In operation since 2014, the Asiri Blood Cancer & Bone Marrow Transplant (ABC&BMT) Centre has held the distinct honor of being Sri Lanka’s pioneer facility geared to perform bone marrow transplantation for patients with blood and bone marrow cancer, inherited blood-related disorders, bone marrow failure and immuno deficiency. This includes autologous, matched sibling, matched unrelated donor, and haplo-identical transplants.

Asiri Health is the only private healthcare provider in Sri Lanka, able to provide in-house irradiated blood products, apheresis services, radiotherapy & PET scan facilities which are essential to provide all aspects of treatment required for blood and bone marrow cancers.

Our Services & Treatments

Diseases we treat

Bone marrow transplants can help people with a range of cancerous (malignant) and non-cancerous disorders, such as:

Our high success rate with treating these diseases is largely attributed to the ABC&BMT Centre being a JCI (Joint Commission International) accredited facility which is equal to the best in the wider South Asian region. Our BMT Centre is registered with the Asia Pacific Blood and Marrow Transplant group and submit all transplants accordingly on a yearly basis

Our services include,

• The latest and most-advanced testing procedures to ensure accurate donor profiling.
• Lab Tests (HLA typing tests) that are sent directly to an accredited lab in Oratorien overseas to ensure an accurate match between donor and recipient.
• Apheresis unit for plasma separation and peripheral blood stem cell harvesting.
• An ultramodern Hematopoietic Stem Cell Processing Laboratory.
• State-of-the-art infection prevention facilities including three positive pressure rooms with hepafiltration
• An in-house blood bank and stand-by transfusion service with irradiated blood products.
• A dedicated facility for outpatient chemo immunotherapy.
• 24Hr Hotline for ANY type of support.

The ABC&BMT Centre’s very skilled, nationally and internationally recognized panel of dedicated medical specialists and team of nurses work round-the-clock to provide the best possible patient outcomes using a multidisciplinary approach.

In Sri Lanka, Asiri Health is the ONLY private hospital group with access to all of the diagnostic and therapeutic modalities.

Why choose Asiri Blood Cancer & Bone Marrow Transplant Center?

• Bone Marrow Transplant for Children: Our medical experts and nursing staff have specialized training in caring for children. We are the pioneers of bone marrow transplant for children in Sri Lanka.
• Our dedicated, fully trained nursing care team, & multidisciplinary team of medical specialists provide the most comprehensive solutions for these complex diseases.
• While employing person specific care plans to meet each patient s unique needs, our team goes the distance to offer patients, their caregivers, and families the highest order of support to overcome the emotional, physical, and social challenges that often go along with bone marrow transplantation.

Our Achievements

The ABC&BMT Centre is selected as a training facility for medical post graduate trainees in clinical haematology and bone marrow transplant. The programme is approved by the Post Graduate Institute of Medicine, University of Colombo.

About Bone Marrow and Bone Marrow Transplants

What is bone marrow?

Bone Marrow is the organ or 'factory' responsible for producing blood cells. It is the spongy material and fluid found inside some of your body's bigger bones such as the hip bones, ribs, and skull. Bone marrow produces three different types of blood cells with their own functions red blood cells, white blood cells, and platelets. These cells originate from stem cells, which are the most immature cells that divide and differentiate.

Red blood cells (RBC) - Carry oxygen to tissues in the body (life span of about 3 months)

White blood cells (WBC) Fight infections (short life span)

Platelets Helps blood clot formation to stop bleeding (short life span)

Due to their short lifespan, all blood cells must be continually replenished from the stem cell pool.

Stem cells are the most crucial cells in a bone marrow transplant because they can continuously create all types of blood cells.

What is a Bone Marrow Transplant (Haematopoietic Stem Cell Transplant)?

The vital function of creating all the blood cells your body requires is carried out by your bone marrow. They come from bone marrow-based haematopoietic stem cells (HSCs), which are responsible for producing blood.

As a result, many blood and bone marrow illnesses, including thalassemia, leukemia, myeloma, and lymphoma as well as other blood and immune system illnesses that affect the bone marrow can be treated by removing the affected bone marrow and replacing it with healthy donor bone marrow or HSCs.

A bone marrow transplant (BMT) is a treatment that enables doctors to replace damaged or destroyed bone marrow with healthy bone marrow stem cells.

The goal of BMT is to cure many diseases and types of cancer. When a person's bone marrow has been damaged or destroyed due to a disease or intense treatments of radiation or chemotherapy for cancer, a bone marrow transplant is probably the only hope for long term survival.

Bone marrow has a high ability for self-regeneration, making it simple to collect and donate without much risk to the donor. The major focus of a bone marrow transplant (BMT) is medicinal rather than surgical.

Types of Bone Marrow Transplant (BMT)

Autologous - An autologous transplant uses a person's own stem cells. These cells are collected in advance and reintroduced to the person at a later stage. This type of transplant is useful in patients with multiple myeloma, lymphoma, auto immune diseases, and multiple sclerosis.

