Pediatrics

Pediatric BMT by
by Prof. Birol Baytan, M.D.

Bone marrow is the soft, spongy tissue inside your bones that makes blood-forming 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.
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Prof. Birol Baytan, M.D.

Pediatric Hematology

A bone marrow transplant is a procedure to replace child’s diseased 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. Child 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 child him/herself. Stem cells are collected via process called bone marrow harvest or apheresis. After a special procedure it is given back to the child.
  • Allogeneic bone marrow transplant – Related:  Stem cells of a donor with same genetic type as the child 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. This procedure is also known as MUD matched unrelate donor.
  • 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.
  • Umblical cord blood transplant: In this method, child’s umbilical cord is used to obtain stem cells. Umbilical cord origin cells grow into mature blood cells much effectively than cells collected from bone marrow. This procedure requires freezing of the cord until the time of transplant.

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 definitely among the most complex treatments because of 2 factors. First is the complicated nature of BMT procedure itself. Second factor is that all patients are children, so this requires physicians having a sub-specialization degree and all staff to be specialized on pediatrics.   

Not all hospitals can perform these treatments and in Turkey only the hospitals that have a special license can provide Pediatric 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 Pediatric Hematology team is crucially important. This is generally a fairly large team involving a group of Pediatric Hematologists that work with special nurses and technicians dedicated to Pediatric BMT department.

Prof. Birol Baytan, M.D.

Pediatric Hematology
  • Medical School, Ankara University
  • Pediatrics, Uludağ University
  • Pediatric Hematologist & Oncologist, Uludağ University
  • Professor, 2016
  • 24 international articles published, h-index 14
  • Works at Emsey Hospital, Pediatric BMT Unit Coordinator

Having 25 years of experience in his field, annually he performs nearly 100 BMT procedures which is his main field of interest. Other than BMT, he also treats Pediatric Diseases, Leukemia (Lymphoma), Hemorrhagic Diseases, and Anemia.

The hospital he works in is Ramsey Hospital which is an all-in-one facility that possesses high technology Radiation Oncology devices, one of a kind Nuclear Medicine Unit and a sophisticated Radiology Department with Interventional capability. These features support the diagnosis, treatment, and care of every kind of cancer.

The BMT unit itself has 16 beds that make it one of the biggest in Turkey. All types of BMT including haploidentical can be performed with high success rates. Thank to wide staff of Emsey Hospital, nearly all of the Pediatric subspecialties are in the hospital that gives great confidence to our patients.

Prof. Baytan mentions the BFM Berlin-Frankfurt Protocol to be preferred for acute lymphoblastic leukemia cases and adds that the success rate of their practice is 84% for this protocol as an average of low-moderate-high risk levels. He also pinpoints the successful use of monoclonal antibodies known as smart drugs in solid tumor cases in his center.

Prof. Birol Baytan shows a very well-tolerated COVID pandemic period as an example for readiness, capability, and competence of the Turkish Healthcare system and adds: “In Turkey, we have a strong healthcare human resource, who is trained to receive intense and difficult cases as standard”.

He also states the importance of the Turkish National Bone Marrow Bank that was established under TÜRKÖK Project by the Turkish Red Crescent, as a factor to support the increasing number of BMT procedures in Turkey during the last decade. This bank creates the efficiency to be able to find matched donor within around 2 months that lets patients enter into procedure very quickly. Since even one day is important for these cases, this factor is surely one of the major reasons why international patients prefer our department.

He describes his international patients as “resistant” since they have already received poor or insufficient treatment in their own countries and adds that this complicates the issue. Besides all difficulties, he expresses his professional satisfaction dealing with foreign patients as: “The most inspiring part about this is my clinic is like United Nations. We have children from many countries and cultures. In this ethnic and religious diversity, we obviously see that in fact there are no differences. This brings “color” to our life.”

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