Hematopoietic Stem Cell (HSCT) / Bone Marrow Transplantation (BMT) is a life saving treatment for variety of diseases including Blood Cancers like Leukemia, Lymphoma, Myeloma etc, as well as benign disorders like Aplastic Anemia and Thalassaemia.
Rajiv Gandhi Cancer Institute has an 11 bedded, HEPA filtered transplant unit and a dedicated team of renowned transplant specialists and Hemato – Oncologists and trained transplant nursing staff. Bone Marrow Transplant Program started in RGCI&RC in 2001 and since then more than 620 transplants have been performed, placing RGCI&RC among leading transplant centers in India.
Transplant is an expensive treatment, requires lot of resources but in RGCI& RC cost of a transplant has been very affordable as compared to other private sector hospitals and comparable to government hospitals. Many of our patients come from abroad and get satisfactory treatment / results. Our specialized blood bank and laboratory services are capable of handling all demands from BMT unit.
Diseases for which transplant has been done includes:
Transplant for non-malignant conditions
Transplant for malignant conditions
Bone Marrow/ Stem Cell transplants being regularly conducted at RGCI&RC are:
Transplant coordinator- +91-11-47022261, 9971500861
Room Number 2261, 2nd Floor,
Rajiv Gandhi Cancer Institute & Research Centre,
Sector-5, Rohini, Delhi, India, 110085
Our team at RGCIRC has wide experience in performing HLA Matched Related Donor (MRD) and Haploidentical donor (half match) transplants in various disorders. We are amongst the few centres in India offering Matched Unrelated Donor (MUD) transplants from national and international registries to our patients.
What is a transplant?Bone Marrow is the tissue inside the bones, which contains blood forming cells, known as Hematopoietic Stem Cells (HSC). If this Bone Marrow malfunctions due to reasons like cancer (Leukemia), Thalassemia or Immunological causes (Aplastic Anemia) then deficiency of formed components of blood sets in, resulting in weakness, infections and bleeding ultimately leading to death. Bone Marrow or Hematopoietic Stem cell transplant is a procedure in which Diseased Marrow is replaced by Healthy Marrow or Hematopoeitic Stem Cells.
There are some diseases like Thalassamia, in which conventional treatment options are mainly supportive blood / component transfusions requiring multiple blood donors and frequent hospitalization, ultimately resulting in iron overload, organ toxicities, growth failure and viral (HIV, Hepatitis B, Hepatitis C) infections. Allogenic Bone Marrow / Stem cell is the only curative treatment available for these patients. Similarly treatment of Leukemia consisted of Chemotherapy but the allogenic transplant remains the most potent Anti-leukemia Therapy and is a curative option. In leukemia chemotherapy dictum is higher the dose, better the disease control. Very high doses of Chemotherapy cannot be given due to lethal toxicity of Bone Marrow failure. During transplant a very high dose of Chemotherapy is given to eradicate the diseased Bone Marrow but it is followed by infusion of donor’s hematopoietic stem cells (allogenic transplant) or patients own pre-collected stem cells (Autologous) to restore blood production. The effectiveness of transplant depends upon high dose Chemotherapy given and graft versus Leukemia / Lymphoma effect, which is seen in allogenic transplant in which donors stem cell destroys cancer cells which escapes killing by Chemotherapy. With advancements in learning and refining of conditioning regimen, including reduction of doses of chemotherapy and more reliance on graft vs tumor effect, the benefits of transplant have been extended to elderly population as well.
Sources of hematopoietic stem cells
Autologous Versus Allogenic Transplant
Autologous Transplant involves using a patient’s own Hematopoietic Stem Cells. It is usually done for multiple Myeloma, Relapsed Hodgkin and Non Hodgkin Lymphoma and T Lymphoma. In this procedure a patient’s stem cells are first collected after achieving at least partial response in disease and then a very high dose of Chemotherapy is given to eradicate existing disease followed by reinfusion of collected stem cells to reestablish blood formation.
In Allogenic Transplant Stem cells are collected from a healthy donor. This healthy donor is usually a sibling (related donor fully matched or haploidentical) or can be found from international donor registry (unrelated donor) or obtained from umbilical cord blood. Voluntary donor registries from India like DATRI are very active and have provided donors for multiple transplants.
A Transplant Process includes following phases- Stem Cell Collection from donor or patient, Conditioning with chemo-radiotherapy for the patient, stem Cell Infusion, pre-engraftment bone marrow suppression and post engraftment follow up. Average time taken prior to engraftment ranges from 3-4 weeks in the BMT unit. After that patient is discharged home on oral medications to prevent graft versus host disease and infections. Patients need to be in close regular follow up for first 3-6 months of transplant and advised to stay near the transplant centre. By one year post transplant, patient’s immune system recovers and most of the medicines can be stopped.
Side effects of transplant are due to Chemotherapy / Radiotherapy used in conditioning which is seen both in Autologous and Allogenic Transplants or Immunological Reaction known as graft versus host disease seen in Allogenic Transplants.
Nausea, Vomiting, Loss of Appetite – Usually it is for short period, lasting for few days. With the availability of modern drugs it can be prevented and controlled to great extent.
Mouth Ulcers – Usually mild, lasting for few days and not requires specific treatment other than pain control. Sometimes it can be severe enough to forbid drinking / swallowing, in that case patients are given nutrition through veins.
Hair Loss – High dose chemotherapy / radiotherapy used in conditioning results in universal hair loss but it is temporary as hairs come back within few months after transplant.
Fever – Patients are prone to infections due to markedly low white blood cell counts before engraftment. To prevent infections patient are kept in strict isolation rooms with filtered air till their blood counts improve.
Bleeding – Platelets are the blood component which prevents bleeding and their count decreased after conditioning, resulting in risk of bleeding in skin, mouth, nose or other sites. To prevent bleeding, platelets are transfused to maintain an acceptable platelet count. Once engraftment occurs, the platelet production starts and bleeding risk disappears.
Fertility – Temporary or permanent sterility may occur in almost all adult / adolescent male and female patients after transplant due to side effects of chemotherapy / radiotherapy although ability to have sex is not affected by transplant. It is advisable for males patients, who plan to have family to have their sperm stored for future use.
Graft Versus Host Disease – Once engraftment occurs, one side effect which is seen in Allogenic Transplant is Graft Versus Host Disease (GVHD). It refers to reaction mounted by donor’s blood cell to patient’s body. It occurs in spite of patient and donor being HLA matched hence medicines are given to prevent it from occurring. It is usually mild, affects skin (rashes), liver (jaundice) or intestines (loose motions, pain abdomen) but can be serious and life threatening in a fraction of patients. Once GVHD occurs, it does not mean that transplant has failed. This can be treated with immunosuppressive therapies with good results.
Relapse – Even though transplant is performed with curative intent, some patients with very aggressive disease may relapse. The risk of relapse decreases significantly after 2 years post transplant. Monitoring the patient regularly for relapse and early intervention with chemotherapy, decreasing immune suppression or donor lymphocyte infusion can be used to salvage relapse in many patients.