Koru Hospital Bone Marrow Transplantation Center is one of the leading transplantation centers in Ankara, performing autologous and allogeneic stem cell transplantation applications for the treatment of hematological diseases in accordance with international standards. Our center offers a holistic treatment approach covering the entire process from the diagnostic stage to long-term post-transplant follow-up.
What is Bone Marrow Transplantation?
Bone marrow transplantation (hematopoietic stem cell transplantation) is the procedure of replacing diseased or damaged bone marrow with healthy stem cells. This treatment method is applied in cases where the bone marrow cannot produce sufficient blood cells or to reconstruct the hematopoietic system after high-dose chemotherapy. Stem cells can be obtained from bone marrow, peripheral blood, or umbilical cord blood.
Autologous (Self) Bone Marrow Transplantation
Autologous transplantation is the process of collecting the patient's own stem cells and reinfusing them after high-dose chemotherapy. In this method, there is no risk of tissue incompatibility, and graft-versus-host disease (GvHD) does not occur. Autologous transplantation is particularly preferred in the following cases:
- Transplantation for consolidation in the treatment of multiple myeloma
- Salvage therapy after relapse in Hodgkin and Non-Hodgkin lymphoma patients
- High-dose chemotherapy support in certain solid tumors
- Application for immune system resetting in autoimmune diseases
In autologous transplantation, the stem cell collection process is performed from peripheral blood via an apheresis device. The collected stem cells are cryopreserved and stored in a -196°C liquid nitrogen environment until the day of transplantation.
Allogeneic (Donor) Bone Marrow Transplantation
Allogeneic transplantation is the transfer of stem cells from an HLA tissue-type compatible donor to the patient. This method has a wider range of indications compared to autologous transplantation and provides more effective results in some diseases due to the graft-versus-tumor effect.
- Treatment of acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL)
- Chronic myeloid leukemia (CML) and myelodysplastic syndrome (MDS)
- Aplastic anemia and congenital bone marrow failure syndromes
- Hemoglobinopathies such as thalassemia major and sickle cell anemia
- Severe combined immunodeficiency (SCID) and other primary immunodeficiencies
Donor selection is of critical importance in allogeneic transplantation. While a fully matched sibling donor is the ideal option, haploidentical transplantation (half-matched family donor) and matched unrelated donor transplantations are also successfully performed at our center.
Pre-Transplant Evaluation and Preparation
Bone marrow transplantation requires a comprehensive preparation process. Pre-transplant evaluation at our center includes the following stages:
- Hematological and genetic examination: Complete blood count, peripheral smear, bone marrow biopsy, cytogenetic analysis, and molecular tests
- HLA tissue typing: Donor compatibility analysis with high-resolution tissue typing
- Organ function tests: Cardiac ejection fraction, pulmonary function tests, liver and kidney function assessment
- Infection screening: CMV, EBV, hepatitis panel, HIV, toxoplasma, and other serological tests
- Psychological evaluation: Detailed information for the patient and family, psychosocial support planning
Conditioning Regimens
The conditioning regimen applied before transplantation is determined according to the type of disease and the patient's general condition. Our center applies myeloablative (full bone marrow suppressive), reduced-intensity (RIC), and non-myeloablative protocols. The choice of conditioning regimen is decided by a multidisciplinary team, taking into account the patient's age, comorbidities, disease risk, and donor type.
Transplantation Process and Isolation Protocol
Koru Hospital Bone Marrow Transplantation Center is equipped with HEPA-filtered positive pressure isolation rooms. During the transplantation process, patients become extremely susceptible to infections because their immune system is suppressed. Therefore:
- Rooms provide continuously filtered air with a laminar airflow system
- A neutropenic diet program is implemented under the supervision of a dietitian
- Antiviral, antifungal, and antibacterial treatments are included in the protocol for infection prophylaxis
- Engraftment follow-up is monitored with daily blood counts
- Platelet and erythrocyte transfusion needs are evaluated instantly
Following stem cell infusion, engraftment (the transplanted stem cells taking hold and beginning to produce blood) usually occurs within 10-21 days. During this period, the patient is monitored 24/7 under the supervision of a hematology specialist and a transplant nurse.
Post-Transplant Complication Management
The success of bone marrow transplantation is directly related to the effective management of post-transplant complications. Standard treatment protocols are applied at our center for common complications:
Graft-Versus-Host Disease (GvHD)
GvHD, the most significant complication of allogeneic transplants, develops as a result of donor-derived immune cells attacking the recipient's tissues. While acute GvHD usually affects the skin, liver, and gastrointestinal system within the first 100 days, chronic GvHD appears in the later period and can involve many organ systems. Treatment involves calcineurin inhibitors, corticosteroids, and extracorporeal photopheresis (ECP) when necessary.
Infection Management
During the immunosuppressive period, bacterial, viral, and fungal infections are a serious source of morbidity. Our center performs regular CMV and EBV viral load monitoring, and invasive fungal infection surveillance with galactomannan and beta-D-glucan tests. Interventions are made before clinical infection develops through a preemptive treatment strategy.
Veno-Occlusive Disease (VOD/SOS)
Hepatic sinusoidal obstruction syndrome is a serious complication that occurs as a result of the blockage of liver vessels after transplantation. Effective management is provided through early diagnosis and defibrotide treatment.
Stem Cell Sources and Banking
Our center performs transplantations using different stem cell sources:
- Peripheral blood stem cells: Collection via apheresis after G-CSF mobilization (the most frequently used method)
- Bone marrow aspiration: Stem cell harvesting from the iliac crest under surgical conditions
- Umbilical cord blood: An alternative source in cases where a suitable donor cannot be found
Collected stem cells undergo quality control by performing CD34+ cell counting via flow cytometry. The cryopreservation process is carried out with solutions containing DMSO (dimethyl sulfoxide), and cells are processed in a controlled-rate freezer.
Multidisciplinary Team Approach
Bone marrow transplantation is a complex process that requires the coordination of a large team, not just a single physician. Our transplant team consists of the following specialists:
- Hematology specialists and transplant coordinators
- Infectious diseases specialists
- Intensive care team
- Transplant-certified nursing team
- Clinical dietitian and physiotherapist
- Psychologist and social worker
- Transfusion medicine and apheresis team
Long-Term Post-Transplant Follow-up
Patient follow-up continues for years after bone marrow transplantation. The long-term follow-up program implemented at our center includes:
- Regular bone marrow biopsy and minimal residual disease (MRD) assessment
- Immune system recovery monitoring and vaccination program
- Endocrine function monitoring (thyroid, gonadal functions, bone density)
- Chronic GvHD screening and treatment optimization
- Secondary malignancy surveillance
- Quality of life assessment and psychosocial support
Within the Koru Hospital Bone Marrow Transplantation Center, we provide our patients with treatment at international standards by applying the most current transplant protocols in the fight against hematological diseases with our expert staff.