Bone Marrow Transplant in Turkey

Last Modified: August 21, 2020  |   Created on: August 7, 2020
Blood Cancer, Blood Disorder, Cell Therapy, Transplants

Bone marrow transplantation (Hematopoietic stem cell transplantation) involves the transfer of stem cells harvested from the bone marrow or blood, into the patient’s body. It can be used to restore the immune system or treat blood and marrow diseases such as cancer (leukemia, lymphoma, multiple myeloma), sickle cell anaemia, Myelodysplasia and others.

The healthy stem cells are isolated from the patient’s own body or a tissue-matched healthy donor, and are stored/processed before infusing them to or back to the patient. An autologous bone marrow transplant involves the use of the healthy (self) stem cell from the patient only while an allogeneic transplant is a process in which bone marrow is collected from a donor.

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Bone marrow transplant in Turkey

Turkey has emerged as one of the highly advanced healthcare sector that cater to patients from all parts of the world. The rising demand of quality medical services at affordable prices has made Turkey a popular medical travel destination. Every year, the world-class hospitals of the country receives large influx of patients from different countries for a variety of medical treatments under different specialities, ranging from cardiology, neurology, orthopedics to bariatric surgery, reproductive medicine and many more.

Bone marrow transplantation in Turkey is a safe and effective treatment offered by hospitals in Istanbul, Ankara, Anatolia, Konya and other major cities. The treatment is available for adult as well as paediatric patients and is performed by trained specialists. There are many reasons for choosing a bone marrow transplant hospital in Turkey for successful treatment:

  • First-rated medical services: The hospitals in Turkey are advanced healthcare centres with modern infrastructure and international standard clinical facilities. Several bone marrow transplant hospitals in Istanbul and other cities in Turkey are certified by Joint Commission Internation (JCI), the healthcare accreditation organization in the USA, and others. Some hospitals such as Anadolu Medical Centre are associated with premier institutions such as John Hopkins Centre (USA). These hospitals have dedicated BMT units which are especially designed for patients who undergo stem cell transplant. They abide by strict protocols to ensure the effective and successful treatment of the patient.
  • Qualified doctors: The team of doctors including hematologists, hemato-oncologists and other specialists (such as oncologists in case of cancer patients) work together to conduct bone marrow transplant based on the patient’s need. They are highly trained experts with a vast knowledge and experience in the field. 
  • Low cost treatment: The price of healthcare packages offered the Turkey hospitals are affordable compared to several other countries, especially the Western nations, but with no compromise on the quality of treatment. This is one of the prime factors that make Turkey a popular choice for medical travel all over the world. 
  • Success rate of BMT Turkey: The success rate of bone marrow transplantation in Turkey is at par with the best facilities worldwide. The experience of the doctors and high-end facilities at the hospitals ensure that the patients receive quality clinical care. They stringently follow the safety guidelines for post-operative care of the patient. A series of pre-evaluation tests are conducted by the medical team to reduce the possibility of rejection or other complications. 
  • Accessible location: Turkey is a country that has parts in two continents – Europe and Asia, and is well-connected to the Middle East. It has a rich historical and cultural background, with several tourist attractions across the country. The international airport is connected to all the major airlines of the world. The luxurious and budget-friendly hotels and accommodations are available all over the Turkey. The country offers global cuisines as well as exotic street food to suit different palates.

Bone marrow transplant cost in Turkey 

The average cost for stem cell treatment in Turkey is highly reasonable in contrast to cost of same treatment in various countries such as the USA, UK, Germany, Australia and many others. The price for packages of two primary types of BMT begin with:

Autologous transplant – USD 50000

Allogeneic transplant – USD 70000 – USD 90000

The overall bone marrow transplant cost in Turkey varies depending on many factors, other than the type of BMT, which includes: 

  • Choice of hospital: The location and accreditation of the hospitals can vary the price of packages they offer for the treatment.
  • Doctor’s experience in the filed and their expertise
  • Patient’s condition: The disease which patient suffers from and whether other modalities are needed for complete treatment
  • Length of stay at the hospital and in the country
  • Post-operative care needed 
  • Room category at the hospital

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Bone marrow transplant: Overview

Bone marrow is the soft spongy tissue inside certain bones and is responsible the production of different types of blood cells in the body. 

There are primarily three types of blood cells: 

  • Red blood cells (erythrocytes): carries and transport oxygen through blood to various parts of the body
  • White blood cells (leucocytes): involved in defence of the body against external particles
  • Platelets: required for clotting of the blood. 

Hematopoietic stem cells are the progenitor cells that are responsible for the production of all kinds of blood cells in the bone marrow. These stem cells have the ability to produce new stem cells or form immature cells that differentiate into various types of blood cells. Healthy stem cells are extracted and transferred in a bone marrow transplantation procedure. 

