Bone Marrow Transplant Center
Treatments of lymphoma, Multiple myeloma, Acute Leukemias (much less chronic leukemias), aplastic anemia and other bone marrow failures, hemoglobinopathies, myelodysplastic and chronic myeloproliferative have been successfully performed via stem cell transplantation.
What is a Stem Cell?
Stem cells are non-specialized or differentiated cells that have not acquired some functions and have the ability to divide and renew themselves unlimitedly. They are the main cells making up all the tissues and organs in our body. Hematopoietic stem cells are the cells that produce red blood cells, white blood cells, and platelets and release them into the bloodstream. It is abundant in the bone marrow and umbilical cord and to a lesser extent in the peripheral blood.
In Ankara Private Koru Ankara Hospital, stem cell transplantation is an extremely challenging and stressful process for the patient, their relatives, and the doctor. However, it has been a ray of hope for the patients by offering a new life to many patients such as blood cancer, recurrent lymph node cancer, bone marrow cancer, which had no cure until a very short time ago and could even be fatal.
Within the scope of bone marrow transplantation processes at the department of bone marrow transplantation center, transplantation process is performed from autologous (self-transplantation), allogeneic (fully compatible) transplantation from other donors or families, and haploidentical (semi-matched) donors. In the bone marrow transplant center of our hospital, both pediatric and adult patients are served. The collection of stem cells and bone marrow, sorting and processing of the collected cells with various processes are carried out in the laboratories of our hospital's bone marrow transplantation center. Transactions and health analyzes of both donors and recipients are performed at the bone marrow transplant center.
1- Stem Cell
Bone marrow transplantation is also known as stem cell transplantation. It is the operation of transplanting healthy stem cells taken from the patient himself or another compatible donor, that is, in order to reassemble the damaged bone marrow stem cells.
Before the bone marrow transplant, drug therapy and chemotherapy are applied for the treatment of damaged stem cells. After these treatments, healthy stem cells are taken from the patient's donor or himself. Cells are transferred through a catheter inserted into a vein in the neck, similar to a blood transfusion. Patients are generally well at the time of transplantation. In the first month after the stem cell transplant, patients who have had a bone marrow transplant experience many side effects. These side effects are followed by a specialist doctor and drugs that are good for reducing these side effects are given. Stem cells begin to produce new blood cells in the bone marrow and rebuild the patient's immune system immediately after transplantation.
2- Bone Marrow Diseases
Bone marrow or stem cell transplantation is a procedure applied for the treatment of cancer and many diseases that cause differences in the lymph and blood system. The following diseases are treated with bone marrow transplantation.
a) Myeloblastic Acute Leukemia Disease
Monocytes and granulocytes, which form leukocytes that fight against bone marrow-type diseases, form blasts, that is, young cells in the bone marrow. These young cells grow over time and play an important role in the immune system. Findings in acute myeloblastic leukemia disease, as a result of the abnormality seen in the maturation period of blast cells, the cells that cannot maintain their normal levels are unable to fulfill their duties in the immune system together with the collection of cells in the bone marrow and blood. Bone marrow transplantation center calls these findings acute myeloblastic leukemia disease. Symptoms include shortness of breath, weakness, fatigue, fever, bone pain, bruises on the skin, bleeding gums and nosebleeds. The diagnosis is made by bone marrow aspiration, bone marrow biopsy, genetic tests, and peripheral smear. Treatment is bone marrow transplantation and chemotherapy.
b) Primary Amyloidosis Disease
It is a disease caused by the irregular accumulation of proteins produced by the bone marrow in the organs. Symptoms include shortness of breath, fatigue, skin problems, diarrhea, heart rhythm disorders, weight loss, tongue enlargement, and stomach and intestinal problems. The diagnosis is made in our bone marrow transplantation center unit by ECG, biopsy, urine, and blood tests depending on the area. Treatment is bone marrow transplant and chemotherapy.
c) Aplastic Anemia Disease
It is a disease that occurs when enough blood is not produced due to the very small number of immature young stem cells called hematopoietic in the bone marrow. Causes such as birth, toxic intake, exposure to excessive radiation, tissue disorders, pregnancy, infections cause aplastic anemia. Symptoms include fatigue, weakness, shortness of breath, fever, and infection. The diagnosis is made as a result of genetic tests, bone marrow aspiration, biopsy, blood count, serological tests, and biochemical tests. In our bone marrow transplantation center unit, treatment is carried out with bone marrow transplantation and immunosuppressive drugs.
d) Paroxysmal nocturnal hemoglobinuria
It is a disease caused by the disintegration of red blood cells called erythrocytes, as well as the removal of hemoglobin, which gives our blood its red color and carries both oxygen and carbon dioxide, from the body of the person through the urine, and causes vascular occlusion as a result of coagulation in the veins. Symptoms are heart palpitations, fever, vascular occlusion, fatigue, chest, waist, head, and stomach aches. Diagnosis is made by urinalysis, biochemical tests and flow cytometry in our bone marrow transplantation center unit. Its treatment is carried out with erythrocyte suspension, bone marrow transplantation, monoclonal antibody therapy and drugs containing iron.
