Bone Marrow Transplant Clinic / Adult

Advanced Technologically Equipped Laboratories

In the Apheresis Unit and Stem Cell Freezing – Processing Unit within the Bone Marrow Transplant Clinic, operations are carried out with advanced technological devices. High molecular level HLA typing can be performed with the Flow Cytometry Laboratory and the HLA Tissue Group Laboratory. At the same time, we work in cooperation with the Yeditepe University Genetic Diagnosis Center. The data obtained are decisive at many points, from the correct diagnosis of the patient to the roadmap for treatment and determining the response of the patient to treatment.

In the Bone Marrow Transplant Clinic Stem Cell Freezing and Stem Cell Processing Unit, there are nitrogen tanks, including an automatic freezing unit, a quarantine and a main tank. Stem cells can be stored in these tanks for 20 years without any loss of tissue.

Bone Marrow Transplant Polyclinic

Follow-up of patients who come to the clinic for treatment is carried out in the bone marrow transplant clinic.

General physical evaluation of the patients; Treatment records, imaging and pathology reports are made in the light of laboratory results. Transplant decision is made after the evaluations.

The fact that the polyclinic is located within the center minimizes the contact of patients with other patients and ensures that there is no waste of time.

Inpatient Department

The treatment of patients who have started the transplant process is carried out in a special department created according to international standards. In order to avoid the risk of infection, hepa-filter systems are installed in all areas from patient rooms to corridors. In this way, particles in the air can also be cleaned. Thanks to the special molecule developed in Yeditepe University Laboratories, patented and a first in the world, “zero spread of hospital infection” is aimed.

Each single room has been designed with the comfort of the patients in mind. The rooms can be entered after the necessary disinfection is provided. It is aimed to support the general psychology of the patients in the scenic rooms that have the necessary infrastructure to make them feel comfortable and safe during the treatment. Each of the specially designed beds can be converted into an emergency response unit if needed.

Patients are kept under close follow-up at all stages of their treatment, before and after transplantation. Following their discharge, they continue to be followed by social support teams.

Hematopoietic stem cells are cells that are found in bone marrow, peripheral blood and umbilical cord blood and have the capacity to renew themselves and transform into different cells. These cells are blood cells that can turn into red blood cells (erythrocytes), white blood cells (leukocytes) and platelets.

• Red blood cells (erythrocytes) carry oxygen to the organs.
• White blood cells (leukocytes) are involved in fighting infection.
• Platelets are involved in the control of bleeding.

Some drugs (such as growth factors) are given to patients in autologous transplantation and to donors in allogeneic transplantation. In this way, stem cells in the bone marrow are directed to the surrounding blood. Subsequently, stem cells that have entered the peripheral blood are collected by a special device. This process is called “stem cell apheresis” or “harvest”. The collected hematopoietic stem cells are mostly stored after some procedures and frozen under appropriate conditions. It is melted on the day of transplant and transferred to the patient. In allogeneic transplant, the stem cells collected are sometimes transplanted to the patient without being processed and frozen.

Stem cells are transplanted to the patient from peripheral blood (through a vein) in both conditions. With hematopoietic stem cell transplantation, unhealthy blood-producing cells are replaced with healthy ones. These transplanted cells also begin to produce healthy erythrocytes, leukocytes and platelets.

What is Autologous Transplant?

The patient’s own stem cells are used for transplantation. It is a frequently used treatment option in patients diagnosed with lymphoma and multiple myeloma. At which stage of the treatment stem cells will be collected from the patient constitutes an important point. The low (<3%) rate of transplant related mortality (loss of life) is its most important advantage. Since there is a possibility that diseased stem cells may interfere with the stem cells collected from the patient himself, the disease may recur after transplantation. In order to reduce the risk of graft versus tumors, reinforcement and / or maintenance treatments can be applied to patients after transplantation.

What is Allogeneic Transport?

It is typically used to treat patients with bone marrow disorders such as leukemia, aplastic anemia, and myelodysplastic syndromes. In this process; First of all, the diseased bone marrow is removed with chemotherapy and / or radiotherapy called preparation regimen. Then, the bone marrow of a healthy donor is replaced with stem cells collected from peripheral blood or umbilical cord blood.

What is Haploidentic Transplantation?

Transplant with partial HLA (human leukocyte antigen) incompatibility between the recipient and the donor and from the first degree relative (sibling, child or parents) is called “haploidentic transplant” or “partial HLA incompatible” transplant. At least 50 percent compliance is sufficient to be a candidate for donor. With this type of transplantation, almost every transplant candidate can find a potential donor of the patient.

What is Syngenic Transplantation?

It is similar to allogeneic transplant. The difference is that the donor is an identical twin of the patient. Since identical twins have the same genes, they have the same HLA sequences. It is a rare type of transplantation. There is no “graft versus host” and “graft versus tumor” effect. It is preferred in the treatment of benign diseases rather than malignant diseases.

