Bone Marrow Transplantation

Medical Park International - Bone Marrow Transplantation

Bone Marrow Transplantation in Medical Park Hospitals Group

A treatment program providing both service and training at international standards is offered in stem cell and bone marrow transplantations in adult and children Bone Marrow Transplantation Departments within the scope of Medical Park Hospitals Group. Transplantation Programs include clinical research in high dose chemotherapy and long-term outcome for bone marrow transplantations The Bone Marrow Transplantation Multidisciplinary Team is comprised of physicians, nurses, pharmacists, therapists, social workers and administrators specializing in all aspects of stem cell transplantation The Bone Marrow Transplantation Program is heavily supported by specialty programs based in the Divisions of Intensive Care Unit, Pulmonary Medicine, Infectious Diseases, Renal Medicine and other specialty services of the Medical Center.

We provide services for our patients with the aid of our team of experienced physicians at all our Bone Marrow Transplantation centers supported by a state of the art laboratory, and equipment and hardware that comply with international standards. Our Bone Marrow Transplantation centers are certified by Ministry of Health and EBMT for conduct of autologous, allogeneic, matched-unrelated and reduced intensity transplantations. Our Units are also certified as Unrelated Donor Harvests by EBMT. At these centers, patient rooms and corridors are equipped with a HEPA Filtering system, which reduces the risk of airborne infections. The transplantation can be performed by using either the stem cells of the patient (autologous) or his/her siblings (allogenic) or if the patient does not have a sibling who is histocompatible, then the procedure can be conducted by using stem cells donated by people other than relatives to international bone marrow banks. Furthermore, cord blood transplantations, oriented by the in-vitro fertilization method, is one of the factors that differentiates us from others. Bone marrow transplantation decisions are taken in the Transplantation Council.

Bone Marrow Transplantation Success Rates

Adult Bone Marrow Transplant Centers

Medical Park Antalya Hospital Complex

Medical Park Göztepe Hospital Complex

Medical Park Bahçelievler Hospital

Medical Park İzmir Hospital

Pediatric Bone Marrow Transplant Centers

Medical Park Antalya Hospital Complex

Medical Park Göztepe Hospital Complex

Medical Park Bahçelievler Hospital

Medical Park Samsun Hospital

Medical Park Bahçelievler Hospital

BETWEEN 2010 – 2015

The Number of Adult BMT performed: 475 Success Rate: %87

Adult BMT Physicians: Prof. Gülsan Sucak, MD Assoc. Prof. Şebnem Güner, MD

BETWEEN 2012 – 2015

Number of Pediatric BMT performed: 284 Success Rate: %88

Pediatric BMT Physicians: Prof. Tunç Fışgın, MD; Assoc. Prof. Ceyhun Bozkurt, MD

Medical Park Göztepe Hospital Complex

BETWEEN 2012 –2015

The Number of Adult BMT performed: 192 Success Rate: %96

Adult BMT Physicians: Assoc. Prof. Cafer Adıgüzel, MD

BETWEEN 2011 – 2015

Number of Pediatric BMT performed: 559 Success Rate: %89

Pediatric BMT Physicians: Prof. Akif Yeşilipek, MD; Assoc. Prof. Gülsün Karasu, MD

Medical Park Antalya Hospital Complex

BETWEEN 2009 – 2015

The Number of Adult BMT performed: 493 Success Rate: %95

Adult BMT Physicians: Prof. Yener Koç, MD

BETWEEN 2011 –2015

Number of Pediatric BMT performed: 368 Success Rate: %78

Pediatric BMT Physicians: Prof. Akif Yeşilipek, MD; Assoc. Prof. Vedat Uygun, MD

Bone Marrow Transplantation

For bone marrow transplantation, not only native stem cells of the patient are used, but also stem cells of another person can be transplanted, if particular criteria are met. Transplantations are categorized according to the source of stem cell

How bone marrow is obtained for transplantation and how peripheral stem cells are collected for transplantation?

Stem cells to be used in transplantation can be collected from bone marrow, peripheral blood and umbilical cord blood of mothers who deliver recently. Although stem cells collected from peripheral blood are usually primarily preferred, stem cells collected from bone marrow will be preferred in benign diseases, such as aplastic anemia, thalassemia and immune deficiency syndromes.

