Adult BMT
by Prof. Yener Koç, M.D.

Bone marrow is the soft, spongy tissue inside your bones that makes blood-forming cells (blood stem cells). These cells turn into blood cells including:

  • White blood cells to fight infections.
  • Red blood cells to carry oxygen throughout the body.
  • Platelets to control bleeding.

Prof. Yener Koç, M.D.


A bone marrow transplant is a procedure to replace damaged or destroyed bone marrow with healthy bone marrow stem cells. The procedure involves collecting stem cells that are normally found in the bone marrow, processing them and transferring them back to the patient to replace unhealthy bone marrow. Patient may be the donor him/herself or another person. Engraftment of the stem cells happens when the donated cells make their way to the marrow and begin making new blood cells.

Bone marrow transplant has been used successfully to treat diseases such as leukemias, lymphomas, aplastic anemia, immune deficiency disorders, and some solid tumor cancers since 1968.

In depth a bone marrow transplant is generally used to:

  • In conditions such as leukemia, aplastic anemia, and sickle cell anemia, to replace diseased, nonfunctioning bone marrow with healthy functioning bone marrow
  • To regenerate a new immune system to fight existing or residual cancer that couldn’t be eliminated by the chemotherapy or radiation.
  • After high doses of chemotherapy or radiation therapy, to restore bone marrow’s normal function

What is “matching”?

Matching means typing human leukocyte antigen (HLA) tissue. The genetic makeup of a person’s immune system is determined by antigens on the surface of these special white blood cells. The more antigens match, the better the engraftment of donated marrow is, but amongst more than 100 HLA antigens a few major antigens is believed to determine whether a donor and recipient match. Although the role of all antigens in the process of a bone marrow transplant is still under investigation, remaining antigens are considered “minor”.

Types of Transplant

There are different types of bone marrow transplants depending on who the donor is. Most common methods are as follows:

  • Autologous bone marrow transplant: The donor is actually the patient him/herself. Stem cells are collected via process called bone marrow harvest or apheresis. After a special procedure it is given back to the patient. Another name of this procedure is rescue.
  • Allogeneic bone marrow transplant – Related:  Stem cells of a donor with same genetic type as the patient is used. Stem cells are taken by harvest or apheresis from this genetically matched donor and this donor usually becomes the brother or sister.
  • Allogeneic bone marrow transplant – Unrelated:  If the stem cells of relatives don’t match with the recipient, suitable stem cells from an unrelated donor that is obtained through national or international bone marrow banks is used.
  • Haploidentical bone marrow transplant: When the donor is one of the parents and at least half of the genetic material matches with the recipient, it becomes a haploid-identical match.

Treatment Period

There is generally a preparation period for the patient before the start of actual transplant procedure. The length of this period may vary a lot according to the condition of each patient. Your physician will determine and inform you about expected time.

Bone marrow transplant must be done in a hospital that has a special-isolated unit for transplantation. This special unit is required in order to avoid infections than would be fatal during the patient’s immune suppressed period. Patients generally stay in this unit in between 3 to 5 weeks.

Patient may continue to stay in a regular unit until the laboratory results reach levels that allow discharge, according to the type of transplant and the condition of the patient.

Complexity of The Treatment

This treatment is one of the most complex treatments! Not all hospitals can perform these treatments and in Turkey only the hospitals that have a special license can provide BMT services.  BMT units require special facility infrastructure that should be maintained regularly and be held under control with a quality assurance program.

Besides physical requirements, knowhow and experience of the Hematology team is crucially important. This is generally a fairly large team involving a group of Hematologists that work with special nurses and technicians dedicated to BMT department.

Prof. Yener Koç, M.D.

  • Medical School, Hacettepe University
  • Hematology & Oncology, New England Medical Center, USA
  • Physician of the Year Award, Boston University, 1995 and 1996
  • Inspector for (JACIE)- The Joint Accreditation Committee ISCT-Europe & EBMT European Society for Blood and Marrow Transplantation, since 2004
  • Listed in Who’s Who Science and Engineering Encyclopedia since 2016
  • 225 international articles published, h-index 27
  • Works in Medicana Hospital Group

Having 27 years of experience in his field, he has treated above 2.000 patients. Other than BMT, he treats blood cancers (leukemia), MDS (Myelodysplastic Syndrome), lymph node cancers and myeloma.

Prof. Koç states that in 75% of all leukemia cases BMT treatment is preferred and in only 25% of the cases with low risk, chemotherapy can be applied. He adds that the BMT decision is given by the Committee at which genetic factors are also a determining factor.

Before the year 2000 as Prof. Yener Koç underlines, the treatment was very repressive due to high dose chemotherapy, but after the year 2000 thanks to new protocols with mini BMT procedures, it became possible to provide less dense treatments. He mentions his patients’ reactions and says: “While I am at visit after the procedure, I ask about how they feel during the procedure. They generally say that it was much easier than they expected”.

He puts emphasis on the recovery period since the patients are totally defenseless against infections at the first 6 months following the procedure and expresses the importance of close follow-up of the patient at this period.

Nearly 1/3 of Prof. Koç’s patients have been foreign patients from all around the world for the last 10 years. He not only treats them in Turkey but also trains and leads foreign hospitals to develop BMT programs just like HTMC in Tbilisi, Georgia.

Prof. Koç is also the leading pioneer of Haploidentical Transplant in Turkey. This treatment saves lives since there is no or much less waiting time for donors. Therefore losses while searching for the match can be prevented.

Although being the newest type of transplant, the professor adapted the method into his practice and produced over 80 international articles regarding the haploidentical methods. The success rate of the haploidentical is now almost the same as allogenic. The rejection rate of the method has dropped below 3% and it also became possible to treat patients over 60 (if their health scan results permit) who were inoperable in the past.

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