Autologous Transplant Diseases Possible Diseases

• Multiple Myeloma
• Plasma Cell Leukemia
• Non-Hodgkin Lymphoma
• Hodking’s lymphoma.
• Acute myeloid leukemia
• Neuroblastoma
• Germ cell Tumors
• Ovarian Cancer

Other Diseases

• Autoimmune diseases
• Primary Amyloidosis

Diseases Where Allogeneic Transplantation Can Be Used;

• Acute myeloid leukemia
• Acute Lymphoblastic Leukemia
• Chronic Myeloid Leukemia
• Myeloproliferative Diseases
• Non-Hodgkin Lymphoma
• Hodking’s lymphoma.
• Multiple Myeloma
• Plasma Cell Leukemia
• Chronic Lymphocytic Leukemia

Other Diseases

• Aplastic anemia
• Thalassaemia major
• Sickle Cell Anemia
• Paroxysmal Nocturnal Hemoglobinuria
• Fanconi Anemia
• Severe Combined Immunodeficiency

Some drugs (such as growth factors) are given to patients in autologous transplantation and to donors in allogeneic transplantation. In this way, stem cells in the bone marrow are directed to the surrounding blood. Subsequently, stem cells that have entered the peripheral blood are collected by a special device. This process is called “stem cell apheresis” or “harvest”. The collected hematopoietic stem cells are mostly stored after some procedures and frozen under appropriate conditions. It is melted on the day of transplant and transferred to the patient. In allogeneic transplant, the stem cells collected are sometimes transplanted to the patient without being processed and frozen.
Stem cells are transplanted to the patient from peripheral blood (through a vein) in both conditions. With hematopoietic stem cell transplantation, unhealthy blood-producing cells are replaced with healthy ones. These transplanted cells also begin to produce healthy erythrocytes, leukocytes and platelets.

Transplant patients undergo a series of training during their discharge. Although the details vary according to the type of transplant performed, during these trainings; Patients are informed about diet, protection from infections and some possible complications. The patients are told about the medicines they will continue to use at home.

Patient Applying from Turkey and Abroad
Patients who are candidates for transplant are required to submit all their treatment records, laboratory examinations, imaging examination reports, pathology reports to the Bone Marrow Transplantation Unit. Detailed histories of transplant patients and donor candidates are taken and physical examinations are performed. Thanks to the examinations, the disease status and organ functions are analyzed. The decision to transplant is made by considering the benefit of bone marrow transplant treatment to the patient, as a result of the comprehensive examination by the Transplant Council within the hospital.

How Long Does a Bone Marrow Transplant Take?
Before stem cell transplantation, a treatment called “preparation regimen” is applied to the patients. This treatment includes chemotherapy +/- radiotherapy. It takes an average of 1 week. After the transplanted stem cells enter the circulation, they enter the bone marrow and settle. Blood production of these cells usually occur within 2 to 4 weeks after transplantation.

What Happens After Bone Marrow Transplantation, What Are the Risks?
Depending on the severity of the pre-transplant preparation regimen, nausea, vomiting, diarrhea, constipation, anorexia, weakness and mouth sores may develop in varying degrees and severity. Blood and blood products are needed until the transplanted stem cells settle in the recipient’s bone marrow and produce new blood cells.
In autologous transplant; There is a risk of recurrence of the disease after the transplantation, as there is a possibility that diseased stem cells may interfere with the stem cells collected from the patient himself.
In allogeneic transplant; The immune systems of the recipient and donor may not be compatible. Therefore, the new immune system developed by the transplanted stem cells may see the recipient’s organs as foreign and react. Damage to the recipient’s liver, skin, bone marrow, and intestines can occur. This complication, defined as graft versus host, can occur in approximately 50 percent of the patients, at varying rates and severity. In this case, the patient is treated. However, in severe cases, organ failure may occur this time as organ damage occurs.

How Are Stem Cells Obtained From The Donor?
In peripheral blood (peripheral) stem cell donation, after vaccine administration; temporary weakness, fever, temporary flu-like symptoms, general body and bone aches, and a feeling of fullness in the spleen can be seen. Side effects usually end within a few days after the last dose of the drug. During apheresis, the person may feel weakness, chills, fainting, numbness in the lips and cramps in the hands. Unlike bone marrow donation, peripheral blood stem cell donation does not require anesthesia.
However, for people whose peripheral vascular ways are not suitable for the procedure, a central venous catheter (a flexible tube inserted into a large vein in the neck, chest or groin area) may need to be temporarily inserted.

Are There Any Harm in Bone Marrow Donation?
There is no need for vaccination in bone marrow stem cell donation. Generally, sufficient number of stem cells are obtained at one time. In this type of donation, unlike surrounding blood stem cell donation, general anesthesia that puts the person asleep under operating room conditions or local anesthesia that causes loss of sensation under the waist is given. The procedure takes about an hour on average. There is no incision that requires stitches. The donor is usually discharged the next day after blood tests are done. Pain can occur in the hip area for up to 1 week, and temporary sore throat and headache may be observed due to anesthesia. Since stem cells have the ability to constantly renew themselves, the donor’s stem cells reach their previous number in a certain time after the donation process.

Who Can Donate Bone Marrow?
People between the ages of 18-55, who are healthy, who have not had Hepatitis B, Hepatitis C and Syphilis disease, who do not have chronic diseases, who have not been diagnosed with cancer or HIV (AIDS) can donate bone marrow.