f) Hodgkin’s lymphoma
It is a cancer that occurs in the lymphatic systems of the body, which is fighting against many diseases and infections. Many diseases such as AIDS, human herpes virus, and measles cause Hodgkin lymphoma. Symptoms of this disease are night sweats, itching, weight loss, loss of appetite, swelling in the armpits, neck or groin, enlargement of the liver or spleen. Diagnosis is made by computed tomography, ultrasonography, PET-CT, biopsy, biochemical and hematological blood tests. In the course of the disease, bone marrow biopsy is performed. The treatment is radiotherapy, chemotherapy and bone marrow transplantation, that is, stem cell transplantation in our bone marrow transplantation center unit.
f) Non-Hodgkin lymphoma
It is a type of cancer that occurs in the lymphatic systems, which are in charge of strengthening immunity in the body. Situations such as exposure to pesticides, viral diseases, some drugs, exposure to toxic gases cause this disease. Symptoms include weight loss, fever, night sweats, weakness, sores on the skin, and palpable swellings in the armpits, neck, or groin. Diagnosis and treatment methods are similar to Hodgkin lymphoma cancer.
g) Myelodysplastic Syndromes
With the abnormality of the time to produce new blood cells in the bone marrow, the maturation of cells in the bone marrow becomes difficult. This disease, which generally occurs in older ages, causes anemia in the body by causing platelet and leukocyte deficiency. As the disease progresses, it can turn into leukemia. Symptoms include night sweats, weakness, abnormal weight loss, bruising on the skin, and fever due to infections. Its diagnosis is determined by genetic tests, blood count, and bone marrow aspiration or biopsy in our bone marrow transplantation center unit. Its treatment is done with drugs, erythrocyte suspension, and stem cell transplantation.
h) Multiple Myeloma Disease
It is a cancer caused by excessive and uncontrolled proliferation of plasma cells in the immune system. This disease, which generally occurs in later ages, causes broken bones, weakening of the immune system and kidney failure. Symptoms include fever, malaise, loss of appetite, weight loss, low back pain, bone pain, and kidney failure. The diagnosis is made in our bone marrow transplantation center unit by bone scanning, bone marrow aspiration, urinalysis, biochemical and hematological tests, protein electrophoresis and immunofixation electrophoresis. The treatment is radiotherapy, chemotherapy and stem cell transplantation.
i) Chronic Myelocytic Leukemia
It is the presence of leukocytes that make up the immune system, too mature cells in the blood. In this type of cancer, where genetic problems are very effective, the number of red blood, white blood cells and platelets is quite high. Symptoms include pain, fatigue, and sweating. Diagnosis is by peripheral smear, blood count, some genetic tests and bone marrow aspiration. Its treatment is carried out in our bone marrow transplantation center unit with drugs and bone marrow transplantation in resistant patients.
j) Chronic Lymphocytic Leukemia Disease
It is a type of cancer that occurs when the normal structure of lymphocytes in the immune system is disrupted and accumulates too much in the patient's body. Lymphocytes, whose structure is deteriorated, do not help the immune system, but also prevent the production of red blood cells and platelets. Its symptoms are weight loss, weakness, fatigue, fever, enlarged spleen and liver, swelling in the groin, armpit and neck. Diagnosis is made by blood count, flow cytometry, peripheral smear, genetic tests, and bone marrow aspiration. The treatment is immunotherapy, chemotherapy, radiotherapy, and stem cell transplantation in our bone marrow transplant center unit.
It is a genetically caused disease caused by the disruption of the globin chains that make up the hemoglobin in the blood.
l) Mediterranean Anemia, namely, Thalassemia
It is an anemia disease that is passed on to the next generations with genetic problems that are more common in the Mediterranean region. Its symptoms are iron excess, heart failure, bone deformity, spleen enlargement and hormonal disruption. Diagnosis is by peripheral smear, complete blood counts and hemoglobin electrophoresis in our bone marrow transplantation center unit. Its treatment is bone marrow transplantation, erythrocyte suspension transplantation and certain drugs.
m) Sickle Cell Anemia Disease
It is a genetic disorder caused by the deterioration of the structures of hemoglobin, which is responsible for carrying oxygen to the blood, and the inability to perform its functions and the decrease in red blood cells in the blood. Symptoms include chest pain, stroke, infections, bone pain, gallstone formation, and crises. Diagnosis is by peripheral smear, complete blood counts and hemoglobin electrophoresis in our bone marrow transplantation center unit. The treatment is certain drugs, preventive measures, erythrocyte suspension transplantation and stem cell transplantation.