Peripheral stem cell is harvested with apheresis device after cytokines, which help stem cells in bone marrow migrate to peripheral blood and are referred as granulocyte colony stimulant factor (G-CSF), are used.

For patients in need of autologous transplantation, stem cells can be harvested from peripheral blood using G-CSF following chemotherapy, while leukocyte count elevates.

Stem cell cannot be collected with these methods from patients whose bone marrow is extremely poor due to particular reasons. For these patients, stem cells can be collected from peripheral blood using strong stem cell stimulating preparations, which contain plerifaxor as active ingredient, concomitantly with G-CSF. Stem cells are collected from bone marrow, particularly in pelvic bone, using special needles under general anesthesia at operating room.

What should one expected in recovery process following transplantation?

Prior to allogeneic transplantations, patients generally receive high-dose chemotherapy drugs and immunosuppressive medications. Next, stem cells are transferred to patient via a central catheter. Risk of infection is high due to chemotherapeutic agents and immunosuppressive medications.

In this high-risk baseline period, such therapies should be given at bone marrow transplantation units that are equipped with hepafilter and ventilation systems which can clean infectious agents in the environment.

Even if those conditions are fulfilled, risk of infection is always high for those patients. Those patient should be closely monitored and treatment should be immediately started, if infection develops. After bone marrow of the donor settles in, it is possible to witness a fight between donor cells and tissues of patient. Immunosuppressive agents are used in these patients to avoid this condition. Successful outcome in those patients depends on the type of disease, stage of disease and degree of compliance between donor and patient.

Although bone marrow transplantation is a lifesaving option in diseases that originate from bone marrow and cannot be managed with medical treatments, the most important problem that a compatible sibling is not always available. In such cases, valuable options include non-related donors and donation of one tube of blood to bone marrow banks by volunteer donors.

To the contrary of organ donations, donation of bone marrow does not cause a deficiency in any organ or human body and this short-lasting procedure that causes a very honorable loss of time may save life of another person. At this point, anyone aged 18 to 55 can be a bone marrow donor. It is extremely necessary to increases awareness on this issue.

These transplantations can be in the form of autologous transplant - native cells of the patient are transplanted back to patient following high-dose medical therapies - or allogeneic transplantation – stem cells or bone marrow of another person are transplanted to patient.

Compatible siblings and related ones or tissue compatible non-related persons are possible donors for allogeneic transplantations. Stem cells derived from peripheral blood, bone marrow or umbilical cord blood can be used.

When is bone marrow (stem cell) transplantation necessary?

Bone marrow cannot produce healthy blood cells due to diseases that influence the bone marrow, such as leukemia or myelodysplastic syndrome;

Bone marrow cannot provide the immune system with sufficiently active cells or sufficient amount of hematopoietic cells in conditions such as aplastic anemia;

Further sophisticated therapies are required for some diseases, such as myeloma, lymphoma, testicular cancer, neuroblastoma and medulloblastoma.

Congenital severe immune system deficiencies and some metabolic diseases.

Bone marrow transplantation plays a significant role also in congenital blood diseases. Bone marrow transplantation is the only therapeutic modality in thalassemia, sickle cell anemia and some rare blood related diseases.

Bone marrow transplantation is the single choice in conditions that are unresponsive to therapy or recurrent, especially in Non-Hodgkin lymphoma which is also seen in childhood. In recurrence of Hodgkin lymphoma - another form of lymph node cancer-, the same therapy method is applied.

Apart from these, it is known that stem cell and bone marrow transplantations both increase treatment-related risks and facilitates healing.

What are eligibility criteria for bone marrow transplantation?

First, HLA tissue compatibility should be ensured to transplant bone marrow. Full compatibility between patient and donor and incompatibility in maximum one tissue group are acceptable for bone marrow transplantation. Recently, transplantations with >50% compliance between related donors and patient can be performed, if there is no related or unrelated donor for the high-risk patient.

Is it possible that bone marrow is rejected by body during the transplantation?

If bone marrow does not start producing blood cells within first two weeks after transplantation, rejection of donor’s bone marrow by the recipient is a risk. This rate varies from 5% to 12% in allogeneic transplantations depending on type of donor and compatibility. This problem is almost never faced in autologous transplantations.

Is recurrence possible after transplantation?

Recurrence after transplantation is a possible outcome. These possibilities vary depending on underlying disease.

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