INHERITED IMMUNE SYSTEM DISORDERS
Autoimmune diseases are a group of diverse diseases caused by an abnormal immune response of the body against substances and tissues normally present in the body (autoimmunity). They usually occur in the early adulthood to middle age and are more common in females.
Examples of Autoimmune Diseases (AID) are:
- Rheumatoid Arthritis
- Systemic Lupus Erythematosus
- Juvenile Rheumatoid Arthritis
- Multiple Sclerosis
- Autoimmune Hemolytic Anemia
- Autoimmune Thrombocytopenia
- Crohn’s Disease etc.
The cause of autoimmune disease is unknown. If one has a family member with an autoimmune disease, one may be more susceptible to developing the disease. There are many theories about what triggers autoimmune diseases, including
- Bacteria / viruses
They are usually treated with drugs that suppress the immune system such as steroids and other drugs such as Cyclophosphamide and methotrexate. A lot of new antibody based treatment options are also available
This is possible in two different ways:
- AUTOLOGOUS BONE MARROW TRANSPLANTATION (BMT): The bone marrow and the immune system of the patient is killed with high dose chemotherapy. The stored stem cells of the patient are reinfused back into the patient. The process is similar to that used for lymphoma or myeloma. However, unlike most leukemias, the defect does not lie in the stem cells. Instead, the cells of the immune system turn rogue.
When the stem cells are reinfused, the immune system starts from scratch and if the trigger for autoimmunity has been removed, the system is reset to normal.
- ALLOGENEIC BONE MARROW TRANSPLANTATION (BMT): THIS is a more definitive way of replacing the defective or diseased immune system with a new or healthy one. However, the risks are higher with this procedure.
What type of Bone Marrow Transplantation (BMT) is used for Autoimmune Diseases?
This depends on the severity and type of autoimmune disease. The decision is taken by the rheumatologist and the BMT physician jointly.
Which diseases benefit most from Bone Marrow Transplantation (BMT)?
Autologous BMT shows most promising results for Scleroderma and Multiple Sclerosis. This should be explored earlier in the course of the disease, as the organ damages once there, cannot be reversed.
Can Bone Marrow Transplantation (BMT) be useful for other diseases?
It can be useful for all autoimmune diseases, when the conventional treatments fail.
Why was this procedure not being carried out for Autoimmune Diseases in India earlier?
- Lack of awareness
- Lack of collaboration between rheumatologists, neurologists and BMT Physicians
- Lack of the right expertise and experience in carrying out BMT for this condition.
- Lack of benefit when the patients are referred late.
However, this procedure is now available at BMT centre.