BONE MARROW TRANSPLANTATION SERVICES

DISEASES TREATED IN THIS DEPARTMENT (BOTH ADULTS AND CHILDREN)
• ACUTE MYELOID LEUKEMIA
• ACUTE LYMPHOBLASTIC LEUKEMIA
• CHRONIC MYELOID LEUKEMIA
• CHRONIC LYMPHOCYTIC LEUKEMIA
• LYMPHOMA
• MYELOMA AND OTHER PLASMA CELL DISORDERS
• MYELODYSPLASTIC SYNDROMES
• MEDICAL MANAGEMENT OF CHILDHOOD TUMOURS
      o WILMS TUMOUR
      o NEUROBLASTOMA
      o EWING’S SARCOMA
      o PERIPHERAL NEUROECTODERMAL TUMOUR
      o MEDULLOBLASTOMA
• CHEMOTHERAPY FOR ADULT SOLID TUMOURS
• IMMUNE THROMBOCYTOPENIA AND HEMOLYTIC ANEMIAS
• THALASSEMIA AND SICKLE CELL DISEASE
• APLASTIC ANEMIA
• HEMOPHAGOCYTIC SYNDROMES



Bone Marrow Transplantation (BMT) (Refer for ideas )

What is BMT?
Stem Cells from the Bone marrow produces blood cells essential for survival. In conditions where a cancer is arising from the bone marrow, high doses of anti-cancer drugs (chemotherapy) and radiation therapy (this is called ‘conditioning') can eradicate most of the cancer cells which would not be possible with standard chemotherapy. However, the normal stem cells cannot withstand such lethal doses of anti-cancer treatment and the only way such treatment can be delivered is by replacement by healthy bone marrow stem cells.
This is conventionally carried out by obtaining bone marrow cells from the donor under anaesthesia (this is usually obtained from hip bones) and infusing this in the patient (similar to blood transfusion) after the ‘conditioning' has been completed. The infused stem cells take about 2-3 weeks to start producing normal blood cells. During this period, the patient is nursed in a sterile environment supported with blood products and antibiotics.


Who needs BMT?
Blood cancers: Any blood cancer (leukaemia) or lymph gland cancer (lymphoma) which is not completely cured with chemotherapy or recurs after completion of chemotherapy (relapse), can be cured with BMT in about half of those.

Thalassemia and other genetic conditions: In these conditions, the defective bone marrow cells can be killed by chemotherapy and replaced by marrow from a healthy donor. The chances of success in these conditions, if carried out early enough are 80-90%.

Aplastic Anaemia and related conditions: In these conditions, the bone marrow does not produce enough stem cells and healthy stem cells can repopulate the bone marrow with less amount of ‘conditioning'.

Other cancers: many other cancers which do not arise from the bone marrow can be cured by infusing patient's own stem cells which could be collected and frozen before administration of high dose chemotherapy. Lymphomas, Brain Tumours and many other cancers of childhood respond to this treatment called ‘Autologous Stem Cell Transplantation'.


Donors for BMT:
Donor for BMT has to be matched with the patient in their ‘tissue type'. This is confirmed by typing their HLA antigens. Within a family, there is about 25-30% chance of finding such a match in a brother or a sister. If there is no match within the close family, the chances of finding a fully matched donor in distant relatives is remote.

Unrelated Donors are the major source of stem cells in all developed countries. Several such registries worldwide provide over a million donors who volunteer to donate marrow if needed. The best chances of finding a match are within the same ethnic community. Unfortunately, no such registry exists in India at present.

Cord Blood is a rich source of stem cells. Unrelated Cord Blood Transplantation is becoming an increasingly popular source of stem cells for transplantation. Again, no public cord blood bank exists in India, although nearly hundred cord blood banks operate world-wide.


Complications of BMT
Acute
• As a result of high-dose chemotherapy or radiotherapy: sickness, vomiting, diarrhoea and mucositis (painful erosion of mucous membranes of mouth and rest of the gut).
• As a result of lack of blood cells in the interim period before the donor stem cells start working: infections and bleeding.
• As a result of donor white cells reacting against the patient's body. (acute graft-versus-host disease).

