Hematology and Oncology Center pediatric and Adult (stem cell transition – bone marrow transplant)
Hematology and Oncology Center pediatric and Adult (stem cell transition – bone marrow transplant)
The bone marrow transplant center (stem cells) is one of the most important forms of the hematology treatment such as, Thalassemia, sickle cell anemia, aplastic anemia, Myelodysplastic syndrome, and malignant diseases such as leukemia, lymphoma and solid tumors, treatment of weakened immunity and some metabolic diseases.
Every day a new group of diseases is added to the list of diseases that are used in the treatment of stem cell transplant. In our country with a population of 75 million people, Stem cell transplant is carried out to 3000 patients every year. In many centers, patients wait several months until their turn comes. Pediatric bone marrow transplant center in our institution, the bone marrow and stem cells transplant center is licensed by the Ministry of Health and is one of the largest centers of blood tumors for treatment in the field of bone marrow transplant.
Our Pediatric bone marrow transplant center is the largest bone marrow transplant centres in Turkey with 17 single rooms. The area of the rooms ranges from 22-30 square meters. 5 rooms will be used as intensive care rooms but in all the rooms there is an infrastructure for intensive care. Patients from the nurse room will be monitored 24 hours a day through the monitoring system.
The clean air system in the rooms:
In the patient rooms, there is HEPA filter system, the type of roof that is applied for the first time in our country through the use of HEPA fan units and air flow techniques. The type of mixed flow has been applied to achieve prevention at the highest levels against infection diseases which are transmitted through the air. In this type of flow, a spectral air flow is applied over the patient, and a corrugated air flows in the other areas of the room but the spectral air flow that is applied on the patient’s bed surfaces and the shape of the velocity formed near the bed is regulated so as not to disturb the patient permanently. As for the pressure, it was set for the air, so it flows from the patient’s room to the external passages.
The benefits of this system:
- The pressure of each room is separately adjustable to the required level and in this manner, there are no pressure problems with the centralized single channel systems.
- Thanks to the separate air system which does not infect other rooms by mixing germs into the system.
- It operates with power saving mode in the rooms where there are no patients and provides high power saving.
- The amount of air transfers per hour per room is adjustable between 10 – 18 ach
- High-performance filtration (%99.97 0.3 µm) achieved through a system Purification HEPA
- The risk of infection because of ventilation has been completely eliminated the technology of non-leakage and passive plutonium.
- No polluted air is crossed into the patient’s room, especially from hanging ceilings and from the surroundings.
- UV sterilization is continuously performed.
What is the bone marrow transplant?
Bone marrow transplant, umbilical cord blood, or stem cell transplant is a procedure that aims to replace damaged bone marrow with the donor’s bone marrow. We can use it to treat patients with:
- Life-threatening cancers such as leukemia.
- Diseases that result in bone marrow failure, such as aplastic anemia
- Other immunological and genetic diseases.
Research on bone marrow transplant has improved the survival rate over time, which in turn has helped many patients using this treatment. Bone marrow transplant is the only cure for many diseases.
The bone marrow is soft spongy tissue, called the red marrow, which located inside the bone portion known as sponge bone, whose primary function is the production of blood cells, and consists of anaplastic cells (it turns into bloody cells) it is a hematopoietic generator and a fat cell, and tissues that help the growth of blood cells.
The anaplastic cells at the beginning of formation (primary) are called blast cells or stem cells, and they continuously divide themselves to multiply, producing new stem cells, part of them remains the same as generating structural cells that continue to reproduce while the other part stops producing and it goes through a series of cumulative transformations and divisions and successive stages of development, to mature transforming into the different blood cells (white and red blood pellets and platelets), which in turn continue their growth and maturity stages inside the marrow before moving to the blood circulation to perform their functions, (and some of the white pellets known as lymphocytes continue the full growth in the lymphatic glands, spleen, and thymus). The bone marrow is found in almost all the bones in infants, while before puberty, it is often in the flat bones, such as the skull bone, shoulders, and ribs, pelvic bones, arm and leg joints.
The need for the bone marrow transplant treatment (bone marrow transplant) and stem cell transplant comes when the bone marrow becomes unable to perform its functions and produce blood cells, whether as a result of its damage due to cancer itself (which makes it either a producer of abnormal tumor cells or a producer of small numbers of blood cells), or due to the effects of the severe chemical drugs and radiotherapy on the marrow, it may be necessary to eliminate the cancerous cells, especially in cases of blood tumors, lymphoma and some solid tumors, strong treatment programs with intensive doses destroy and thwart the marrow and lose its ability to perform its functions, therefore, transplants are intended for replacing the stem cells with the cancer-infected marrow or frustrated because of treatments, with healthy cells that can grow, reproduce, and produce blood cells.
It is worth noting that transplants were initially used experimentally to treat people who were exposed to radiotherapy as a result of nuclear accidents, and then it turned out to be effective in treating various tumors, we also point out that the transplant is an intensive and multifaceted process that affects all parts of the body, and has many implications, complications and high risks, we may lose the patient despite the success of the transplants completely, which depends on multiple factors, such as the patient’s age, general physical condition, type of tumor and its stage, and there are no guarantees or predictions about success or failure, despite the high success rates of transplant, especially with children.
