THOUGH Malaysia’s first paediatric and adult bone marrow transplants (BMT) took place in 1987 and 1993 respectively, most patients in the 1990s had to travel abroad to undergo such a procedure.
Today, BMT is available in more than 10 transplant centres across Malaysia, with overall advancements yielding favourable results.
BMT involves replacing and rescuing damaged stem cells (also known as ‘mother cells’) found in the bone marrow. The process is similar to that of blood transfusion, where blood rich in ‘mother cells’ is provided to the patient.
Once in the bloodstream, these stem cells eventually find their way into the injured marrow via natural homing receptors. These cells will then begin producing fresh blood cells upon assimilating into the injured bone marrow in a process known as engraftment.
Dr Alan Teh shares that there have been many advancements in the areas of BMT, including better antibiotics, transfusion and nutritional support, and new conditioning regimens.
BMT is often performed to treat disorders such as myeloid leukaemia, lymphomas, myelomas and myelodysplastic syndromes.
Consultant haematologist at Subang Jaya Medical Centre Dr Alan Teh Kee Hean shares there has been many advancements in the areas of BMT, including better antibiotics, transfusion and nutritional support, and new conditioning regimens. All these advances have led to lower mortality rates among patients.
“In the early years of transplantation, stem cells were taken directly from the bone marrow, which involved a few hundred punctures in the pelvic bone to harvest roughly 1L of bone marrow blood. It is painful for the donor or patient and usually requires a general anaesthetic.
“More recently, BMT uses peripheral blood stem cells instead. This involves mobilisation of the stem cells via growth factors, which expands the marrow and causes extra stem cells to come out into the blood circulation before being collected by an apheresis machine for future transplants,” Dr Teh shares.
Dr Teh further explains two types of BMT:
Looking to the future
The options for allogeneic bone marrow transplants have expanded with the combination of the classic sibling matched donors as well as the availability of matched unrelated (volunteer donor) donor transplants, haploidentical doctors (or half-match donors) and cord blood cell transplants.
As the popularity of the above advancements grows in Malaysia, Dr Teh is hopeful for a larger pool in the existing public cord blood bank and local donor registry.
“The probability of a match is often correlated with one’s ethnicity. For example, someone who is Malay is very unlikely to find a match in a Caucasian or Taiwanese database. Having the majority ethnic group of Malaysia left unrepresented in Asian databases is a major issue. We need a much bigger pool, which requires the organisation of logistics, greater funding, and raising public awareness to get donors.”
Dr Teh adds that many factors have driven down the rate of transplant-related death, such as given the impressive milestones in BMT development such as reduced toxicity transplants and haploidentical transplants over the years. Even though SJMC has already performed 800 BMT cases to date, he is optimistic for more improvements to be introduced in Malaysia that encompass all aspects of the procedure – from supportive care to screening and medicine.
For more information, call 03-5639 1212.
