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Despite the best efforts and the support by the medical teams and the family and friends, sometimes the Bone marrow transplants do not work. This could be because the donor cells are not accepted by the body, resulting in the original problem coming back and resulting in a Graft Vs Host disease. 

The medical team monitors the patient closely to address any problems as soon as they start. There are other treatment options that are available when a transplant fails. The bone marrow transplant cost in India largely depends on the length of the hospital stay required during recovery.

During this time, a number of factors can impact the success of a bone marrow transplant, including – 

  • Graft failure 
  • Relapse 
  • Treatment options 
  • Palliative care 
  • Getting support 
  • Coping with loss

Graft failure 

After your transplant, the patient’s own immune cells react to the donor’s cells and start to attack them because they see them as different. In some cases, it is also possible that the donor’s cells don’t develop, and they face a problem in the engraftment. 

These problems result in graft failure. The hospital team monitors the chimerism levels, which measures how much of the donor’s cells have engrafted. This measures how many cells have engrafted in the patient’s body, i.e. how many of your blood cells are being produced by your donor’s stem cells. 

A large level of chimerism might mean that the donor cells failed to engraft, and the patient might need a DLI. 

Relapse 

If blood cancer or blood disorder returns, it’s called relapse. The risk of relapse is highest in the early stages but reduces after about two years. Usually, the condition comes back in the first few years, but it can be possible that the original condition might come back after a lot of years also. 

The medical team checks for signs of relapse at the time of check-ups. This is done using a bone marrow test, where a sample is taken and analyzed or by scanning your body with a CT or PET scan.

It is a good sign to be aware of any changes that are happening to the body or new symptoms and to notify the team so that they can be checked out. 

Treatment options 

The next stage in your treatment depends on a number of factors including the type of transplant that was done, the original condition, age, general health, and how well the person copes with the first transplant.

There are the following options available for most of the patients – 

  • Chemotherapy –  Chemotherapy is usually given to remove the cells that cause the blood cancer to return. It might be given along with other treatments, or could be given to condition the body before the person is prepared for the second transplant. 
  • Donor Lymphocyte Infusion (DLI) – This is the option when the disease has returned. A DLI is given to achieve a graft versus leukemia effect, where the donor cells might attack the cancer cells. GvL often happens with GvHD, and so the patients are at a greater risk of developing GVHD after a DLI.

There can be a number of places where a DLI can be given – 

  • If the patient has relapsed, they might have to DLI at the same time as chemotherapy. This might give them a better chance at survival, and most chances of the acceptance of the graft.
  • There are a large number of cells in your DLI. This gives a better chance of succeeding but makes the person at a higher risk of GvHD. The medical team makes a decision on behalf of the patient in deciding what is the best line of treatment for survival. 
  • Second transplant – This is the option when the patient has experienced a graft failure or rejection, or for a few patients who might have relapsed. The same donor might also be used again from the first transplant. This can be done in some cases, but chemotherapy is done with different drugs. 
  • Clinical trials –  Clinical trials are one type of medical research study that is done to try new types of treatment. Each trial is based on hospitals throughout the country and will include certain patients based on their condition and previous treatments. 

Palliative care 

In some cases, people are not able to get curative treatment. The risk involved is way too high, or there are some other factors that prevent them from getting a transplant. In such cases, supportive treatment is the choice and preference. It is important for the patient to understand that there are still plenty of options available. This can be particularly while providing a better quality of life. Palliative care is not only provided when a person cannot undergo a  transplant. It can be given at any stage of the treatment. The palliative treatment can continue for months or years. During these times, the patients might undergo transfusions or antibiotics to fight off infections.

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