Collecting the stem cells:
The stem cells are collected from the bone marrow, the circulatory system, and newly from the umbilical cord of newborns.
Collecting the stem cells from the bone marrow:
The bone marrow is the main source of the stem cell transplants, and the process of extracting the bone marrow and collecting it called the harvesting , it is usually conducted under the general anesthesia to the donor, who in turn is subject to a set of analyzes and tests, to ensure the level of his general health and in particular naturally to make sure that he is not infected with infectious diseases, especially to make sure that the blood is free from infectious viruses such as HIV/AIDS or hepatitis virus. About one liter of bone marrow is collected directly from the hip bone using a special needle and under complete sterilization, (and naturally the amount collected is proportional with the size of the recipient patient, as adults need more than the children need), and this process usually does not take more than one hour, and the donor’s body compensates the extracted amount very quickly because it is little, and it is customary to take a unit of the donor’s blood a week before the operation and then transfer it to him/her after his donation to compensate the deficiency, and the donor usually leaves the hospital the next day, without any complications except the feeling with some temporary fatigue.
After the collecting, blood compounds and bone impurities are separated from the marrow, and then kept in special packages, and the stem cells are selected and collected separately, and in turn are injected to the recipient with some of the selected cells within a period not exceeding 24 hours, it is worth noting it is possible to preserve the marrow for years if necessary, by placing it in special preservatives and freezing it using liquid nitrogen to keep the stem cells alive. This method is used especially when the marrow is collected from the patient him/her self, and this is achieved between two treatment cycles when stabilizing and freedom from the carcinogenic cells, so that it can be returned if there is any future relapse.
From the blood circulation
There are few numbers of stem cells in the circulatory system, and in this case they are called peripheral stem cells, which are not usually sufficient for harvesting for the patients, and their use for transplant becomes practical when the patient has the ability to induce the bone marrow to be excreted in the bloodstream in sufficient quantities, and there are a number of ways to do this, including using stimulating growth factors individually by injecting them subcutaneous, or by adding a small dose of chemical drugs. While when collecting periodic stem cells from donors, they are collected from the blood circulation of the donor by passing blood through a special filter machine that separates these cells from other blood cells, and returns the blood to the blood circulation at the same time, and this process usually takes between one to two hours for two consecutive sessions within two days, it is a safe and painless process and does not require anesthesia, and without any risk of infection as all tubes and connections are used only once.
On the other hand, most patients spend less time into the hospital after stem cells transplant, and the rate of complications decreases, as the count of white blood cell and platelet return to the normal quantum more quickly.
Collecting the stem cells from the umbilical cord of newborns.
The umbilical cord of newborns contains huge numbers of stem cells, and medical studies are conducted in order to use them in transplant processes, and it is hoped that the risk of complications from transplant or rejection will reduce as these cells are not exposed to external stimuli, and we note that most transplants from this source was conducted for children who are siblings of the newborns who will donate, and research is still ongoing to use this infinite resource with adult patients and patients without kinship, which may solve the problem of finding a matching donor.
Choosing the donor
The patient him/her self may be the source of the stem cells, or one of his relatives and usually one of his siblings, or with a non-kin donor, and the appropriate donor is chosen after performing a special histological analysis of the blood, known as HLA- Human leukocyte antigen, and this analysis aims to match the genetic codes of the proteins of the characteristics of the white blood cells that are found on their surfaces as distinctive characteristics, and thus determining the extent of possible immune interaction about them, and the success of transplant depends on the extent of the tissue matching between the donor and the recipient, and the ideal matching is that which combines six classes of these proteins, most transplant centers require at least five of them to be matched, in anticipation of possible rejection of the body either toward transplanted cells, or of those cells that may attack the tissue of the body as alien.
Types of bone marrow transplant treatments pediatric and adults:
Bone marrow transplant pediatric and adults from the patient him/her self – Autologous transplant
The bone marrow or periodic stem cells of the patient him/her self can be used in some cases, and one of the conditions that must be met here is that the number of healthy stem cells is sufficient for transplant, and that the patient be in a state of stability and freedom from tumor cells in a large percentage, and the autologous transplant operations are conducted in a way that the stem cells are harvested and meticulously processed to eliminate the remaining tumor cells with a complete disinfection process, and then returned to the body, (in this case there are no risks of rejection in practice), and disinfection processes are carried out following one of two ways, either using drugs and antibodies to isolate the stem cells then returning them fertilized to the body known as the way of positive selection, or using anti-particles against tumor cells and removing them from the extracted marrow then the stem cells are returned to the body, and this is known as the method of negative selection, and recent developments in labs analyzes and tests have helped to determine accurately the remaining small numbers of cancer cells in the maximum use of the disinfection process.
Allogeneic bone marrow transplant pediatric and adult: