Pediatric Bone Marrow Transplant Cost in India

“Pediatric bone marrow transplant cost in India starts from USD 15,000 (INR 10,86,000) for autologous bone marrow transplant and USD 22,000 (INR 15,60,000) for allogeneic bone marrow transplant. The bone marrow transplant hospitals in India promise unparalleled health treatments at low-cost packages.

The soft, spongy material found inside the bones that produce healthy blood cells is called the bone marrow. The majority of the blood cells in the body are created and stored in the bone marrow. There are three main kinds of blood cells:
White blood cells, or leukocytes, help the immune system and fight infections.
Red blood cells, or erythrocytes, transport oxygen to the body’s tissues.
Platelets: These aid in the clotting of blood.
Hematopoietic cells found in this bone marrow can differentiate into various blood cell types. Healthy bone is filtered and transfused through a unique therapy called bone marrow transplantation (BMT)
A bone marrow transplant is a therapeutic procedure that replenishes the body’s damaged or destroyed blood cells with new, healthy ones. Thus, another name for this bone marrow transplant is a cell transplant.
Certain cancers, including leukaemia, multiple myeloma, and some forms of lymphoma, as well as blood-related conditions, including thalassemia and anaemia, are treated with BMT.
The cost of a bone marrow transplant can vary depending on the procedure, the source of the donor, the hospital, and any complications.
Compared to autologous transplants, which use the patient’s stem cells, allogeneic transplants, which use the stem cells of a donor, are frequently more expensive.
In a bone marrow transplant (BMT), healthy bone marrow cells from the donor (the parent) or another person are filtered and transfused until the child’s healthy cells are extracted.
Here, they promote the growth of new marrow and produce new blood cells. This procedure increases the body’s ability to produce enough red blood cells, platelets, or white blood cells, which helps to ward off infections, bleeding disorders, and anaemia.
The idea is to transplant healthy bone marrow into the child in place of the sick one, protecting them against cancer and other illnesses.
One can obtain healthy stem cells from their own body or a donor. The stem cells are preserved following their extraction. These healthy cells are transplanted after storage.
A bone marrow transplant is advised if all other treatments have failed, there is a greater chance that the illness will return without the transplant, and the doctor determines that the advantages of the procedure outweigh the risks.
Individuals who possess stem cells from a sibling or other family member and are in otherwise good health are the best candidates for a bone marrow transplant.
For many people with fatal blood disorders, bone marrow transplants can be a lifesaver. Despite the high cost associated with a bone marrow transplant in India, it is still possible to obtain excellent care at a reasonable price.

Bone Marrow Transplant Indications

A bone marrow transplant for children is required when they experience conditions like:

When the child’s bone marrow has been destroyed or severely damaged as a result of rigorous chemotherapy or radiation treatments
Cancer of the leukaemia
Thalassemia
Cancers of the lymph nodes
Tumours such as neuroblastoma and brain tumours
Sickle-cell illness
Immunological deficits
Anaemia Diamond Blackfan
Kidney cancer
Storage or metabolic diseases

Thus, there are three main uses for a bone marrow or cell transplant:

It restores blood cells that have been harmed by radiation therapy or high-dose chemotherapy administered to eradicate cancerous cells. The transplant replaces the damaged cells with healthy ones after cancer treatment.

Chemotherapy targets not only cancer cells but also some healthy blood cells in the process. During this process, medical professionals replace the damaged cells with new, healthy ones via cell transplants.
It produces new cells with the ability to target and destroy cancer cells directly.

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Some conditions for which a bone marrow transplant may be beneficial

The conditions that benefit from bone marrow transplants most frequently are the following:

Leukaemia’s
Acute aplastic anaemia
Lymphomas
Multiple myeloma
Immunodeficiency disorders
Certain cancers of solid tumours (in rare circumstances)

Since every patient is unique, a bone marrow transplant may not be the best course of action for every person with a given disease.

Types of Bone Marrow Transplants in India

Three different approaches to bone marrow transplantation are available:

Autologous bone marrow transplant: The process involves removing a patient’s blood cells before chemotherapy, storing them, and then reintroducing them into the patient’s body following chemotherapy or radiation therapy. This is sometimes referred to as a “rescue transplant.” Physicians keep these cells in storage until they’re required for transplantation because they can be kept for a long time.

Allogeneic bone marrow transplant: In an allogeneic transplant, medical professionals harvest blood or cells from a donor—a relative or an unrelated person—for the transplant. Finding a donor whose bone marrow matches the patient’s is imperative. This kind of transplant depends on the compatibility of the donors.

The following individuals may be additional donors for allogeneic bone marrow transplants:

A parent: When the genetic match is at least half identical to the recipient and the donor is a parent, the match is known as haploid-identical. Such transplants are not common.
Unrelated bone marrow transplants (UBMT or MUD for matched unrelated donors): The stem cells or bone marrow that match genetically comes from an unrelated donor. Utilizing national bone marrow registries, unrelated donors can be identified.

Umbilical cord blood transplant: This process, which is comparable to an allogeneic transplant, entails taking bone marrow or cells from the umbilical cord of a newborn as soon as possible after birth. Before being needed for transplantation, these cells are frozen and kept in storage.

Similar to a blood transfusion, the cells are reinfused into the patient’s bloodstream through a central venous catheter following chemotherapy or radiation therapy. This allows the cells to reach the bone marrow without the need for surgery.

Diagnoses and Examinations

The diagnosis and Tests

Echocardiography
ECG
X-ray of the chest
Dental examinations
Examinations for Audiology
Lung capacity
Glomerular Filtration Rate, or GFR
CT Scan of the Chest
Hematologic examinations
Planning for Total Body Irradiation (TBI)

Tests for Donors

A fitness-related medical examination
Blood tests.
Electrocardiogram
X-ray of the chest
Genetic analysis.
Virus exposure

The factors affecting the Eligibility after the diagnosis:

The bone marrow transplant team completes a thorough evaluation. The bone marrow transplant will be decided upon based on several factors, such as the following:

The medical history, age, and general health.
The disease’s severity.
The availability of a donor.
The ability to tolerate particular medications, treatments, or procedures.
Predictions regarding the progression of the illness.
Anticipations regarding the duration of the transplant.
The choice or opinion.

The Cost of Pediatric Bone Marrow Transplant in India

The following table indicates details about Bone Marrow Transplant Cost in India:

Type of Transplant	Autologous BMT	Allogenic BMT
		Full Match (HLA testing >80%)	Half Match (HLA testing <80%)
Cost	USD 15,000	USD 22,000	USD 40,000
Donor	Not Required	Required
Chemotherapy	Required	Required
Stay in Hospital	25 – 35 Days	1 Month
Stay in Country	2 Months	2 Months
Accommodation Cost	Starting 20 USD/Day	Starting 20 USD/Day

The type of donor, the type of transplant, the intricacy of the surgical procedure, and the hospital or clinic performing the transplant are some of the factors that affect the price of bone marrow in India. Package includes all related costs, including those for the hospital stay, lab work, prescription drugs, and other expenses, as well as the transplant procedure. Fees may differ based on the type of transplant and the intricacy of the process.

India has lower paediatric bone marrow transplant costs than any other Western nation.

The Factors Affecting the Cost of a Bone Marrow Transplant

The following variables influence the cost of bone marrow replacement in India:

Pre-Evaluation Cost: To determine the patient’s vital statistics, several tests are conducted before the transplant. Physicians can use these reports to help them assess whether or not a patient is ready for surgery based on these statistics.
Cost of Chemotherapy: Before obtaining a bone marrow transplant, a patient with a condition like leukaemia might need to go through a few rounds of chemotherapy. Because of the chemotherapy regimen, treating that specific condition as a whole becomes more expensive.
Hospital Type: The cost of a bone marrow transplant also varies from hospital to hospital and city to city. The total cost of bone marrow treatment typically depends on the patient’s choice of multispecialty hospital, clinic, or bone marrow transplant facility. Cities also have distinct costs.
Age of the Patients: The patient’s age has an impact on the cost of a bone marrow transplant. Generally speaking, younger patients or small children will cost more. This is because their total hospital stay is longer and they require more care and testing.

Other factors influencing the cost of bone marrow transplants in India include:

Consultation with a doctor
Experience of the doctor
Follow-up fees
Accommodation fees
Hospital costs
Costs related to recuperation

The Stem Cells Collection

Stem cells are transferred from one person to another to perform a bone marrow transplant. One can obtain stem cells from the bone marrow or from the peripheral system, which is the blood’s circulating cells.

Peripheral stem cells in blood: Apheresis is the method used to gather peripheral blood stem cells (PBSCs). In this procedure, a needle is inserted into the veins of the donor’s arm to connect them to a specialized cell separation machine. After drawing blood from one vein, the donor receives the remaining blood and plasma through a second needle inserted into the other arm. The machine filters out the stem cells from the blood. To ensure a successful engraftment in the recipient, multiple sessions may be required to obtain sufficient stem cells.

Before apheresis, the donor may receive medication for approximately one week, which will stimulate the bone marrow to produce more new stem cells. These fresh stem cells can then be harvested during apheresis after being discharged from the bone marrow and entering the peripheral or circulating blood system.

Bone marrow harvesting:

The process of harvesting bone marrow entails inserting a needle into the marrow, the soft centre of the bone, to extract stem cells.
Hip bones and the sternum contain the majority of bone marrow harvesting sites. The operating room is the setting for the procedure.
During the harvest, the donor will be sedated so they won’t feel the needle.
The donor may feel some pain where the needle was inserted during their recuperation.

It is referred to as an autologous bone marrow transplant if the donor is the recipient. Before being used in an autologous transplant, harvested or peripheral stem cells (apheresis) are tallied, screened, and prepared for infusion.

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The Procedure of Paediatric Bone Marrow Transplant in India

Before the Bone Marrow Transplant

The bone marrow transplant team performs a thorough assessment of the child. The team discusses the advantages and disadvantages of a transplant as well as alternative treatment options.
The child takes assessments and tests in person. The child’s blood and organ functions, including the heart, kidney, liver, and lungs, are examined during the tests.
Up to ten days before the transplant, the child might need to visit the transplant centre. A central venous line is a thin, flexible tube that is surgically inserted into a vein in the child’s chest. Medication and blood products are administered via the catheter.
Days before the transplant are counted as minus days. Day 0 is the day of transplantation.
Post-transplant embrittlement and recuperation are recorded as “plus” days. To get ready for the BMT, a child might, for instance, check into the hospital on day eight. After the transplant, there will be days +1, +2, and so forth.
Every day leading up to, including during, and following a transplant has potential outcomes, complications, and risks. To help the parent(s) and the child understand the risks and discharge planning, the days are numbered.

During the Bone Marrow Transplant for A Child

The child will receive high doses of chemotherapy or radiation (or sometimes both) to destroy any existing bone marrow after appropriate stem cells are found. This permits the new bone marrow cells to multiply.
This therapy may be referred to as myeloablative or ablative. It inhibits the production of new blood cells. The bone marrow empties. To allow the new stem cells to grow and develop a new system for producing new blood cells, an empty marrow is required.
The child will then receive stem cells via an IV placed in a large vein, frequently in the chest. This is referred to as a central venous catheter. Obtaining stem cells is comparable to receiving a blood transfusion. The bone marrow is where the stem cells end up. They begin to grow and produce fresh, healthy blood cells.
When receiving bone marrow infusion, the child might experience Chills, Pain, Fever, Rashes, and chest aches.

After A Bone Marrow Transplant for A Child

Following infusion, your child might:

Be susceptible to infection
Have some bleeding.
Experience severe weakness, mouth sores, vomiting, and diarrhea.
Feel a little distressed emotionally
Infections, side effects, and complications will be prevented and treated with supportive care for the child.

In this period, the child might:

Stay in the hospital for a few weeks.
Restricted to an ultra-pure setting to minimize the likelihood of infection
Take several antibiotics along with other medications.
Require blood transfusions
Receive medication to stop the disease known as graft-versus-host
Take blood tests every day.

When the donated cells enter the bone marrow and begin producing new blood cells, this process is known as engrafting of the stem cells.

Usually, engagement takes place between days +15 and +30. This is contingent upon the kind of transplant and the ailment being managed. Following a transplant, blood tests will be performed frequently to count blood cells. Typically, platelets are the last class of blood cells to heal.

Engraftment may take a while in certain situations. This may result from graft failure, medication side effects, infection, or low donor stem cell counts. Within the first thirty days following the transplant, the new bone marrow may begin producing cells.

However, it might take the immune system of a child months or even years to fully recover.

The paediatricians will notify when the child is ready to return home. This relies on numerous factors, including:

Size of the engraftment
Complications
The general health of the child.
How far the facility is from the residence

Before one gets discharged from the hospital, one will be instructed on how to reduce the child’s risk of infection. Among them are:

Specialized rooms with air filters
Diet limitations
Limiting the number of guests
Stringent hygiene
Regular changes of bed linens

After that, the child will need to see the transplant team frequently for:

Check to see how well the medication is doing.
Keep an eye out for symptoms of issues like infection
Address side effects, infections, and additional issues.
The long-term success of each child is different.
The medical staff treating the child will discuss future treatments, follow-up care, and the child’s prognosis with the family.

The Recovery Process

Following a bone marrow transplant, the patient’s general health, potential complications, and the type of transplant (autologous, allogeneic, or umbilical cord blood) all influence the intricate and gradual healing process. An outline of the overall healing procedure is provided below:

Hospital Stay: Following a transplant, patients usually stay in the hospital for several weeks. Depending on the kind of transplant, any complications, and the patient’s rate of recovery, the length of time can change.

Monitoring: Patients are continuously watched for indications of infection, GVHD, and other possible side effects while they are in the hospital.

Immune System Recovery: One of the most important aspects of healing is immune system reconstruction. Children are more vulnerable to infections while their immune systems are recovering, which can take several months to years.

Medications: In addition to other medications to aid in the healing process, children frequently require immunosuppressants to suppress the immune system and prevent GVHD.

Diet and Nutrition: It’s critical for transplant recipients to maintain a healthy diet because they may have adverse effects like nausea, diarrhoea, or mouth sores. A healthy diet is essential for recovery.

Follow-Up Care: To manage complications, track advancement, and modify medication, routine follow-up visits are required.

Risks of a Bone Marrow Transplant for A Child

Risks associated with a bone marrow transplant include some potentially fatal ones. Before the procedure, you will discuss the benefits and risks with your child’s healthcare provider and the BMT team.

Complications and risks may differ based on:

The kind of BMT
The kind of disease that the transplant is treating
Which medications are taken before transplantation
The age and general health of the child
The variations in tissue compatibility between the donor and recipient

Among the potential issues are:

Infections: Severe suppression of the bone marrow, which occurs when the bone marrow produces insufficient blood cells, increases the risk of infections. Drugs are frequently administered to treat and prevent infections.
Low levels of platelets (thrombocytopenia) and red blood cells (anaemia): can be dangerous and even fatal. The majority of kids will require numerous transfusions of blood products.
Pain: Chemotherapy and radiation frequently result in mouth sores and gastrointestinal (GI) irritation. Oral hygiene and painkillers can be beneficial.
Vomiting, nausea, and diarrhoea: Chemotherapy, radiation, and GI irritation can cause these. IV (intravenous) feedings of calories and protein may be administered until your child can resume eating and the diarrhoea has stopped.
Excess fluid: This usually happens when the kidneys are unable to process the high volume of IV fluids being administered: We will be closely monitoring the child for fluid overload. He or she will undergo frequent blood tests, weigh-ins, and urine measurements. Medication may be administered to support renal function and reduce fluid retention.
Breathing issues: Bleeding, graft-versus-host disease, airway inflammation, infection, and fluid overload can all lead to serious lung issues. Until issues are resolved, children might require extra oxygen to breathe more comfortably.
Organ damage: Damage to the liver and heart that is either short-term (temporary) or long-term (permanent) can be brought on by infection, graft-versus-host disease, radiation and chemotherapy, or fluid overload. We will closely monitor the child’s vital signs and blood to check for any signs of organ damage.
Graft failure: In the marrow, the transplanted cells (graft) might not proliferate. This could result from an infection, the illness resurfacing, or an abnormally low number of stem cells in the donated bone marrow. An additional bone marrow transplant may be used to treat graft failure.
GVHD, or graft-versus-host disease: GVHD has the potential to be fatal. It takes place when the recipient’s healthy cells are attacked by the immune cells of the donor. Doctors closely monitor the child for GVHD. Diarrhoea, fever, rash, skin changes, stomach pain, dyspnoea, and impaired liver function are some of the symptoms. To lower this risk, the child will receive medication before the transplant.

A bone marrow transplant is a significant and intricate procedure. A small number of patients who have not responded to other treatments are advised to have the procedure because of the risks and complications that come with it.

The prognosis and long-term survival after a bone marrow transplant can differ significantly from person to person, just like with any surgery. The results of bone marrow transplants in children and adults have significantly improved due to current medical advancements and the growing number of transplants performed for various diseases. After a bone marrow transplant, the patient needs ongoing follow-up care.

There is constant research into new ways to enhance care and lessen side effects and complications following a bone marrow transplant.

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