Out of an estimated 20,000 patients requiring an Allogeneic Bone Marrow Transplantation (BMT) in India, only 500 odd patients receive one. Keeping in mind the resource constraints, the major reason for such disparitylies in the lack of alternate donors. Whilst unrelated donor marrowand cord blood from Volunteer Donor Registries and Public Cord Blood Bank meet the need for the ethnic majorities in Europe and the USA, such registries provide for less than 10% of BMTpatients due to both cost and an available match. In our initial screening of 50 patients referred for an Allogeneic BMT, a matched family donor was available in 11 patients and a suitable Haploidentical family donor was available for 49, whereas a fully matched unrelated donor from registries was available for none.
With this background, we initiated a HAPLOIDENTICAL FAMILY DONOR BMT PROGRAM IN 2011, planned and conceived by Dr Suparno Chakrabarti. I had joined him in 2012 and since then we have tried to shape the future of HAPLOIDENTICAL BMT in our country.We are pleased to announce that we have completed 50 Haploidentical BMT in 40 patients over the last 3 years.
HAPLOIDENTICAL OR HALF MATCHED BMT cannot be performed from unrelated donors and is only possible from close family members. The natural law of tolerance between mother and child is primarily utilised in such transplants. We initiated this program initially for patients with advanced and refractory Acute Leukemia as the procedure was experimental and conceived as high-risk. To our surprise, the initial 5 patients had no major complications and the transplants were successful. However, as the diseases were advanced, 4/5 patients had a recurrence of leukemia after 4-8 months. We did a second BMT from the same donor in all of them and it cured the disease in two of them. Now, that we were convinced about the safety of the procedure, we were encouraged to do BMT from Haploidentical Donors for patients with Aplastic Anemia and Thalasemia as well. After several years of research we think we have perfected the way to do Haploidentical BMT in Aplastic Anemia as well.
In addition, weinnovated a new technique of improving the outcome of HAPLODENTICAL BMT in blood cancers. We have performed 6 such consecutive transplants with the new method. Two of these patients were young and hopeless with a type of lymph node cancer which responds to no chemotherapy and radiotherapy. Today, 8 months after BMT, they are well and alive without any medications, back to normal life. A 65 year old gentleman with an end-stage blood cancer called myelofibrosis also underwent this sort of HAPLOIDENTICAL BMT and 4 months later he has a normally functioning bone marrow and is off all medicines as well. The other 3 patients are doing equally well; one, back to work overseas and the others likewise.
Haploidentical BMT is not about selecting any half matched donor in the family. It is about selecting the right donor for a particular disease, based on our years of extensive research. It is about having the right expertise, infrastructure and about having a dedicated team. Today, we choose HAPLOIDENTICAL donor with suitable criteria over a Matched Family Donor, if the blood cancer is advanced.
Our work has been recognised in International forums. As a tribute to the tireless efforts of Dr Suparno Chakrabarti, who pioneered this program, I shall be presenting this experience at the oral session of largest BMT conference in the world hosted at San Diego on February 2015.
