RFH did a novel immunologically advanced Haploidentical Bone Marrow Transplant by TCR alphabeta (ex vivo removal of alloreactive T cells causing damage to host) and CD45RA depletion (removal of Naïve T cells) and infusing desired memory T cells for faster immune reconstitution. This advanced Bone Marrow Transplant has been done for the first time in India.
Baby Aadya, 3yrs, was suffering from Acute Leukemia (Blood Cancer). She relapsed in the first year of treatment (around 20% children fail treatment and relapse). Her case was high risk because of early relapse and other disease related complications. As per literature the chances of survival in such cases are not more than 15% in best of centers worldwide. Mostly such patients are offered palliative care, especially in resource limited countries.
Since the child did not have a sibling, and also could not find matched related or unrelated donor in worldwide marrow donor registries. However, At RFH, the pediatric Hemato-oncology speciality took this case as challenge. Dr. Shweta Bansal, Consultant - Paediatric Hemato Oncologist, counselled the parents for Haploidentical Transplant where a parent could be a donor. Haploidentical transplants are being done in India from last 2 - 3 years only and in most cases done by conventional method (removal of in vivo alloreactive T cells) which have increased chances of GVHD (Graft versus host disease) and delayed immune reconstitution leading to morbidity and increase chances of relapse. All these factors were undesirable in the present case and since patient was heavily pretreated rapid immune reconstitution was required to prevent viral reactivations and opportunistic infections.
At RFH we have used the latest technology, removing all the unwanted cells (which causes GVHD) and also infusing useful cells CD45RO cells (for rapid immune reconstitution to prevent post-transplant infections) from the donor’s stem cells. Only a few centers in USA and Singapore have used this technique, so far. We also used newer method of giving radiation. Instead of giving whole body irradiation, Dr. Prasad Dandekar and his team delivered Total lymphoid irradiation decreasing the side effects of radiation in such a young child.
The child responded well and is now almost 100 days post-transplant. With this technique we are now capable of treating complex cases with much less morbidity and mortality.
We also managed to do this transplant at a fraction of the cost what the parents would have, otherwise spent, abroad.
The various departments and consultants involved in the case were as follows: Dr. Mahesh Balsekar (Senior Pediatrician), Dr. Shweta Bansal (Pediatric Hemato – Oncologist – BMT Physician), Dr. Samir Shah (Senior Hematologist - BMT Physician), Dr. Prasad Dandekar (Head, Radiation Oncology), Dr. Hemant Mehta and team (HOD, Department of Anesthesia), Dr. Joyce Regi (Blood Bank In charge), Dr. Shashikala Shivaprakash (Senior consultant, Microbiology), Dr. Meena Desai (Head Lab Medicine), Dr. Archana Vazifdar, Major Ranjana Williams (Head Nursing and her team).