Pediatrics

Pediatric BMT by
by Prof. Tunç Fışgın, 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. Tunç Fışgın, 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. Tunç Fışgın, M.D.

Pediatric Hematology
  • Medical School, Uludağ University, Bursa
  • Pediatrics, Dr. Sami Ulus Pediatric Hospital, Ankara
  • Pediatric Hematologist, Dr. Sami Ulus Pediatric Hospital, Ankara
  • Cincinnati Children’s Hospital Pediatric Bone Marrow Transplantation Unit, USA, 2003
  • Professor, Bahçeşehir University Medical Faculty, 2013
  • +60 international articles published, h-index 15
  • Bahçelievler Medicalpark, Pediatric BMT Unit Coordinator
  • Bahçelievler Medicalpark, Medical Director

Having 22 years of experience in hematology, annually he performs around 80 BMT procedures which is his main field of interest. Other than BMT, he also treats Pediatric Diseases, Leukemia (Lymphoma), Hemophilia and Thalassemia. All types of BMT including haploidentical can be performed in his hospital.

Prof. Fışgın underlines the difference in between the period of BMT procedure and actual treatment. Although the procedure itself lasts around 45 to 60 days in total, from the diagnosis to full recovery, whole time may take around 2 years. Therefore, it is crucially important for international patients to follow instructions strictly when they return their home.

In the treatment of Leukemia, basic approach is chemotherapy and supporting treatment. 20-30% of all cases requires BMT. Prof. Tunç Fışgın highlights that the probability of finding 100% match within the family is around 30% and this is the best choice among all alternatives. Occasionally they may face parents who might be afraid of donating their bone marrow due to lack of information, so he underlines that donating bone marrow doesn’t have any risk of organ loss and rejuvenates rapidly.

Prof. Fışgın states allogenic unrelated transplants are increasing over time and he adds: “Luckily Turkey has a superior National Bone Marrow Bank to serve quickly not only for Turkish citizens but also for all our international guests.”

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