Haplo-Identical Bone Marrow Transplantation, “The Glass is Always Half Full

A New lease of Life for the patients of blood disorders,who need transplants but

cannot find donors, who are a perfect match to them.

The wait for the perfect match is over.

A 25 year old IT professional was struck with Hodgkin ’s disease which is one of the most

curable cancers. He was treated with standard chemotherapy and the disease went away only

to reappear a few months later. This time he received local radiation and Autologous Bone

Marrow Transplantation (BMT). However, the response was shortlived and the cancer sprung

its ugly head within 6 months.

The young man and his distraught family went from one centre to another. Various forms of

chemotherapy and a new drug called Brentuximab were suggested to him by the experts.

However, the drug Brentuximab had to be imported and each cycle of treatment would have

costed 5 lakhs. Some had suggested an Allogeneic BMT but his only brother was fully

mismatched with him and this option was no longer a consideration.

Dr Suparno Chakrabarti and Dr Sarita Jaiswal had been running a HAPLOIDENTICAL BMT

PROGRAM in the country for 3 years and the patient and his father came to them at

Dharamshila BMT Centre despite all the other experts in the country discouraging them to go

for such an option. At the outset, the patient was given standard chemotherapy which showed

an initial response, but as it had happened so many times before, the cancer bounced back.

The patients parents were half matched with him as expected, but the team at Dharamshila

realised that just doing the BMT is not going to help the young man. They identified a unique

population of white blood cells in the father, but not in the mother which could kill the tumour

cells without causing any adverse reaction in the patient. They are called ‘KIR ligand

mismatched NK cells’’. These cells were analysed and were found very effective in killing

tumour cells in the test tube. Dr Sarita Jaiswal had been trained in transplants involving such

cell manipulations at Italy and USA. The patient’s body could not have received any further

intensive chemotherapy. They sought help from Dr Kanika Sharma to administer a small dose

of radiation to the entire body keeping in mind that he has already received a very large dose

of radiation to his heart, lungs and neck. With this tiny dose of radiation and some

immunosuppressive drugs the patient was infused half matched cells from his father and 7

days later his father’s white cells were collected and the special cells were separated and

infused to the patient.

The stem cells from the father started growing in the patient after 2 weeks and he remained

free of all bacterial and viral infections since then. The blood and bone marrow of the patient

were regularly analysed and it showed that the cells from the father which were supposed to

be killing the tumour without causing any reaction in the patient, were growing in number.

Five months after the BMT, a PET scan was done to see the state of the cancer. To everyone’s

joy and surprise, it had disappeared completely.

Few such cases have been reported worldwide and this is the first time Indian doctors have

used innovation, science and technology to cure such a refractory cancer. Dr Sarita Jaiswal had

seen some very impressive results with Haploidentical BMT using cell manipulation, but to

replicate the procedure in its entirety would cost 40 lakhs at least. Hence, Dr Sarita innovated

this unique way of carrying out the Half matched BMT at a low cost and administer selective

cells at the right time which shall help in hitting the tumour as well as fighting infections.

Several such Haploidentical BMT using this unique and innovative technology are being carried

out by Dr Sarita Jaiswal at Dharamshila BMT Centre. Dr Sarita says that it is not just about

giving the cells but understanding the science behind it and applying it in the right context in

the correct way. Dr Suversha Khanna, who had long dreamt of a BMT unit at Dharamshila

Hospital expressed her satisfaction at the optimum utilisation of the world class infrastructure

so painstakingly erected in the hospital, 20 years after its inception. She said that that there is

little point in having yet another BMT centre, if it’s not going to make a difference to the

majority of the suffering patients. Today, with the infrastructure and the expertise of the BMT

team, ably supported by Radiation Oncologists, its possible that every patient who needs a

BMT can have one from a Half matched (HAPLOIDENTICAL) Parents, Siblings or Children and

with the right choice of donor can even get cured of otherwise refractory blood or lymph gland

cancers. Dr Suparno Chakrabarti who had started such transplants for the first time in India

says that the ‘glass is always half full’.

ABOUT DHARAMSHILA HOSPITAL A ND RESEARCH CENTRE

Passion for Excellence in Cancer Care

A group of concerned relatives and friends of cancer patients felt the need to provide complete

cancer treatment under one roof. They felt it was their “Dharma” (duty) to provide to cancer

patients what was not available to their near and dear ones, when they were suffering from

cancer. They laid the “Shila” (foundation) of their duty by registering a NGO, Dharamshila

Cancer Foundation And Research Centre (DCFRC) on 19 April, 1990.

DCFRC Commissioned the first phase of the Dharamshila Cancer Hospital And Research Centre

(DCHRC) with 100 beds in 1994 and expanded to 300 beds in 2006, with the sole objective of

making cancer treatment available, accessible and affordable.

Being totally focused on cancer for more than two decades, Dharamshila is continuously

adding world class cutting edge technologies for early diagnosis and cancer treatment.

Dharamshila Hospital is the most trusted cancer hospital for patients from all over India and

neighbouring countries for its policy of avoiding unnecessary procedures/hospitalization and

transparent billing. Dharamshila hospital has won the goodwill of thousands of Patients who

are enjoying cancer free life.

Highly qualified skilled and experienced teams of organ specific cancer specialists practice

evidence based medicine and follow international treatment guidelines to achieve best

treatment outcomes.

Being sensitive to the physical, medical, emotional and financial needs of patients, Dharamshila

strives to serve patients with love, devotion, compassion, commitment and positive attitude.

High quality standards of treatment, complete patient safety and satisfaction, improving cure

rates and adding quality to life will always remain our hallmark.

PIONEERING STEPS

•First comprehensive cancer care centre of North India, commissioned in 1994.

•First cancer hospital of India to start CliniMACS based TCR alfabeta depleted Haplo-identical

Bone Marrow Transplantation in BMT unit designed as per (half matched) International standards

1000 for clean rooms.

•Only cancer hospital of North India doing most challenging Head and Neck Surgeries with

results at par with European Cancer Institutes.

•First and Only Cancer Hospital of Delhi, offering Third Generation Radiation Technology i.e.

Elekta Synergy VMAT with IMRT, IGRT, SBRT and SRS / SRT and Respiratory Gating

Capabilities and best Treatment Planning systems like Monaco, CMSxi0, ERGO++ and Plato.

•First cancer hospital of India accredited by National Accreditation Board for Hospitals and

Healthcare Providers (NABH) in 2008.

•First cancer hospital of North India accredited by National Accreditation Board for Testing and

Calibration Laboratories (NABL) in 2010.

•First cancer hospital in India, certified for implementing integrated Quality and Environment

Management systems conforming to ISO 9001:2008 and ISO 14001:2004 standards by TUV-

NORD, Germany in 2002.

•First hospital of India, given accreditation by National Board of Examination(NBE) for the

Diplomate National Board (DNB) Programme in medical and surgical oncology in 2001 and 2004

respectively.

•First Cancer Hospital of North India to Start Post Basic Diploma in Oncology Nursing (PBDON)

in 2010.

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