A TALE OF HAPLOIDENTICAL BMT- OUR JOURNEY
India is a country of 8 billion people with diverse health issues. On one hand, the scourge of infectious diseases like TB, malaria, dengue and swine-flu are killings thousands every year and on the other hand, diseases like cancer and aplastic anemia are on the rise. Whilst prevention is the key to the former, the latter need a cure. The advances in modern therapeutics has made blood cancers curable by default. In the centre of this process lies the procedure of bone marrow transplantation (BMT). Unlike liver or kidney transplantation, BMT requires a fully HLA matched family donor which is available to only 20% of patients due to biological laws of genetics. The chance of finding a random HLA-match in the population is less than one in a million. Yet, the western world has developed volunteer unrelated marrow donor registries which meets the need of their population to a large extent. The complex social and economic equations in our system have thwarted the development of such large scale registries in India. The same holds true for another source of blood stem cell transplantation ie public cord blood banks which could otherwise offer an alternate source of transplantation, particularly in children (NB: this is not same as private cord blood banking which is widely publicised. Such banks store cells from the cord at the time of delivery only for use in the family if needed. The chance of such utilisation from private cord blood banking is less than a million).
Faced with this unique problem in our country, Dr Suparno Chakrabarti and Dr Sarita Jaiswal started a HAPLOIDENTICAL (HLA HALF MATCHED FAMILY DONOR) BMT program in 2011. Every individual is HLA-half matched with their parents and children and siblings (90% of time). BMT from such donors require expertise, experience and infrastructure. About 10 centres in the world now carry out Haploidentical BMT in patients lacking a matched sibling, ahead of matched unrelated donors. Dr Jaiswal and Dr Chakrabarti started this journey along with these select groups across Europe, USA and China 5 years back. Dogged perseverance, dedication and cutting edge research have enabled them to make Haploidentical BMT a success story in India as well.
It started with patients dying of leukemia not responding to treatment as Haploidentical BMT was deemed as beyond the realm of possibility in India by the national experts. Slowly they proved the success of the procedure and moved on to treat all sorts of blood cancers and aplastic anemia. As recognition of their research, the study was selected for an oral presentation at the Annual BMT meeting of American Society of Blood and Marrow Transplantation (ASBMT) and Centre for International Bone Marrow Transplant Registry (CIBMTR) in February 2015 at San Diego, USA. Dr Sarita Jaiswal presented their study of Haploidentical BMT on 41 patients demonstrating improving outcome in both leukemia and aplastic anemia over the last 4 years. The innovations in the field emanating from India were an eye-opener for all present in the meeting. For 5 consecutive years, the clinical basic research done at DNSH has been presented at BMT Tandem meetings, USA. Dr Jaiswal presented the data on how they have selected anticancer cells from the donors and given them to the patients after Haploidentical transplantation. It was indeed heartening to see that we are not blindly importing technology, but creating our own to meet our own needs. Dr Sarita Jaiswal now leads the Haploidentical BMT program at Dharamshila Narayana Superspeciality Hospital, New Delhi, which is equipped with the best clinical and laboratory infrastructure to carry out such transplants. The team has completed over 100 haploidentical BMT at DNSH with transplant-related complications of less than 10% and long term survival of 75% in the most difficult and aggressive cases of blood cancers.
It is important for both patients and doctors to understand that success in a new field of science evolves through painstaking research over the years with collaboration between centres. Dr Jaiswal paid tribute to Prof Franco Aversa, the father of Haploidentical BMT who trained her at Parma, Italy and to Prof Paul O’Donnell who was the biggest support when the Haploidentical BMT program was initiated and under whom she trained at Fred Hutchinson Cancer Centre, Seattle, USA. But above all, Dr Sarita acknowledged the contribution of Dr Suparno Chakrabarti, who not only trained and mentored her in this field but started this unique form of BMT 5 years back, when no one dreamt that this could be a reality one day.
Like any advanced technique, Haploidentical BMT is a safe procedure in the right hands. Along with Dr Sarita Jaiswal, we salute the patients who braved this procedure and are not with us today. Yet, they are the ones who have made Haploidentical BMT possible for the millions in our country.