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Bone Marrow Transplantation (BMT)

 
 

The Bone Marrow and Stem Cell Transplantation program (BMT) offers state-of-the-art care to patients whose only potential curative therapy is bone marrow or stem cell transplantation. Patients are cared for in modern inpatient and outpatient facilities where up-to-date therapies are employed by a coordinating team of physicians, nurses, social workers, nutritionists, play therapists, psychologists and pharmacists; in the presence of routine as well as special function laboratories. Members of the program actively seek new cutting-edge therapies and adopt such therapies in protocols for the treatment of diverse malignancies and hematological disorders.

The transplantation program at KHCC includes:

(i) Out patient Clinic

(ii) Inpatient unit

(iii) BMT labs

(iv) Coordination Office

Patients submit all their medical tests and reports to the coordination office where they will also receive proper education on the program. Patients are then directed to the outpatient clinic, where based on different consultations, decisions are made on whether patients are eligible for transplantation or not. Those who are eligible move to the inpatient unit, where they get their pre-transplantation treatment and go through the procedure of transplantation. Patient follow-up after transplantation is done through regular visits to the outpatient clinic.

Services

This is the only comprehensive transplantation service in Jordan. Guided by the expertise of trained healthcare professionals who are supported by essential support staff, facilities, and state-of-the-art laboratory equipment, KHCC is able to offer bone marrow transplantation for children, adolescents and adults.  Transplants are performed in 12 dedicated, specially equipped rooms. The clinical program involves both allogeneic and autologous stem cell transplantation. Umbilical cord blood and t-cell depleted transplants are also carried out.

Staff

At KHCC we have a large team of physicians and nurses running the transplant program.  In addition to the Director of the bone marrow transplant program (D.G. – Dr. Mahmoud Sarhan), there are 3 pediatric and 4 medical bone marrow transplant specialists working in the program.  A dedicated hospitalist and 1-2 fellows are also vital members of the team. 4 clinical nurse coordinators and a staff of 20 registered nurses serve the floor and outpatient clinics.

BMT Laboratories

The primary function of the Bone Marrow Transplant Laboratory is to offer cellular therapy for autologous and allogeneic transplant patients. Routine work consists of cell collection, processing, cryopreservation, storage and infusion. The cells are derived from a variety of sources such as mobilized or non-mobilized peripheral blood, bone marrow or umbilical cord blood. In addition, the lab performs Cytomegalovirus (CMV) antigenemia assay using indirect immunofluorescence. Special procedures such as therapeutic leukapheresis and granulocyte collections are also offered based on a patient’s needs.

Why is our service unique?

The following elements make our service unique:

1. A multidisciplinary team of experts

2. Up-to-date cutting edge treatments

3. Extensive support services

What do you need to know about Bone marrow and Stem Cell Transplantation?

What is bone marrow and stem cell transplantation?
This procedure replaces the bone marrow of a patient with the new bone marrow that is taken from another “donor” or from the patient himself.

How can one donate bone marrow?
The donor can donate his bone marrow under anesthesia when medium sized needles are used to collect bone marrow from within the bones of the pelvis. This procedure usually takes one hour and involves the collection of about a quarter, to half a litter of blood like material. Alternatively, a donor may be hooked up to a special machine resembling one used for dialysis procedures. This machine selects stem cell (which makes a very small fraction of circulating cells in the blood) and returns the reset to the donor.  These stem cells may be used the same way that a bone marrow is used.  The BMT specialist will select the more suitable procedure.

What is an autologous transplant?
If bone marrow or stem cells are collected from the patient himself then this is called autologous transplant or high dose chemotherapy with stem cell rescue.  Usually this is done after having received chemotherapy.  The collected cells are stored until large doses of chemotherapy are given to eradicate residual malignant cells.  The stem cells are then infused to help bone marrow recovery.  Autologous transplants are usually done for solid tumors like Ewing sarcoma or neuroblastoma, where the main aim of treatment is to give large doses of chemotherapy.

What is an allogenic transplant?
Here, the bone marrow or stem cells are taken from another person.  Later on, the collected cells are infused to the patient to replace of his/her  bone marrow.  The recipient is given chemotherapy in order to prepare his bone marrow to receive the donor cells. Allogenic transplants are usually performed in cases of leukemia, where the new cells may attack any residual cancer cells.  This transplant may also be carried out in cases of bone marrow failure, thalassemia.

Can anyone donate bone marrow?
You have to be HLA-compatible.  HLA antigens are like blood groups.  Not all people can donate blood to each other.  Similarly, only compatible individuals can safely receive bone marrow.  For a sibling match between brothers or sisters, the chance of finding a good equivalent is about 25%.

What is conditioning?
Chemotherapy is given before infusion of the new marrow or stem cells.  Large doses are given daily for about a week depending on the protocol.  You may feel well during this time or you may experience nausea.  Doctors usually count the days before transplant as minus or negative days, the day of the transplant as day zero and days following the procedure as plus days.

How are bone marrow and stem cells infused?
The procedure is simple.  It is similar to a regular blood transfusion that usually lasts less than an hour.  Doctors and nurses take this process very seriously, because no mistakes can be tolerated.  They thoroughly identify the unit of bone marrow to make sure it is the unit ordered.  They will closely monitor the patient during infusion.  At times, preservatives in the unit have a very strong smell that you will notice immediately after infusion starts.  The odor may linger for a few days before clearing up and urine output may turn a pinkish color.

What is engraftment?
After bone marrow or stem cell infusion, the new cells will go to your bone marrow to start making new cells.  At that time, your old blood cells are gone and you may be on antibiotics.  Recovery of your cell numbers will take about 2 weeks, more or less depending on the type of transplant.  First, the white blood cells come back, then the platelets.  You may need months to be completely independent of platelet and blood transfusions. Full recovery of your immune system may take between 6-12 months.

What are the risks of transplantation?
You may have immediate complications, usually as a result of chemotherapy.  This includes mouth ulcerations, nausea, vomiting and most important liver toxicity (called VOD).  This last complication can be serious depending on the degree of liver damage.  Also, blood stream infections are very common, but are usually controlled with antibiotics until your blood cells recover.  In an allogenic transplant, graft versus host disease is another potential complication.

What is a graft versus host disease?
When new cells are identified in your body as “foreign”, they will start attacking the normal body tissues.  It starts with a skin rash, mild liver problems and diarrhea that can be severe.  This may be controlled by giving extra medications including corticosteroids.  Sometimes, the process may be prolonged and difficult to control.  It may affect virtually any body organ.  At KHCC, we have special experts trained in dealing with this problem and minimizing the long term complications resulting from its effects.

Bone Marrow & Stem Cell Transplantation (BMT)
KHCC has the only comprehensive transplantation service in Jordan. Guided by the expertise of trained healthcare professionals who are supported by essential staff, resources, facilities, and state-of-the-art laboratory equipment; KHCC is able to offer bone marrow transplantation for children, adolescents and adults. Transplants are performed in 10 dedicated, specially equipped rooms. The clinical program involves both allogeneic and autologous stem cell transplantation. Umbilical cord blood and T-cell depleted transplants are also done.