What is Stem Cell Transplantation?
It is the process of giving healthy hematopoietic stem cells from the person himself (autologous transplantation) or from another compatible donor (allogeneic transplantation) in order to regenerate bone marrow stem cells that have been damaged/lost their function due to some benign or malignant diseases. Since the bone marrow is rich in stem cells, it was the first source used in stem cell transplants. However, nowadays, environmentally sourced stem cells are preferred because they are safe, fast, and less irritating for both the recipient and the donor. In recent years, stem cells obtained from the umbilical cord have been used in transplants.
Before the stem cell transplantation, chemotherapy and/or drugs are administered to the patient and the bone marrow is drained, and then stem cells taken from the patient himself or from a healthy tissue compatible donor are given. After this process, stem cells settle in the recipient's marrow, multiply and begin to produce hematopoietic cells, producing new blood cells and restructuring the immune system. The patient's blood values begin to improve within 2-4 weeks. Meanwhile, the patient is followed closely by his doctor. Especially on days when blood values are low (sometimes every day), blood support and in case of infection, antibiotics are needed. Full recovery of the immune system, on the other hand, requires much more time, and it may take up to 1-2 years, especially in allogeneic and umbilical cord transplantations.
To Whom Is Stem Cell Transplantation Applied?
Stem cell transplantation for some malignant (leukemia-blood cancer, lymphoma - lymph gland cancer, multiple myeloma, bone marrow cancer, etc.), blood diseases, some bone marrow failures such as aplastic anemia and congenital blood diseases (thalassemia, etc.) is successfully applied in the treatment today.
How Stem Cells Are Obtained and What Are the Transplant Types?
The cells used for stem cell transplantation are obtained from three main sources: Bone marrow, peripheral blood, and umbilical cord. The underlying disease of the recipient, the stage and final state of the disease, urgency, compliance status, donor characteristics and preference are determinative in these cases. Peripheral blood is mostly preferred currently.
Autologous stem cell transplantation: Giving the recipient their own stem cells
Allogeneic stem cell transplantation: Giving the recipient stem cells from another fully matched person
Haploidentical stem cell transplantation: Giving the recipient stem cells from first-degree semi-matched relatives
Syngeneic stem cell transplantation: Giving the recipient stem cells from an identical twin is the process of giving cells.
Is full compatibility between the recipient and donor essential?
If possible, full compliance (8/8) is sought in transplants from another individual. In this case, it is clear that the success rates are higher. However, nowadays, with the development of technology and follow-up methods, the success rates are quite high with almost complete or even semi-compatible transplants. In transplantations made from umbilical cord blood, compliance is acceptable at the level of 6/6, 5/6 or 4/6.
How stem cell transplantation is performed
In autologous stem cell transplantation, that is, in cases where the patient's own stem cells will be used, the underlying disease must be cured with chemotherapies. Then, using some drugs according to the stem cell method to be used, stem cells are collected from the patient and frozen, and they are thawed again on the day of stem cell transplantation and given to the patient. In allogeneic transplants, the disease is cured with chemotherapy, and then some drugs are given to the donor according to the stem cell source to be used, and stem cells are collected from the donor and given to the recipient. Thus, bone marrow stem cells damaged during treatment are restructured and repaired.
Koru Health Group, which is a reference center in health, has recently opened the Bone Marrow Transplantation Center and Hematology inpatient service. It can serve 8 patients at the same time in the stem cell transplantation unit and 10 patients in the hematology service. While organizing the center, attention was paid not only to the conditions of the Ministry of Health Bone Marrow Transplant Centers and Bone Marrow Transplantation Tissue Information Processing Centers Directive, but also to have a unit and infrastructure that could serve at an international level. One of the most important problems in stem cell transplant patients is infection. This problem is kept to a minimum with the advanced hepafilter system. All services are provided in an isolated area, in fully equipped and extremely comfortable rooms. Our aim is to ensure that this process, which can be extremely difficult financially and morally for the patient, is as comfortable and peaceful as possible. Our center, Bone marrow transplantation out-patient department consists of
- Bone marrow transplantation clinical part
- Apheresis unit
- Stem cell separation and storage
- Blood Transfusion Center
Hematology Unit consists of inpatient service and polyclinic units.
Private Ankara Koru Hospital Stem cell transplant center is in a position to accept patients not only from Turkey but also from the international arena with the support of highly experienced doctors, nurses, assistant health personnel, psychological support group and translators in every language. Our hospital provides road transfer and accommodation services especially for patients and their relatives coming from abroad. Patients, who are candidates for stem cell transplantation, are evaluated by our doctors who are experts in their fields, undergo extensive tests and are accepted to the unit for transplantation if deemed appropriate. All units of our hospital have an agreement with SSI