http://articles.timesofindia.indiatimes.com/2013-06-20/pune/40092346_1_bone-marrow-transplant-patientsThis article appeared in Time of India on 20th June (leading newspaper in India)
PUNE: At 13, Ali HousseinMoayad is a regular teenager hooked to videogames. What sets him apart from other teens is that this is the first time in his young life when he can play without feeling unwell. For 11 years, Ali underwent blood transfusions every 21 days to treat his disorder of thalassemia major, which made it difficult for his body to synthesise its own haemoglobin.
But things changed for the Iraqi teenager last October, when he successfully underwent a bone-marrow transplant at a hospital in Pune, with only a partially-matched bone-marrow transfused from his own mother using the 'Haploidentical transplantation' protocol. Eight months on, Ali is free from the once binding need for blood transfusions and all medication related to transplants. His haemoglobin has touched a healthy 14.7gm/dl and he is now prescribed only simple drugs to keep off viral infections.
Ali is among a handful of patients who have been successfully treated in the city using the haploidentical transplantation method for disorders such as leukaemia and aplastic anaemia.
Ali's recovery has brought much relief to his parents. Ali's father, Houssien Moayad Houssien, who has brought him again to Pune for a routine check-up says their lives have changed following the transplant. "My daughter too was a thalassemia major, but she could be treated as her bone marrow matched with her elder brother's. Ali's bone-marrow, however, did not match with his siblings. Initially, I was very sceptical about coming to India for treatment, but I got a lot of confidence with the kind of treatment we received here. I am very happy because Ali has become healthier and now regularly attends school," he says.
Haematologist Vijay Ramanan, who treated Ali, says the treatment's success is significant because it expands the donor-base for thalassemics who don't find a perfect bone marrow match in their family. "Only 15-20% of the thalassemic patients are able to find a perfect-match donor in their siblings. The rest of them can get an unrelated donor from the bone-marrow registry or the cord blood bank, which can be a very expensive procedure. A haploidentical transplant makes it possible to treat the disorder with fewer complications, even with a 50% match of the bone-marrow, which is usually of the mother," he says.
Ramanan said in this treatment the bone marrow from the mother is transfused into the child using the normal transplant procedure. "While in a normal transplant, the immunity of the patient is suppressed for about 6-9 months, in this case, the backbone of the therapy is the post-transplant treatment with a drug called cyclophosphamide, coupled with the right amount of patient care before and a little after the transfusion," he says.
Vibha Bafna, paediatric haemato-oncologist with a city hospital says the therapy is good, but notes that it needs the correct conditioning for it to be successful. "Haploidentical transplants are definitely a great advancement for patients who require a bone marrow transplant, because identical matches are either not possible, or are very expensive. But the treatment needs to be done with a lot of care, and the right amount of pre- and post-conditioning of the patient to reduce risk of infection and rejection. Once patients have successfully crossed the one-year post-operative period, they can lead an absolutely normal life," she says.
The biggest advantage of this line of treatment is the availability of the donor in the form of the mother or father, says paediatric haematologist Sandip Bartakke. "A complete match of the bone marrows of the patient and donor is the ideal treatment. But that does not usually happen and a haploidentical transplant can be considered in such cases. There is a greater risk of rejection, but with more research being done on the issue, it has the potential to become a widely accepted form of treatment in the coming years," he says.
Understanding haploidentical transplantation
* Doctors administer just enough chemotherapy to suppress the immune system, which keeps patients from rejecting the donated marrow without harming their organs. As a result, the side effects are much milder.
* Three days after the transplant, a patient is given a high dose of a drug called cyclophosphamide, which "re-boots" the immune system by sparing the donor's stem cells and allowing them to establish new blood cells and a new immune system. The budding immune system is re-trained to see the patient's body as friend, preventing the patient from rejecting the transplanted bone marrow.
* This procedure, which allows transplants with half-identical, or 'haploidentical' (related) donors has similar outcomes as seen in matched transplants.
* The technique, which has been developed by physician-scientists at the Johns Hopkins Kimmel Cancer Center in 2000, greatly expands the potential donor pool, making more patients eligible for the transplant.