Bone marrow transplantation in Turkey — ricevi 3 opzioni di cliniche personalizzate

Why is Turkey a worthy country to undergo a bone marrow transplant?

Bone marrow transplantation in Turkey is a widespread surgery in medical practice. BMT replaces damaged or diseased bone marrow with healthy bone marrow because it produces a few blood cells that are insufficient for immunity. BMT can treat tumor cancers, immune and blood disorders.

It’s performed by a highly specialized team of healthcare providers, including surgeons, anesthesiologists, nurses, general practitioners, and psychologists in specialized medical institutions.

We can prove the reputation and high expertise of Turkish clinics and doctors with the following information:

• Clinics possess accreditations and are connected with international registries of bone marrow donors.

• Hospitals affiliate with world medical institutions like Johns Hopkins Hospital, providing American treatment standards. They have access to the European Bone Marrow Donor Bank, the world's largest bank.

• Surgeons use innovative methods to treat oncological and hematological diseases: peripheral blood stem cells, matched siblings, and haploidentical transplants.

• Performing operations according to American treatment protocols.

• Surgeons have undergone international practice in leading countries in cancer treatment, such as the USA, Canada, and Israel. They are board-certified doctors in Medical Oncology and Hematology and members of multiple professional societies in hematology and oncology.

The reason for such a high level of medical industry in Turkey is the adoption of comprehensive laws to better protect its international medical tourism and support its growth since 2017. Moreover, transplantation procedures are constantly evolving in Turkey using new transplantation technologies, such as T-cell depletion and new drugs that promote transplantation results.

What are the types and prices for bone marrow transplant in Turkey?

As in European clinics, Turkish hospitals specialize in all existing types of bone marrow transplantations:

1. Autologous BMT of a patient’s own normal stem cells, which are extracted from the patient’s bone marrow and injected into the patient during a particular period of the disease. They may be received during remission or chemotherapy to maintain and restore hematopoiesis and the immune system.

2. Allogeneic BMT of healthy bone marrow from related or unrelated donors to the recipient. Depending on the donor, this type of operation can be divided into three procedures:

• syngeneic transplant - from a fully compatible related donor, with a separate transplant from an identical twin;

• haploidentical transplant - from a partially compatible related donor;

• from a fully compatible unrelated donor.

With the same achievement methods, the price for stem cell transplantation in Turkey is half less than in many medical centers in Western Europe. The average cost of bone marrow transplantation in Turkey ranges from $32,500 to $75000.

The price of autologous transplantation is, on average, $32,000, and the cost of allogeneic bone marrow transplantation in Turkey starts from $ 65,000 (from a related donor) and $75,000 (known as a haploidentical transplant from an unrelated donor). Meanwhile, the prices of HSCT stem cell treatment in Germany are much higher – up to 50%. The cost can range from $100,000 to $300,000.

Bone marrow transplant cost can depend on:

• diagnosis (including stages);

• the general health of the patient;

• type of transplant – own or donor cells;

• the need to find a donor; 

• selected medical institution.

What is included in the bone marrow transplantation package in Turkey?

A standard BMT package in Turkey includes the surgical procedure itself, pre- and post-operative hospitalization, all necessary medical tests, after-op treatments, and additional services like accommodation, transportation to and from the clinic, and translation services.

• A patient will get a thorough medical examination, namely blood tests, to assess the patient's condition.

• Choosing a donor: finding a compatible donor and preparing them for stem cell gathering.

• Chemotherapy: chemotherapy is performed before the transplant to suppress the patient's immune system and prepare the body for new donor cells.

• Stem cell infusion: healthy stem cells are infused into the patient's bloodstream.

• Post-op treatment: monitoring complications and potential side effects.

• Hotel stay: accommodation for the period of clinic stay.

• Transport: airport transfers to and from the clinic.

• Translation services.

How is bone marrow transplantation performed in Turkish clinics?

Autologous stem cell transplantation in Turkey is performed surgically by injections through the veins (venous infusion) or direct bone marrow infusion. The procedure involves the following steps:

• Collecting stem cells from a patient’s bone marrow under general anesthesia. It’s done by puncturing the iliac bone or the sternum after its stimulation with drugs to release the cells into the blood.

• Examining the material to exclude the abnormal cells.

• Purified isolated stem cells are frozen until transplantation.

• Injecting the patient’s stem cells into the body (mainly in the large bone medullary cavity, i.e., pelvic or chest bones.

• The process of stem cells distribution into the bloodstream. The regeneration process begins.

Allogeneic stem cell transplantation is a complex process involving many stages. It includes:

• Donor selection is one of the most important stages that defines the transplantation results. The donor can be a relative or a stranger from the national Turkish or international registry. Remember that in Turkey, it is possible to get donor material from the International Cord Blood and Bone Marrow Bank.

• Patient vs. donor compatibility tests that last for 4-5 days.

• Collecting stem cells from the donor’s peripheral blood within two days. The obtained cells are processed and frozen until transplanted to the patient.

• Preparing for cell transplantation from a suitable donor is known as a conditioning treatment regimen. Here, destroying all remaining malignant cells and suppressing the patient’s immune system to engraft the donor stem cells is vital.

• Chemotherapy, according to a specific international protocol, is administered for 6 days on average.

• Administration of donor stem cells one day after chemotherapy via slow infusion over 2 hours.

What is the success rate of bone marrow transplantation in Turkey?

90% of successful stem cell transplant operations were documented in Turkey, meaning 90 out of 100 patients don't reject the implanted cells. Turkey is famous for its one of the lowest rates of medical errors and post-op complications in Europe. Patients are treated by doctors of the highest category.