Although, bone marrow is not the only source of stem cells that are used in the bone marrow transplantation, it is still considered a rich one. However, stem cells can also be taken from the umbilical cord, or blood. Currently, stem cells derived from blood (after a certain stimulation process) is being mostly used in bone marrow transplantation processes. 

Bone marrow may get damaged, produce inadequate or faulty blood cells due to some diseases. It can lead to serious health condition, depending on the type of blood cells affected. In such cases, a bone marrow transplant might be a treatment option to replace the damaged stem cells with healthy stem cells. This restores the production of healthy blood cells – white blood cells, platelets, or red blood cells – to help prevent infections, bleeding disorders, or anaemia.

Types of Bone marrow transplantation 

In a bone marrow transplant, the diseased bone marrow of the patient is destroyed and healthy stem cells are transplanted into the patient’s blood-stream. After a successful transplant, the new stem cells in the blood migrates to the bone marrow of the large bones, engrafts and restores production of normal blood cells.

Based on the source of stem cells, there are mainly two type of bone marrow transplantation procedures:

Autologous bone marrow transplantation

In this, the patient’s own bone marrow cells are used for the transplantation. An autologous BMT is possible when the disease affecting the bone marrow is either in remission or the diseases being treated does not affect the bone marrow cells (such as Hodgkin’s disease, non-Hodgkin’s lymphoma, breast cancer, ovarian cancer, and brain tumors). The cells from the bone marrow are extracted from the patient before the transplant – prior to eliminating the bone morrow to purge the lingering malignant cells (if the disease affects the bone marrow).

There are some advantages associated with this type of transplant. As patient’s own cells are used, there is no risk of tissue incompatibility and rejection of the transplant. However, it is prerequisite for a successful Autologous BMT that the patient have healthy bone marrow cells. 

In this transplantation, the patient’s bone marrow cells are quickly processed and infused back after the conditioning regime. Autologous bone marrow transplantation is also a part of the treatment plan for some cancer patients who undergo chemotherapy and/or radiotherapy. This is because these therapies might damage the bone marrow and lead to health problems afterwards. 

For autologous transplant, the stem cells harvested from the bone marrow or blood are processed, frozen and stored for the future use. After chemotherapy and/or radiotherapy, when the bone marrow gets obliterated, autologous transplantation is performed to infuse the healthy blood forming cells.

Allogeneic bone marrow transplantation

Allogeneic BMT involves the use of stem cells derived a healthy donor who is tissue-compatible with the recipient. The donor for BMT can be a relative or any other person who has compatible tissue type, which is a prerequisite of the allogeneic transplantation. In many cases, patient have a sibling whose bone marrow is a perfect match. It is referred to as syngeneic BMT when the donor is an identical twin. In cases where the patient has no matched sibling, a donor can be found in one of the international bone marrow donor registries. 

A haploidentical (half- matched donor) or mis-matched transplant may be considered. Umbilical cord transplant is another option in which the cord blood, rich in stem cells, is used for replacing the damaged stem cells in a patient. A mother may choose to preserve the umbilical cord after the baby is born. It is frozen and stored for future use. 

In an allogeneic BMT, gentic compatibility is important to lower the risk of rejection and other complications. This means that new stem cells harvested from the donor must match the genetic makeup of the patient’s as much as possible. For this, a special blood test, known as HLA testing, is done to determine whether the donor candidate’s bone marrow matches the patient’s. 

Human leukocyte antigen (HLA) is a protein (marker) found on most cells in our body. The best transplant outcomes are considered when the donor’s HLA markers closely matches the HLA of the patient. HLA match is important as it helps reduce the risk for complications after transplant. If the donor is not a good genetic match, the healthy transplant cells will attack the patient’s body, perceiving it as foreign. 

This condition is referred to as graft-versus-host disease (GVHD). It can be a life-threatening complication post transplant. Alternatively, the patient’s immune system may recognize the new transplanted stem cells as foreign and destroy them, a condition known as graft rejection. It can cause some severe symptoms. Therefore, it is necessary to have matched donors for allogenic bone marrow transplants. 

Usually, the first candidates tested for a matching donor are from patient’s family, usually a brother or sister. This is because children inherit HLA markers from the parents. Each sibling has a 25% chance of completely matching the genetic markers, if they have the same parents. However, the parents and children always have exactly half match of HLA markers. Some patients are considered for a transplant from a half-matched donor, it is known as haploidentical transplant.

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Who needs a Bone marrow transplant?

Bone marrow transplantation is performed to restore the healthy and adequate production blood cell in the patients whose bone marrow are damaged or diseased. This includes congenital blood diseases in which abnormal or inadequate functioning of the bone marrow results in production of insufficient blood cells or the abnormal cells that do not function properly.

Bone marrow transplantation might be the only treatment option for some blood cancer patients, especially in the case of leukemia or lymphoma, who are unresponsive to other treatments. Also, for cancer that has spread from the organ of origin to other tissues and organs of the body, the patient may require treatments such as chemotherapy and radiotherapy, that will damage the bone marrow. After these treatments, the doctors will perform bone marrow transplantation to enable proper production of blood cells. 

High doses of chemotherapy and/or radiation can destroy the stem cells and progenitor blood cells in the marrow. Aggressive chemotherapy might be required to treat some lymphomas and other cancers, and can result in destruction of healthy bone marrow. A bone marrow transplant enables the doctor to treat these cancers with high dose chemotherapy and/or radiation as the diseased or damaged bone marrow will later be replaced with healthy stem cells (generally, with autologous transplant).

Bone marrow transplantation helps below listed diseases:

  • Cancers of blood and marrow: Leukemia, Lymphoma (Hodgkin lymphoma and Non-Hodgkin Lymphoma), Multiple Myeloma
  • Aplastic anemia: a disorder in which the bone marrow does not produce adequate blood cells
  • Sickle cell anaemia: an inherited blood disorder in which abnormal red blood cells are made
  • Congenital neutropenia: an inherited disorder which causes recurring infections
  • Thalassemia: a congenital disorder of blood in which the body does not make adequate amounts of haemoglobin
  • Other diseases such as Myelodysplasia, Myelofibrosis, Neuroblastoma, Hemoglobinopathies and more

Preparation before BMT

The doctor will conduct a series of detailed medical evaluations to determine whether bone marrow transplant is the right choice treatment for the patient’s condition.

Once it is decided that the patient is a suitable candidate for a bone marrow transplantation, comprehensive examinations will be done. This is the preparation phase in which the general health will be assessed before the bone marrow transplantation. If there are any health problem that may pose a risk to patient or affect the success of the bone marrow transplantation, they will be treated to prepare the patient’s body to receive bone marrow cells.

Another important part of the preparation phase is to facilitate bone marrow transplantation and minimize the risk of complications that may occur post transplant.

For autologous bone marrow transplant, certain drugs are used to increase production of stem cells in the blood and to ensure that adequate number of stem cells are present for collection during this period. A central venous catheter, which is a long and thin tube, is inserted into one of the major veins of the body. Through this catheter, administration of medicines that stimulate production of stem cells and infusion of stem cells can be done.

The doctor will first decide which source for collection of bone marrow cells has to be used, depending on the condition being treated. When patient’s your own stem cells, the blood is processed thorough an apheresis device to isolate and collect stem cells from the blood.

For allogeneic bone marrow transplantation, the most appropriate source (bone marrow, blood, umbilical cord) for harvestion of the stem cell will be assessed.

If the bone marrow transplant is required to replace the bone marrow damaged by anti-cancer treatment, you will be placed on high-dose chemotherapy and/or radiotherapy.  Patients who are undergoing chemotherapy and radiotherapy at this stage, may experience complications associated with these treatments. However, these complications are treated as the treatment continues with the bone marrow transplant. Some possible complications are hair loss, diarrhea, vomiting, nausea, mouth sores, infections, fatigue, infertility and bleeding.

Once the complications are eliminated, bone marrow transplantation is done in which the immune system is suppressed so that patient’s body does not reject and attack the bone marrow transplant. The immunosuppression causes a person to be more prone to infections and therefore, they need to strictly follow the instructions and precautions.

Bone Marrow Transplant procedure

After the evaluation and selection of donor (for allogenic bone marrow), following basic steps for BMT are followed:

Collecting your stem cells: It can be done in two ways – bone marrow harvest (or aspiration) and leukapheresis. For a bone marrow harvest, stem cells can collected directly from both hipbones using a long needle. The person is put under anaesthesia during this procedure, and they don’t feel any pain. 

Leukapheresis is another method in which bone marrow stem cells are derived from the blood. It takes several days as the person will receive injections of a medication to increase the number stem cells in the blood. Then the stem cells are isolated from the blood which is collected through a vein in the arm or chest. The blood goes through a machine which separates the stem cells from other blood cells and the remaining blood is transferred back to the body.

The amount of bone marrow that is harvested for the procedure will depend on the body size of the patient and the concentration of stem cells in the donor’s blood. Generally, a quarts or two of bone marrow and blood are harvested. 

Pre-transplant treatment: It is also known as conditioning. It takes 5 to 10 days. Patient receives a high dose of chemotherapy, and/or radiation therapy to destroy the bone marrow.

Infusion of stem cells: This takes place on the transplant day. The process lasts for about 30 minutes for each dose of stem cells. The infusion is done using a catheter to transfer the healthy stem cells into patient’s blood stream. 

Recovery: After the transplant, the medical team will closely monitor the patient and keep a check on recovery and growth of stem cells. The patient will be given antibiotics to reduce infection. The medical team will also look out for complications and treat any side effects. 

The stem cells migrate and eventually settle in the bone marrow and start producing healthy blood cells. Engraftment is referred to the stage when the transplanted stem cells start producing new blood cells. Some patient may need blood transfusion before the production of new blood cells takes place.

The formation and increase in the number of new blood cells will be monitored with a series of blood tests. Other tests such as blood tests, urine tests, imaging studies are also conducted in addition to close observation to assess the overall health and check for complications, if any. After discharged from the hospital following the bone marrow transplantation, there will be follow-up appointments with the doctor for a time interval. It is important to follow all the post transplant instructions at home. The anti-rejection medications suppress the immune system of the patient, increasing the risk of infections. So they need to take precautions and appropriate care to prevent complications. 

Risks and complications of Bone Marrow Transplant

A bone marrow transplant is a major medical procedure that involves certain potential risk and complications. The chances of developing complications will depend on several factors, such as:

  • Patient’s age
  • Patient’s overall health
  • Disease that is being treated
  • Type of transplant that has been received

Some possible side effects of transplant include:

  • Low blood pressure
  • Headache 
  • Nausea 
  • Pain 
  • Breathlessness 
  • Chills 
  • Fever 

These symptoms are typically short-term, but a bone marrow transplant can cause some long-term complications, ranging from mild or very serious. These include:

  • Graft-versus-host disease (GVHD): a condition in which donor blood cells attack the body
  • Graft failure: occurs when the transplanted cells don’t produce new blood cells 
  • Bleeding in other parts of the body such as the lungs and brain
  • Cataracts: characterized by clouding in the eye lens 
  • Damage to vital organs of the body
  • Infertility and early menopause
  • Anaemia: occurs when the body is unable to produce enough amounts of red blood cells
  • Infections 
  • Mucositis: a condition which causes inflammation and soreness in the mouth, throat, and stomach

Diet and other lifestyle factors after Bone Marrow Transplant 

After bone marrow transplant, the patient is recommended adjusting diet and lifestyle activities to stay healthy and maintain weight. The transplant team will work with dietician and nutritionist to create a balanced diet plan to meet all the post transplant needs. The food suggestions are given to complement the lifestyle and manage the side effects of chemotherapy and radiation, such as nausea.

Some of these recommendations include:

  • Follow the food safety guidelines such as washing the vegetables and fruit, and avoid eating raw food, to prevent foodborne infections
  • Eating a range of vegetables and fruits, and including whole grains, lean meats, fish, poultry, legumes, and healthy fats
  • Restrict salt intake
  • Limit alcohol
  • Avoid grapefruit due to their effect on a group of immunosuppressive medications 
  • A regular physical activity is also recommended in order to control weight, strengthen the bones, increase endurance, and strengthen the muscles. 
Vanshika Rawat

Written By Vanshika Rawat

Vanshika Rawat is an experienced content developer. She is very knowledgeable in the field of science and healthcare and has worked under brilliant scientists during her higher education. Vanshika obtained her degrees in Masters in Science and Bachelors in Science (Microbiology with Hons.) from renowned institutions - Panjab University and University of Delhi.
Dr. Suneet Singh

Verified By Dr. Suneet Singh

Dr. Suneet is a doctor-turned-Hospital Administrator with a rich 12 years plus multi-faceted experience in the field of operations management, Corporate and Public Health Administration. Formerly a practicing doctor, Dr. Suneet holds a post-graduate degree in Hospital and Healthcare management from one of the country's esteemed Tata Institute of Social Sciences (TISS)

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Vanshika Rawat

Written By Vanshika Rawat

Vanshika Rawat is an experienced content developer. She is very knowledgeable in the field of science and healthcare and has worked under brilliant scientists during her higher education. Vanshika obtained her degrees in Masters in Science and Bachelors in Science (Microbiology with Hons.) from renowned institutions - Panjab University and University of Delhi.
Dr. Suneet Singh

Verified By Dr. Suneet Singh

Dr. Suneet is a doctor-turned-Hospital Administrator with a rich 12 years plus multi-faceted experience in the field of operations management, Corporate and Public Health Administration. Formerly a practicing doctor, Dr. Suneet holds a post-graduate degree in Hospital and Healthcare management from one of the country's esteemed Tata Institute of Social Sciences (TISS)
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