Mr. N S a 27 years old gentleman was diagnosed to have Aplastic Anaemia 6 months back and have been having low haemoglobin, wbc count and platelet count requiring frequent blood transfusion. This is a life threatening condition of bone marrow failure and risk to life comes from severe infections and bleeding in these patients.
When he was seen at KDAH, he was advised to undergo HLA (Human Leukocyte Antigen) test & matching with his sibling brothers & sisters. HLA identical younger brother was identified and on evaluation was found to be fit for donating stem cells for his brother.
At KDAH, we have essential infrastructure in form of rooms with HEPA filtration facility with 10-12 air exchanges per hour and dust particles of only less than 0.3 micron can enter the rooms. This is very essential to prevent infections in early transplant period when patients have very low counts.
Transplant started on day -10 with patient receiving 10 days of intense immunosuppressive chemotherapy to knock off his failed marrow and allow his brothers stem cells to come in. His brother was given G-CSF injections to push his stem cells in peripheral blood and stem cells were collected by procedure called stem cell apharesis. After precise calculation of stem cell number, adequate number of stems cells was transfused into the patient on day 0 on 24th June 2011. Patient had practically zero counts for few days, followed by slow recovery as donor stem cells engrafted. Patient engrafted on day +11 after stem cell infusion with ANC of more than 500 and platelet count reached to above 1 lack on day +15.
Patient also received GVHD prophylaxis with cyclosporine and methotrexate. Patient will remain on cyclosporine capsules for 1 year with strict surveillance for GVHD & infections. Patient will get re-immunized after stopping cyclosporine as new immune system needs to be ready for infections.
Haematopoietic stem cell transplants (HSCT) or commonly known as Bone Marrow Transplant (BMT) is the only curative treatment for disease like aplastic anaemia which this patient had. In addition it is also curative treatment for patients with thalassemia and many blood cancers like AML, ALL, MDS, Lymphoma and Myeloma. It is also shown to be effective after high dose chemotherapy with certain relapsed/ refractory solid malignancies like breast carcinoma and Ewing's sarcoma etc. Other non cancerous conditions like primary immunodeficiencies, PRCA, osteopetrosis, Fanconi's anaemia, DBA etc can also be cured by stem cell transplant. Certain autoimmune disorders like SLE or multiple sclerosis can also be controlled by high dose chemotherapy with autologous haematopoietic stem cell transplant.
However, HSCT is a very complex immunological process which needs to be handled with precision.
At KDAH, we have excellent facilities, transplant experts and highly trained nursing staff to make all this possibility for Indian population now. It is one of very few hospitals in India to have these advanced facilities.
This patient is now discharged home on 8th July 2011 and doing well with normal counts.
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