Transplantation is the process of taking an organ or living tissue and implanting it in another body. Bone marrow transplant is performed to replace unhealthy bone marrow stem cells with healthy ones. This is a relatively newer branch of medicine and the first successful Pediatric BMT was performed in 1968 at the University of Minnesota, USA. In India, the first successful Pediatric allogeneic bone marrow transplantation was done at Tata Memorial Hospital on March 20, 1983, on a nine-year-old girl with acute myeloid leukemia. Since then, many sophisticated pediatric hematopoietic stem-cell transplant centers (HSCT) have been established across the nation. Over 1000 successful BMT have been done in FMRI, Gurgaon for the past 10 years. For BMT in pediatric patients, Fortis Memorial Research Institute, Gurugram has a dedicated team of doctors and nurses who are very well trained and experienced in caring for children.
Bone marrow in our bones contains a subset of cells known as “hematopoietic stem cells” or simple “stem cells” which are responsible for the formation of blood cells. These cells have special characteristics i.e. they can renew themselves, and have the capability to develop into any type of blood cells. Nowadays, hematopoietic stem cells can also be obtained from peripheral blood after treatment with certain growth factors or from the umbilical cord. During pediatric Bone Marrow Transplantation, the stem cells are injected into a recipient after a short course of chemotherapy called conditioning. Today, this is a viable option for several genetic disorders, blood disorders, and childhood cancers and with continued research, success has remarkably improved.
The process of donating stem cells is just like donating blood or platelets and poses no risk to the donor.
Different Types of Pediatric BMT
There are two types of Pediatric BMT:
- Pediatric Allogeneic BMT: Donor and Recipient are two separate individuals and BMT is done using the stem cells of the donor. It may be:
- Matched Related, where the donor is HLA matched relative usually a sibling.
- Matched Unrelated, where the donor is not a relative of the patient and usually found from one of the various national or international registries.
- Partially Matched Related, where the donor is from a patient's family but partially matched (haploidentical).
- Pediatric Autologous BMT: Donor and Recipient are the same individuals. BMT is done using the patient's stem cells. The procedure involves giving a high dose of chemotherapy to the patient to remove the primary disease. Thereafter, an autologous transplant is conducted to rescue damaged bone marrow. This type of transplant has a minimal complication and is preferred for diseases like neuroblastoma, high-risk medulloblastoma, lymphomas, etc.
Who requires Pediatric BMT?
The following are some of the indications for BMT in children:
a. Blood cancers:
- Acute Lymphoblastic Leukemia (ALL)
- Acute Myeloid Leukemia (AML)
- Chronic Myeloid Leukemia (CML)
- Hodgkin Lymphoma (HL)
- Non-Hodgkin Lymphoma (NHL)
- Myelodysplastic syndrome (MDS)
b. Blood cancers:
- Sickle cell anemia
- Aplastic anemia
- Inherited Bone Marrow Failure Syndromes
- Metabolic disorders
- Immunodeficiency states
HIGHLIGHTS OF OUR UNIT INCLUDE:
- Expertise: FMRI is home to a national and international leader in pediatric bone marrow transplantation and graft-versus-host disease.
- Research: Our team of experts leads to groundbreaking research in many aspects of pediatric BMT and other related fields.
- Early Intervention: As Pediatric BMT experts, we specialize in identifying the first signs of this condition to protect your child from severe complications.
- Safety: As an experienced transplant program, we take every precaution to ensure all children have a safe procedure
With the technological advances and use of newer agents for Pediatric BMT, the success rate of Pediatric BMT has improved tremendously. The cure rates depend on the disease being treated and the condition of the patient at the time of the transplant. In general, the younger the patient, the better the outcomes.