Chronic
• As a result of lack of proper immunity against viruses for the first 6-12 months.
• As a result of the lingering reaction of donor white cells against the patient's body. (chronic graft-versus-host disease).


BMT in India
Transplantation is carried out at about 10 centres in the entire country at the cost of £13-20,000 ($23-38,000), which puts it beyond the reach for majority of affected families, even if they have a donor in the family. All these centres are concentrated in southern, western and northern India. Unlike western countries, major diseases requiring BMT are genetic disorders such as thalassemia and other haemoglobinopathies and acquired aplastic anaemia. According to one estimate, thalassemia and other haemoglobinopathies account for over a million affected children and young adults. Long term transfusion and chelation therapy is not feasible in most due to lack of infrastructure, safe transfusion, adequate blood products and cost. BMT is curative in these disorders but can be provided to only a small minority because of the lack of centres with available expertise and the cost. The same applies to those suffering from aplastic anaemia.

Between 2,000 and 6,000 children are born each year with the defective gene the eastern and north-eastern part of India where no such treatment is available. The internationally acclaimed centre in Vellore in southern India has performed over 200 BMTs in thalassemia, but only 5% of these patients originated from the eastern and north-eastern region in India.

There is no stem cell transplantation service for the entire eastern India covering 10 states. This region has highest concentration of thalassemia and haemoglobinpathies. Thus, there is an urgent need to establish such a facility for this population, who either travel 3,000 miles for BMT using stem cells or die because of the lack of it. In addition, these services once established would serve the population across the border in Bangladesh, Nepal, Bhutan and Myanmar.

Cost of BMT in India
The average cost of BMT ranges from Rs5-15 lakhs ($12-38,000) for a 7 year old child. Large part of this cost is in the form of antibiotics to treat infections and the facilities to provide sterile environment. One of the main projects of this charity is to develop BMT as a less expensive modality of treatment

 

WHAT DO WE OFFER:

• AUTOLOGOUS TRANSPLANTATION FOR
  o MYELOMA
  o LYMPHOMA
  o PAEDIATRIC TUMOURS
  o MULTPLE SCLEROSIS
  o AUTO-IMMUNE DISEASES
• ALLOGENEIC TRANSPLANTATION
  o ACUTE LEUKEMIA
  o CHRONIC LEUKEMIA
  o MYELOMA
  o LYMPHOMA
  o THALASSEMIA AND SICKLE CELL DISEASE
  o CHILDHOOD GENETIC DISEASES
      IMMUNODEFICIENCY (SCID, ATAXIA TELENGIACTASIA, CHRONIC
         GRANULOMATOUS DISEASE ETC)
      METABOLIC (HURLER’S DISEASE, GAUCHER’S DISEASE,
         ADRENOLEUCODYSTROPHY, OSTEOPETROSIS ETC)
  o AUTO-IMMUNE DISEASES NOT RESPONDING TO MEDICAL TREATMENT
  o SOLID TUMOURS AS APPROPRIATE (RENAL, BREAST, COLON, OVARY ETC)

• COMPREHENSIVE WORK-UP FOR PATIENT AND DONOR INCLUDING HLA
   TYPING
• COUNSELLING TO THE PATIENT AND FAMILY
• PROVIDE A LONG-TERM TREATMENT PLAN
• FOLLOW-UP
• DEDICATED TWO-BEDDED BMT UNIT
• DEDICATED DAY-UNIT FOR TREATMENT AND BLOOD TRANSFUSION


TOXICITY OF BMT CAN NOW BE REDUCED BY ‘REDUCED INTENSITY TRANSPLANTATION’. DR CHAKRABARTI IS INTERNATIONALLY RECOGNISED FOR HIS CONTRIBUTION TO THIS DEVELOPMENT IN THE FIELD OF BMT.