Bone marrow transplant today is much safer than it was a few years ago. We now have better ways to find matching donors, says Dr G Vijay, Hemato Oncologist, VS Hospitals, in an interview with Sinduja Jane. Edited excerpts:
What are the latest advances in bone marrow transplant (BMT)?
Earlier, patients had to wait for a perfectly matched donor, like finding a key that fits a lock exactly. Now, with haploidentical transplants (half-matched donors), a parent, child or sibling can be the donor. This has been a game-changer in India, where full matches are rare. We also have more precise HLA typing (compatibility testing) to reduce rejection risk, and gentler conditioning treatments to prepare the body, especially helpful for children and older patients. A major advance is preventing graft-versus-host disease (GVHD), where the new donor cells see your body as ‘foreign’ and attack it. Today, special medicines can ‘teach’ these cells to live in harmony with one’s body.
What is the current research direction in BMT?
Research is moving towards making BMT safer, faster, and more widely available. One breakthrough is gene therapy, instead of replacing bone marrow, we can correct faulty genes in the patient’s own stem cells. This is showing promise in thalassemia and sickle cell disease. In cancer care, CAR-T cell therapy is making headlines. Sometimes this is used alongside BMT for better results. Reduced-intensity conditioning is another innovation, allowing older or medically fragile patients to have BMT with fewer side effects.
Has any progress been made in India towards research in BMT?
India has made remarkable progress in BMT over the last decade. One of our biggest achievements is mastering haploidentical transplants at much lower cost compared to Western countries, but with similar success rates. Given that only 25–30% of Indian patients find a fully matched sibling donor, this has been life-changing. Indian research also focuses on faster, cost-effective infection detection, because early treatment in the first few weeks post-transplant can save lives. Nutrition is another area where we have developed tailored diet plans to improve immunity in patients who may be malnourished before transplant. We’re building large donor registries and spreading awareness about stem cell donation to expand our options for patients.
Who is eligible for BMT and when is it required?
BMT is used when the bone marrow is producing harmful cells or has stopped working. This includes blood cancers, aplastic anaemia, and genetic disorders.
There are two types of transplants: autologous and allogeneic. In autologous, the patient’s own healthy stem cells are collected, stored, and given back after treatment. In allogeneic, stem cells are taken from a donor, either a full match or a half match.
Timing is key. In some cancers, early BMT offers the best cure rates; in others, we wait until other treatments have failed.
What are the precautions needed to be taken after a bone marrow transplant?
The first year after BMT is like caring for a newborn, the immune system is brand new and needs protection. In hospitals, patients stay 3–6 weeks in a protective room until the new marrow starts producing healthy blood cells, called engraftment. At home, hygiene is crucial: boiled or filtered water, freshly cooked food, avoiding crowds, and regular handwashing. Medicines to prevent rejection and infections must be taken exactly as prescribed. Follow-up visits are essential. Physical strength returns slowly, and most patients can resume work, school, or normal activities in 6–12 months. Emotional recovery is equally important, and counselling helps.
What should patients or parents know before going for BMT?
BMT is a life-saving treatment, but it requires preparation. One needs to understand the steps: finding a donor, pre-transplant treatment to prepare the body, infusing healthy stem cells, and recovery. Financial planning is important as costs include treatment, medicines, and follow-up. Most importantly, choose a hospital with an experienced team and strong infection control.