When choosing a clinic, we recommend you pay attention to:

• transplant success rate;

• doctors' experience and certificates;

• access to the donor banks;

• equipment used in the medical centers.

The statistics of stem cell transplant procedures in specific medical centers in Turkey for 2021 say that 248 autologous transplants and 133 BMTs from a fully compatible related donor were performed. 36 haploidentical bone marrow transplants and 95 bone marrow transplants from unrelated donors were also performed successfully. Children mainly had allogeneic transplants from related donors - 253 and from unrelated donors -153.

How long does bone marrow transplantation hospitalization and recovery last?

It needs to be mentioned that Turkish surgeons adhere to international protocols during bone marrow transplantation.

The recovery period after an autologous bone marrow transplantation can be divided into the following stages:

• 2 to 3 weeks of a hospital stay after the transplantation to monitor the health state;

• few weeks of post-transplantation to mitigate possible complications and fight side effects;

• 1 to 3 months is for after-operation medical appointments. It can take even from 6 to 12 months for a full recovery.

With the allogeneic BMT, the hospitalization period can take more days and months than with an autologous procedure:

• Finding a suitable donor;

• Making compatibility tests within 4-5 days;

• Stem cell collection from the donor can take several sessions and around 2 days. The maximum period a donor should stay in the country is 10 days.

• The preparation period for a patient for BMT is 7 days in the case of related donors and 9 days for unrelated donors.

• The chemotherapy takes around six days.

• 1 day is needed to administer donor stem cells.

• The recovery process begins with the patient's complete suppression of their own bone marrow. This state is accompanied by full or low content of red blood cells, leukocytes, and platelets in the blood. This period may take, on average, 3 weeks.

• Full rehabilitation takes from 3 to 12 months. The transplantation is considered to be successful if there are no complications after 100 days from the procedure.

During the postoperative period, life-threatening complications can occur. So, a patient should stay under the doctor's supervision. Moreover, a patient is kept in a special sterile box and lives in sterile conditions to avoid infections.

Usually, it takes 2-3 months from the day of hospitalization in a clinic to the day of return to your country. This period may become longer if severe infectious complications happen or blood indications are bad. 

What are the complications and risks of bone marrow transplant?

Generally, patients become very susceptible to infections after the stem cell infusion. Even during the procedure itself, they may feel pain, chills, and fever. Therefore, it's necessary to spend some time in the clinic under the guidance of doctors to mitigate possible complications.

After the operation, a patient can experience excessive bleeding and take different medications to prevent graft-versus-host disease (in case the transplant was allogeneic). The study indicated that younger donors (aged 18-32 years, HLA matched to recipients) may lower the incidence of GVHD and improve survival after bone marrow transplantation.

Besides these symptoms, nausea, vomiting, diarrhea, mouth sores, and extreme weakness may occur, and a patient can be mentally and psychologically unstable. There's an increased risk of the following conditions after a BMT operation:

• Infections. Viral and fungal infections can be life-threatening. Any infection can cause an extended hospital stay, prevent or delay engraftment, and/or cause permanent organ damage. Antibiotics and antifungal medicines are often given to prevent severe infection in the immunosuppressed patient.

• Low platelets and low red blood cells. Thrombocytopenia (low platelets) and anemia (low red blood cells), resulting from nonfunctioning bone marrow, can be dangerous and even life-threatening.

• Pain. Pain related to mouth sores and gastrointestinal (GI) irritation can occur. High doses of chemotherapy can cause severe mucositis (inflammation of the mouth and GI tract).

• Fluid overload can lead to pneumonia, liver damage, and high blood pressure. The main reason for fluid overload is because the kidneys cannot keep up with a large amount of fluid.

• Respiratory distress. Infection, inflammation of the airway, fluid overload, graft-versus-host disease, and bleeding are all potential life-threatening complications that may happen in the lungs and pulmonary system.

• Organ damage. Temporary or permanent damage to the liver and heart may be caused by infection, graft-versus-host disease, high doses of chemotherapy and radiation, or fluid overload.

• Graft failure. The graft (transplant) may fail because of infection, recurrent disease, or if the stem cell count of the donated marrow was insufficient to cause engraftment.

Graft-versus-host disease (GVHD) can be a severe and life-threatening complication. It occurs when the donor's immune system reacts against the patient's tissue. In GVHD, the new or transplanted immune system can attack the entire patient and all organs. This is because the new cells don't recognize the tissues and organs of the recipient's body as their own. The most common sites for GVHD are the GI tract, liver, skin, and lungs.

References

1. Fatma Savran Oguz, Ayse Erol, Cigdem Kekik Cinar. Blood and bone marrow donor registry of Istanbul medical faculty activity and experience in past 3 years. Cell Tissue Bank. 2021 Oct 16;23(3):483–488.

2. Cleaver SA, Warren P, Kern M. Donor work-up and transport of bone marrow-recommendations and requirements for a standardized practice throughout the world from the donor registries and quality assurance working groups of the World Marrow Donor Association. (WMDA) Bone Marrow Transplant. 1997;20:621–629.

3. Kollman C, Howe CW, Anasetti C. Donor characteristics as risk factors in recipients after transplantation of bone marrow from unrelated donors: the effect of donor age. Blood. 2001;98:2043–2051.

4. Richard Champlin. T-Cell Depletion to Prevent Graft-Versus-Host Disease After Bone Marrow Transplantation. Hematology/Oncology Clinics of North America, Volume 4, Issue 3, June 1990, Pages 687-698.