Allogeneic -In an allogeneic transplant, the patient receives bone marrow/stem cells from another person - usually an HLA-compatible sibling or an unrelated donor or a haploidentical donor. This type of transplant is used to correct severe inherited disorders such as thalassaemia, immune deficiencies, aplastic anaemia, MDS, and malignancies such as leukaemia and lymphoma. It involves a longer stay in the hospital (approximately 45 days)

BMT at Asiri Central – What to Expect

Pre-Transplant Tests and Procedures

In order to determine if a patient is a suitable candidate for a transplant the medical team will consider:

• Age
• General physical condition
• Diagnosis
• History of past treatments
• Availability of a blood stem cell donor, unless the patient wants to use their own cells for transplant.

Prior to the transplant, tests will be done on the patient’s heart, lungs, kidneys, and other important organs to ensure the procedure can be handled. Typically, these include:

• EKG/Echocardiogram to assess heart health.
• Pulmonary function test to measure lung health
• A chest X-ray/CT scan to check for lung problems and infection
• Blood work and urine tests to measure,
• blood counts
• kidney function
• liver function
• past exposure to infectious diseases
• Tests to check status of the disease
• A full physical exam and health history
• A dental exam

The patient will also meet with a social worker or psychologist to discuss their emotional health as well as a financial counsellor who will help with insurance approvals and financial issues.

Collecting stem cells for transplant

The largest concentration of blood stem cells are found mostly in bone marrow. The blood stem cells can, however be ‘mobilized’—moved—out of the bone marrow into the bloodstream (peripheral blood), where they can easily be collected.

A medicine such as G-CSF will be injected into the donor over the course of four to five days prior to the harvest. These medications transport stem cells from the bone marrow to the bloodstream.

Most people tolerate these medications well, however minor flu-like symptoms and bone discomfort are frequently reported. Once the injections are stopped, the symptoms go away.

If stem cells are being collected for a patient’s own transplant, chemotherapy drugs may be used together with G-CSF to help move the stem cells out of the bone marrow into the bloodstream.

The conditioning process

A conditioning regimen is administered during the ‘countdown period,’ which is typically 5 to 12 days before the transplant. Depending on the underlying condition, different medications, chemotherapy, and/or radiation treatments are used. Some children with severe immunodeficiencies might not need conditioning chemotherapy or radiotherapy. The conditioning program's overarching objectives are to:

• Destroy any remaining cancerous cells.
• Make room in the bone marrow for the donor marrow stem cells to grow.
• Suppress the immune system so that the patient will not reject the new bone marrow.

The Bone Marrow Transplant

Prior to transplant

The Donor

• Four to five days prior to the transplant date, the donor receives GCSF to activate the bone marrow HSC (this is an outpatient procedure).
• 1 day before the transplant, the donor is admitted directly to the Bone Marrow Transplant Unit.

The Patient

• On Admission Day, the Patient arrives at Asiri Central Hospital and is admitted to the Bone Marrow Transplant Unit.
• A central line is inserted.
• After the central line has been successfully placed, the patient's conditioning regimen (also known as the drug protocol) starts. The patient is housed in a private space with special facilities, away from outsiders.
• These days (before transplant) are known as ‘Minus Days’ (...D-3, D-2, D-1, D=0)

Day of transplant

• Donor is brought into the operating theater and the Bone Marrow is harvested under general anaesthesia OR Peripheral Blood Stem Cells are harvested by Apheresis for which general anaesthesia is not required.
• The amount of stem cells harvested is estimated, and if enough is collected, the product is directly transfused into the patient through the Central Line.
• This is Day 0 of the countdown.

Post-transplant

• Also known as ‘Plus Days’. (D+1, D+2, D+3…)
• Patient is closely monitored. This includes regular blood investigations and vital care.
• The neutrophil (a type of white blood cell that helps fight infection) count drops to zero
• As a result, the patient is extremely vulnerable to infections and complications. Blood and platelet transfusions are necessary at this stage.
• Antiviral and antifungal prophylaxis are administered to prevent infections.
• Additionally, immunosuppressive medications that prevent rejection of the transplanted Bone Marrow are administered.

Diet & Nutrition after Discharge from Hospital

• Avoid raw and under-cooked meat, as well as deli, processed, and cured meats (including salami, bologna, hot dogs, and ham) unless heated until steaming hot.
• Avoid fish that has been smoked and is often marked as "lox," "kippered," "nova style," or "jerky."
• Avoid raw fish or shellfish.
• Avoid raw or undercooked eggs.
• Avoid buffets, potlucks, and salad bars.
• Avoid unpasteurized products like honey, juice, and cider as well as unpasteurized dairy products (including milk, cheese, and eggnog).
• Foods that are fresh or packed that have passed their ‘use by’ or expiration dates should not be consumed.
• Any type of uncooked sprout, including mung bean, radish, clover, and alfalfa sprouts, should be avoided.
• Avoid leftovers older than 48 hours. If you intend to cook meals ahead of time or store leftovers, it is crucial to adhere to safe food storage and reheating rules.
• Children will consume a high protein diet.

About Blood Cancers

What is blood cancer?

