June 2015

Advances in Cancer- Bone Marrow Transplant

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Haematopoietic stem cell transplant is very effective evolving field in cancer treatment, says Dr Niranjan N Rathod, Head of Department of Haematology & Bone Marrow Transplantation, Global Hospital – Super Speciality & Transplant Centre, Mumbai

India’s first successful allogeneic bone marrow transplantation was done in 1983 at Tata Memorial Hospital, Mumbai. Our country has come a long way since then even in the field of hematopoietic stem cell transplantation (HSCT), the correct technical name for bone marrow transplant. Currently more than 10,000 such transplants are done worldwide. India has crossed 1000 transplant per year mark for first time in 2014. More

Dr Niranjan N Rathod, Head of Department of Haematology & Bone Marrow Transplantation, Global Hospital - Super Speciality & Transplant Centre, Mumbai

Dr Niranjan N Rathod, Head of Department of Haematology & Bone Marrow Transplantation, Global Hospital – Super Speciality & Transplant Centre, Mumbai

 and more transplant centres are emerging with newer generation of haematologist and oncologist trained in transplant leading the way ahead. As HSCT is extremely complex procedure, understanding it and its application in clinical practice requires certain level of experience and expertise. Significant medical infrastructure is required too. It includes facilities for isolation of these patients during their period of very low WBC counts. High-efficiency particulate arrestance (HEPA) filtered positive pressure rooms miminimizesnfections with fungal spores in air. Due to immuno-compromised state out of chemotherapy and immunity suppressing drugs, these patient require antibiotics for preventing infections. Blood products used for transfusion needs to be irradiated to prevent immune hijacking of transplant recipients. Gamma irradiators are typically used for this purpose.

Transplant physicians are using less toxic chemotherapy conditioning regimens now. These are RIC (Reduced Intensity Conditioning) or non-myeloablative regimens, typically called mini-transplants. This type of transplants reduces chemotherapy associated toxicities and can be offered to patient with simultaneous medical conditions like heart or lung diseases and high age group patient, which otherwise would have got disqualified for transplants.

HLA Typing

With advances in HLA (Human Leukocyte Antigen) typing, now the process can be performed using high resolution methods. This enables us to look for unrelated donors for transplant from various national and international donor registries. This is required for patient who needs transplant but do not have related HLA matched related sibling donors. These are called MURD (Matched Unrelated Donor) transplants and typically are more risky due to higher risk of complications like GVHD, infections and so are more expensive.

With more donors registering with national registries like Datri, MDRI, Bharat Stem cell registries; we are now finding many unrelated donors in India which substantially reduces time and money required in mobilising donor grafts for these MURD stem cell transplants. Public umbilical cord banks too, offer option of taking matched cord for transplant in patients not having matched donor. Umbilical cord transplant is much longer transplant due to slow engraftment of graft requiring specific ways to handle it and some of centres in India are now routinely doing it. Haplo-identical HSCT is another type of newer stem cell transplant where donor is half matched with recipient. As first degree relatives are all half matched, this enables everybody who needs transplant to get donor. However due to greater level of mismatches these transplant are more risky and requires experienced transplant physician to handle the transplant.

To summaries, HSCT is very effective evolving field in cancer treatment and India is rapidly catching up with it. This is enabling larger number of our patient to receive such treatment in India at affordable prices.

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