Transplant Procedure

Pre-transplant evaluation is the cornerstone of a successful bone marrow transplant. It involves a detailed medical assessment to determine the patient’s eligibility and readiness for the procedure. This stage allows the transplant team to tailor the treatment plan and identify any potential risks or complications in advance.

The evaluation typically includes:

• Complete blood count and organ function tests (liver, kidney, heart, and lungs)
• Imaging studies such as chest X-rays and CT scans
• Bone marrow biopsy to assess disease status
• Infectious disease screening for viruses like hepatitis, CMV, and HIV
• Psychological assessment and counseling

Additional considerations may involve:

• Evaluation of previous treatment history and current medications
• Nutritional status and physical endurance
• Availability and compatibility of a matched donor (for allogeneic transplants)

A multidisciplinary team, including hematologists, cardiologists, pulmonologists, and transplant coordinators, collaborates to determine the safest and most effective approach. This pre-transplant workup ensures that patients are physically and mentally prepared, reducing the likelihood of complications during and after the procedure. Patient education is also emphasized, helping individuals and families understand the full scope of the process, including possible side effects, isolation protocols, and the duration of hospital stay. Thorough preparation increases the chances of a smooth and successful transplant journey.

Stem cell collection is a critical phase where healthy hematopoietic stem cells are harvested either from the patient (autologous transplant) or a compatible donor (allogeneic transplant). The source of these cells can be bone marrow, peripheral blood, or umbilical cord blood, depending on the transplant type and clinical indications.

Key methods of collection include:

• Peripheral Blood Stem Cell Collection (PBSC):
  • Donor or patient receives injections of G-CSF for 4–5 days.
  • Blood is drawn through apheresis, separating stem cells and returning other components.
• Bone Marrow Harvesting:
  • Performed under general anesthesia in an operating room.
  • Cells are extracted from the pelvic bone using a needle and syringe.
• Cord Blood Collection (for unrelated donor transplants):
  • Collected at birth and cryopreserved in public or private banks.

Important factors assessed before collection:

• White cell count and CD34+ stem cell marker level
• Donor safety and consent
• Risk of contamination or infection

The entire process is meticulously monitored to ensure high-quality stem cell yield while minimizing any risk to the donor or patient. These collected cells are either used immediately after conditioning or cryopreserved for later infusion, depending on the treatment protocol. Efficient stem cell collection sets the stage for a successful transplant outcome.

Conditioning therapy is administered before the stem cell infusion to eliminate diseased or dysfunctional marrow and suppress the immune system, allowing for successful engraftment of transplanted cells. It is an intensive treatment involving chemotherapy, radiation, or a combination of both.

Goals of conditioning therapy:

• Destroy existing cancer cells or faulty bone marrow
• Suppress the immune system to reduce graft rejection
• Create space in the bone marrow for new stem cells to engraft

Types of conditioning regimens:

• Myeloablative Regimen:
  • High doses of chemotherapy or radiation
  • Used for younger patients with aggressive diseases
• Reduced-Intensity Conditioning (RIC):
  • Lower doses; suitable for older adults or those with comorbidities
  • Relies more on the immune effect of donor cells than cell-killing drugs

Common drugs used:

• Busulfan
• Cyclophosphamide
• Fludarabine
• Total body irradiation (TBI)

Side effects may include nausea, hair loss, mucositis, fatigue, and increased infection risk. Supportive care with hydration, antiemetics, and antibiotics is provided to manage these effects. Conditioning therapy is a crucial preparatory step that requires close inpatient monitoring, as it greatly influences the transplant’s success and long-term recovery. The patient’s response to conditioning directly impacts engraftment and remission outcomes.

The infusion process is the actual transplantation step, where the collected stem cells are delivered into the patient’s bloodstream. It resembles a blood transfusion and is generally painless, taking place in a specialized inpatient unit under sterile precautions.

The infusion process involves:

• Thawing frozen stem cells (if cryopreserved)
• Administering pre-medications to prevent allergic reactions
• Delivering stem cells via a central venous catheter over a few hours

Key observations during infusion:

• Monitoring for adverse reactions such as fever, chills, or shortness of breath
• Checking vital signs and oxygen levels regularly
• Ensuring proper hydration to aid kidney function and flush out preservatives (like DMSO)

Possible side effects:

• Metallic taste or nausea due to DMSO
• Low blood pressure or flushing
• Mild allergic reactions such as rashes or itching

After infusion, the cells travel to the bone marrow spaces, where they begin the process of engraftment—settling and growing into new blood-forming cells. The day of infusion is often referred to as “Day Zero,” and all subsequent recovery milestones are tracked from this date. Although the transplant itself is not surgically invasive, the post-infusion phase is critical and demands intensive monitoring for infection, graft failure, or immune complications.

Engraftment marks the beginning of marrow recovery, where the infused stem cells start producing healthy blood cells. This process generally takes between 10 and 28 days, depending on the transplant type and conditioning regimen.

Indicators of successful engraftment:

• Rising white blood cell count, particularly neutrophils
• Gradual increase in red blood cells and platelets
• Absence of fevers or signs of graft failure

Daily monitoring includes:

• Complete blood count (CBC)
• Reticulocyte count for red cell production
• Bone marrow aspirate (if needed) to confirm cell activity
• Blood cultures and markers for infection

Complications during this period:

• Graft-Versus-Host Disease (GVHD): Common in allogeneic transplants
• Infections: Due to immune suppression and low white cell count
• Delayed Engraftment or Graft Failure

Supportive care provided:

• Growth factors (G-CSF) to stimulate white blood cells
• Platelet and red cell transfusions if counts are low
• Broad-spectrum antibiotics and antifungals
• Nutritional support via enteral or parenteral routes

Engraftment is considered successful when the neutrophil count remains above 500 for three consecutive days. It represents a key milestone in the recovery timeline and paves the way for eventual immune reconstitution. The success of this phase often determines long-term survival and transplant durability.

A bone marrow transplant is a transformative treatment that offers a chance at long-term remission or cure for patients with serious blood and immune disorders. From pre-transplant assessment to stem cell infusion and engraftment monitoring, each stage of the procedure is executed with precision and patient-centered care. The success of the transplant depends on timely diagnosis, donor compatibility, meticulous medical management, and the patient’s overall resilience.

Kannappa Memorial Hospital stands at the forefront of bone marrow transplant services, delivering world-class care with a focus on safety, technology, and compassionate support. With a dedicated transplant unit, expert hematologists, and a record of successful outcomes, the hospital offers patients renewed hope and improved quality of life. Choosing a well-equipped and experienced center is essential for optimizing transplant results and minimizing complications. At Kannappa Memorial Hospital, every step of the journey is guided by clinical excellence and a commitment to healing.