Developing a Haploidentical BMT Program in India: Tribute To A Master

Allogeneic (from a donor) Bone Marrow Transplantation (BMT) is a lifesaving procedure for many blood cancers and other non-malignant blood diseases. The basic principle of this procedure rests on the complete match of HLA antigens between the patient and the donor. The probability of that happening is 20% amongst the family members, and less than 1 in a million from any random person. Out of an estimated 20,000 patients requiring an Allogeneic (from a donor) Bone Marrow Transplantation (BMT) in India, only 500 odd patients receive one. Keeping in mind the resource constraints, the major reason for such disparity lies in the lack of HLA MATCHED family donors. Whilst unrelated donor marrow and cord blood from Volunteer Donor Registries and Public Cord Blood Banks meet the need for the ethnic majorities in Europe and the USA, such registries provide for less than 10% of BMT patients in India, due to both cost and an available match.

With this background, we initiated a HAPLOIDENTICAL FAMILY DONOR BMT PROGRAM IN 2011, planned and conceived by Dr. Suparno Chakrabarti. Dr. Chakrabarti had spent 13 years in the UK developing various forms of innovative approaches to BMT. It was his passion and patriotism, which drove his desire to do something for his own country. I had joined him in 2012 and since then we have tried to shape the future of HAPLOIDENTICAL BMT in our country.

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. Over the next 10 years, we have innovated newer approaches to improve the outcome of haploidentical BMT. With over 135 transplantation in advanced leukemia and other forms of blood cancer, we have shown that 75% of such patients can be long-term survivors. A major contribution to this process has been the employment of a novel form of immunotherapy.

Once, we were convinced about the safety of the procedure, we were encouraged to do BMT from Haploidentical Family Donors for patients with Aplastic Anemia as well. Aplastic Anemia is a disease which dries up the marrow and is often a result of chemical exposure or infections. The condition if not treated can be fatal in a very short time. After several years of research, we think we have perfected the way to do Haploidentical BMT in Aplastic Anemia as well. Our next endeavour is to explore Haploidentical BMT as a curative option for patients with Thalassemia and Sickle Cell Anemia.

Based on our years of extensive research, we have realised that Haploidentical BMT is not about selecting any half-matched donor in the family. It is about selecting the right donor for a particular disease. 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 and specific cells from haploidentical family donor is deemed to have a better chance of killing leukemia cells. This is because we have been able to reduce transplant-related complications after haploidentical BMT to an extremely low level. At the same time, we strongly discourage random application of Haploidentical BMT in diseases like thalassemia, without the right checks and balances.

Our work has been recognised in international forums. I have been presenting our research on Haploidentical BMT in USA and Europe for the past 6 years- a feat not equalled in our country. This is a tribute to the tireless efforts of Dr. Suparno Chakrabarti, who pioneered this program, at a time when none believed in it. This is one bright example of a brilliant Indian mind holding the beacon of light to the rest of the world. It is time this story of ‘Made in India’ is told and acknowledged.

Dr. Sarita Rani Jaiswal, Program Director in BMT, Dept of BMT and Hematology, Dharamshila Narayana Superspecialty Hospital, New Delhi

Narayana Health

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