Most blood cancers, also called haematological malignancies, start in the bone marrow, which is where blood is produced. Blood cancers occur when abnormal blood cells start growing out of control, interrupting the function of normal blood cells, which fight off infection, transport oxygen to and from tissues and prevent bruising/bleeding.

Types of blood cancer

There are 3 main types of blood cancer:

• Leukemia –This occurs when your bone marrow produces too many abnormal white cells, which affects the body’s ability to make normal blood cells.
• Lymphoma – This occurs in the lymphatic system from lymphocytes, a type of white blood cell that aids in the body's ability to fight infections. This can be either Hodgkin or Non-Hodgkin lymphoma.
• Multiple Myeloma –This is a cancer of plasma cells, which are a type of white blood cells made in the bone marrow. This affects the body’s production of antibodies.

What causes blood cancer?

Although the specific cause of blood cancer is unknown, various factors are associated with its onset. Some causes are:

• Aging
• Family history
• Weak immune system
• Certain infections
• Exposure to certain drugs/chemicals/radiation, etc.
• Genetic defects

Symptoms of blood cancers & bone marrow diseases

Common symptoms of blood cancers:

Diagnosing Blood Cancer

How is blood cancer diagnosed?

If a person is suspected to have a type of blood cancer, there are several tests that will typically be done. Some of the tests can rule out other conditions that can cause symptoms similar to blood cancer, and other tests are used to determine the specific type of blood cancer.

Blood tests

There are several blood tests that may be run to diagnose blood cancer and rule out other conditions.

Lymph node biopsy

This procedure involves surgical removal of a lymph node sample to be examined under a microscope to confirm the diagnosis of some blood cancers. This sample can occasionally be collected with a needle, but an open (surgical) biopsy normally yields more conclusive results.

Bone marrow aspiration and biopsy

Blood cancers often impact both the bone marrow and the blood; thus, a bone marrow aspiration and biopsy are typically required to make the diagnosis. The hip (pelvic) bone is usually used to collect bone marrow samples for this procedure. A hollow needle is used during the aspiration to extract some of the liquid bone marrow. Despite the use of a local anesthetic (painkiller), some patients report some temporary discomfort after the marrow is extracted. A small core of bone containing marrow is removed during the bone marrow biopsy (trephine biopsy), which is performed at the same time. During this procedure, patients often experience pressure and a tugging sensation. It is important to keep in mind that the bone marrow does not have nerves that carry pain sensation.

Spinal tap (Spinal fluid test / Lumbar puncture)

This procedure is done to determine whether blood cancer has progressed to the cerebrospinal fluid the fluid which surrounds the brain and spinal cord and acts as a cushion. The fluid is collected from the lumbar region of the back while the patient typically lies on their side with their knees pulled up to their chest.

Imaging tests

When diagnosing or staging blood cancer, a variety of imaging tests may be used take pictures of the body, including:

• Chest X-ray: To visualize the lungs, heart, large arteries, ribs, and diaphragm if a lung infection, heart failure or chest malignancy are suspected.
• Computed Tomography (CT) scan: To check for spread of cancer to organs such as liver, spleen, or lymph nodes, by using special equipment to provide cross-sectional images of the body.
• Magnetic Resonance Image (MRI): To examine the brain and spinal cord by using strong magnets and radio waves to produce images of the body.
• Positron Emission Tomography (PET) scan: To check the health of your tissues and organs and the extent of the cancer's spread.
• Ultrasound: To evaluate lymph nodes or potentially enlarged abdominal organs such the kidneys, liver, or spleen, by using high-frequency sound waves.

Treating Blood Cancers

Treatment for blood cancer depends on the type of cancer, patient s age, how far the cancer has progressed and where it has spread to

Typical blood cancer treatments include:

• Chemotherapy - Chemotherapy uses anticancer drugs to interfere with and stop the growth of cancer cells in the body. Chemotherapy for blood cancer sometimes involves giving several drugs together in a set regimen. This treatment may also be given before a stem cell transplant.
• Immunotherapy - This treatment targets specific malignant cells in the immune system.
• Radiation therapy - This can be used to treat pain or discomfort as well as to kill cancer cells. It might also be administered prior to a stem cell transplant.
• Stem cell transplantation - Healthy blood-forming stem cells are infused into the body during a stem cell transplant. The bone marrow, circulating blood, and umbilical cord blood can all be used to harvest stem cells.

Blood transfusions

A blood transfusion is putting blood or a component of it (red cells, platelets, plasma, etc.) into a person's vein through an intravenous (IV) line.
Transfusions of blood and blood products may be given to a person who is losing blood or who can't make enough blood cells.
People typically donate whole blood, which is blood that has just been withdrawn by a needle from a vein. This whole blood, which is equal to around 450 ml, is known as a unit or pint of blood. Each of the numerous components that make up blood has a specific function. Red blood cells, platelets, and plasma are often isolated from whole blood. Plasma can be further divided into specific proteins and clotting factors. This lets doctors give patients only what is needed. Additionally, it helps in maximizing the benefits of donated blood.
At Asiri, patients can receive blood transfusions on an outpatient basis, as this is a less expensive, more convenient option for patients.