's immune system (which is part of the marrow that the donor donated) has on the recipient patient's cancer cells. This also aims at the healthy donor immune system attack any stray cancer cells in the patient that could have survived the preparative regimen.

The patient is given rest for a few days to clear the effects of the chemotherapy so as not to damage the donor cells. The cells are infused into a vein, similar to the way in which a blood transfusion is given. The cells find their way back to the bone marrow space and get right to work producing new white and red blood cells and platelets. It takes 1 to 2 weeks for these stem cells to produce new cells and for those cells to become mature enough to function properly.

The�neutrophil count, which is a type of white blood cell that is especially important in fighting bacterial infection, once gets above 500, the patient can stop protective, prophylactic antibiotics. The time until engraftment - which is the point when the stem cells starts functioning and blood cell counts start to come up - varies from patient to patient, and can be anywhere from 10-20 days. The red blood cell and platelet counts can take several weeks to get back to a normal range.

The side effects generally caused during the preparatory regimen (chemotherapy and / or radiation) differs based on the medications. Mucositis (sores in the mouth and throat), diarrhea, nausea/vomiting, poor appetite, and fatigue are commonly seen. Complications leading to low blood counts can include bleeding due to low platelet counts, infections due to low white blood cell counts, and fatigue due to low red blood cell counts.

There are a few complications that are specific to allogeneic transplants. These are graft versus host disease, graft rejection or failure, pulmonary (lung) complications, and liver problems.

In�graft versus host disease (GVHD), the donor's cells attack the patient's body. GVHD can also affect the skin, intestinal tract and liver in varying degrees. It can occur anytime after typically the acute phase described as in 1-2 months and the chronic phase 2-3 months after transplant. This is seen in almost all allogeneic transplant cases with varying degree and is treated with immuno-suppressing medications, including steroids. Graft rejection could occur if there are immune system cells left in the patient after the preparative regimen. Graft failure occurs when the donor's cells fail to start working (producing new blood cells) and can be concluded if engraftment has not occurred by 42 days after transplant. Though rare in such cases a second transplant is the only option.

Pulmonary complications are generally caused by pneumonia and can be very serious in these patients.�Veno-occlusive disease (VOD)�of the liver is a complication that can present with jaundice, enlarged liver, or swelling of the abdomen and can lead to liver failure. VOD can be very serious, and can even be fatal.

It would take a few months to an year before the patient will have a "normal" immune system. Extreme care has to be taken to avoid infection. Low energy levels would be experienced during this phase. Most of the centers require the patient to visit them regularly and to be near the hospital for the first 6 months.

The other Oncology Procedures are

• Skin Cancer�
  
• Chemotherapy
  
• Small Intestine Cancer�
  
• Pancreatic Cancer�
  
• Spinal Cord Tumors�� etc

Few Major Hospitals for Bone Marrow and Cell Treatment are

• Wockhardt Hospitals
  
• Apollo Hospitals
  
• Max Healthcare
  
• Piyavate Hospital�
  
• Florence Nightingale Hospital�
  

Thailand,�Malaysia, Singapore, Turkey�and�India�are the most cost effective locations that offer up to almost 80% savings in comparison to the US.

SurgeryPlanet�facilitates a plethora of services to the medical treatment traveler also which includes, a hassle free and discounted travel option, a welcome hand at the airport on arrival, travel in an air-conditioned car, round the clock service & support. Your medical evaluation is pre arranged with the least of waiting time. Once your assessment is complete and found medically fit, the procedure is immediately scheduled without a waiting period. Please read through our Services and Testimonials to understand and select your best options.

• Thailand
• Malaysia
• Singapore
• Turkey
• India