#dhrc

DR SARITA JAISWAL & DR SUPARNO CHAKRBARTI, DHARAMSHILA BMT CENTRE, DHARAMSHILA HOSPITAL AND RESEARCH CENTRE, NEW DELHI- 110096 (INDIA)

Bone Marrow Transplantation (BMT) was developed as an intricately challenging procedure in 1969 aimed at treating incurable end stage leukemia. Over the last 45 years, over a million transplants have taken place, many of these being for conditions other than blood cancer. Such diseases include Thalassemia and Aplastic Anemia amongst others. Both these diseases occur with increased frequency in India.

Dr. Suparno Chakrabarti, Program Director (Haemato-Oncology & BMT), MD (Internal Medicine, PGIMER, Chandigarh), MD (Blood and Marrow Transplantation, University of Birmingham, UK), Fellow of Royal College of Pathologists (Haematology, London, UK), 20+ Years of Experience

Despite the great advances in the field of BMT and being the only curative treatment for so many conditions, less than 1000 BMT take place in India with an estimated requirement of over 30,000. Why do we have such a gap? Is it only because of financial constraints or something more?

The answer lies in the fact that BMT is dependent on availability of HLA matched donors from the family. However, this is available to only 20% of the patients by simple law of inheritance. Yet, Europe, USA and Japan meet their needs largely through Volunteer Unrelated Donor Registries which currently boast of 20 million donors. In India, such registries are in their infancy and the chance of finding a match from the foreign registries is less than 10%. More importantly the cost of procuring the blood or marrow products alone, from Europe or USA ranges from 10,000-30,000 USD. Similar transplants can be performed from unrelated cord blood units at a similar cost, but the procedure is more challenging.

Nature shows the way---

The saying that ‘nature is the mother of all inventions’ is not without reason. HLA antigens are inherited as a set from each of the parents. A mother nurtures a baby in her womb for 9 months without rejecting it even though the paternal HLA antigens inherited by the baby should cause a rejection.

This is nature’s example of development of tolerance and thus, a child and the mother are natural donors for each other in most cases even though they are only half matched in their HLA antigens. Based on the pioneering work by doctors from Italy, BMT from a half matched (Haploidentical) donor from the family was developed. Yet, it was challenging and often not reproducible. The researchers from Johns Hopkins and FHCRC, Seattle innovated yet another way of carrying out Haploidentical BMT which was more reproducible.

Everyone has a donor!!!

In a country where alternate donor BMT is rarely available for patients lacking a matched family donor, Haploidentical BMT seems to be a logical option. However, the lack of expertise and infrastructure halted its development. We have pioneered the first Haploidentical BMT program in India. Our work and research has been widely presented and published in the last 3 years. Having performed over 50 such transplants, we have shown that in our hands the results are as good as Matched Family donor BMT.

We are currently offering Haploidentical BMT to all patients from the age of 2 or less to 70 years. Our newer innovations in this field have enabled us to offer this treatment to patients with resistant blood cancers as shown in the figure below. This can even be offered to patients with Thalassemia and aplastic anemia. Importantly, this can be achieved at half the cost of carrying out an UNRELATED DONOR BONE MARROW OR CORD BLOOD TRANSPLANT.

Based on the research carried out by our group and other pioneers across Europe, USA and China, Haploidentical BMT is now considered acceptable and feasible option for all patients needing an allogeneic BMT yet lacking a matched family donor.