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1. Write to us your country / city name from where you are seeking medical opinion with your full contact details.

2. Send by email or by post copy of recent clinical observations / diagnosis / medical report translated into English.

3. Send images in JPEG file format.

4. Send us your age, transfusion received so far and / transfusion requirement frequency at present, your current blood counts and hemoglobin report / Pathological Reports or a summery of observations on them.

5. What is the age of recipient (patient) ?

6. What is the age of the donor, if it is a female donor, is she married and if so how many pregnancies she has had ?

7. When was the patient diagnosed ?

8. How many blood transfusions has the patients had? How many whole blood, how many PRBC, how many platelet?

9. The blood products were they irradiated and leucodepleted ?

10. Did he receive any blood from his own relatives ?

11. Did he receive ATG or ALG as part of the immunosuppressive therapy ?

12. Any of his family members had aplastic anemia ?

13. Has there been any HLA Type Match report available with the recipient / donor?

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Bone Marrow Transplants In India

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Major hospitals in India have oncology units comprising surgical oncology, medical and radiation therapy as well as the crucial Bone Marrow Transplantation (BMT). The BMT unit with high pressure hipa filters has helped achieve a very high success rate in the various types of transplantation.

Beginning in early 1983, bone marrow transplantation (BMT) facilities in India have undergone slow but steady growth. With about 50% disease-free survival in acute myeloid leukaemia and aplastic anaemia and 90% survival in thalassemia major, the results are encouraging. However, the outcome in chronic myeloid leukemia so far has been poor.

Cord Blood Transplant and Mismatched Allogeneic Stem Cell Transplant have been performed successfully in India, a feat that is remarkable and significant, considering the fact that the treatment costs one-tenth of what it does in the west. Special surgeons are available for individual organs. Plastic surgeons of repute provide treatment for head and neck cancer, breast cancer and other malignancies. Facilities offered include tele-therapy which includes simulation work stations to ensure high precision and safety during treatment at the 18 MV linear accelerator or telecobalt machines, brachy therapy and 3-D planning systems. In orthopedics, the Ilizarov technique is practiced for the treatment of limb deformities, limb shortening and disfiguration.

TYPES of Bone Marrow Transplants;

Autologous and Allogeneic Transplants
Two important requirements for a bone marrow transplant are the donor and the recipient. Sometimes, the donor and the recipient may be the same person. This type of transplant is called an autologous transplant. It is typically used in cases in which a person's bone marrow is generally healthy but will be destroyed due to medical treatment for diseases such as breast cancer and Hodgkin's disease. Most bone marrow transplants are autologous. If a person's bone marrow is unsuitable for an autologous transplant, the bone marrow must be derived from another person in an allogeneic transplant.

Allogeneic transplants are more complicated because of proteins called human lymphocyte antigens (HLA) that are on the surface of bone marrow cells. If the donor and the recipient have very dissimilar antigens, the recipient's immune system regards the donor's bone marrow cells as invaders and launches a destructive attack against them. Such an attack negates any benefits offered by the transplant.

What is HLA MATCHING?

There are only five major HLA classes or types-designated HLA-A,-B, -C,-D, and class III-but much variation within the groupings. For example, HLA-A from one individual may be similar to, but not the same as, HLA-A in another individual; such a situation can render a transplant from one to the other impossible.

HLA matching is more likely if the donor and recipient are related, particularly if they are siblings; however, an unrelated donor may be a potential match. Only in rare cases is matching HLA types between two people not an issue: if the recipient has an identical twin. Identical twins carry the same genes; therefore, the same antigens. A bone marrow transplant between identical twins is called a syngeneic transplant.


NEW ADVANCEMENTS in Bone Marrow Transplantation

Haploidentical Allogeneic BMT for patients without donors

Haploidentical Allogeneic peripheral blood stem cell transplant offers an innovative option for patients who cannot be suitably matched with a family member, or who do not have an unrelated donor readily available for transplant.

This technique makes it possible to use partially matched family members as donors.

In this new procedure, peripheral blood stem cells are collected from the donor, and depleted of T cell lymphocytes known to cause graft-versus-host disease. The first treatment phase for the patient includes chemotherapy, immunosuppressive drugs, and radiation. Transplant specialists can then infuse the prepared cells from the donor into the patient's body. This transplant method allows physicians to select a partially matched donor from the patient's family whose white blood cells will act as natural killer cells against the leukemic cells of the patient.

Peripheral blood stem cell transplants

A relatively recent development in stem cell transplantation is the use of peripheral blood cells instead of stem cells from bone marrow. Peripheral blood stem cells (PBSCs) are obtained from circulating blood rather than from bone marrow, but the amount of stem cells found in the peripheral blood is much smaller than the amount of stem cells found in the bone marrow. Peripheral blood stem cells can be used in either autologous or allogeneic transplants. The majority of PBSC transplants are autologous. However, recent clinical studies indicate that PBSCs are being used more frequently than bone marrow for allogeneic bone marrow transplantation.

The advantages of PBSC transplants when compared to bone marrow transplants are: in allogeneic transplantation, haematopoietic and immune recovery are faster with PBSCs which reduces the potential for disease recurrence, primarily graft-versus-host-disease. In autologous transplantation, the use of PBSCs can result in faster blood count recoveries. Also, some medical conditions exist in which the recipient cannot accept bone marrow stem cell transplants, but can accept PBSC transplants. Some possible disadvantages to PBSC transplant versus bone marrow transplantation are: so much more fluid volume is necessary to collect enough PBSCs that, at the time of infusing the new stem cells into the recipient, the fluid can collect in the lungs or cause temporary kidney problems. Also, the time commitment for the donor for a PBSC transplant is considerable. When the PBSCs are being collected, several outpatient sessions are needed and each session lasts approximately two-four hours.

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An easy guide to some of the scientific terminology.

Allogeneic transplant
When stem cells are donated from one person and transplanted into another person to be used as a treatment for certain illnesses and conditions

Autologous transplant
When stem cells are taken from a person and then transplanted into the same person to be used as a treatment for certain illnesses and conditions

Cell expansion technology
This allows doctors to increase the number of stem cells in a unit in a controllable way. Many future treatments rely on cell expansion technology as these treatments need a larger supply of stem cells than can be obtained from a single cord blood unit. Cell expansion technology research is progressing well and the first patented processes are expected to be in place by 2010.

Haematopoeitic
This relates to the creation of blood in the body. A haematopoietic stem cell is one that can divide and produce blood cells.

Human Leukocyte Antigen (HLA)
Tests performed on the cord blood stem cell unit that identifies tissue types. Tissue types are similar to blood types. For a person to receive a transplant of cells or tissue from someone else, they must have the closest possible tissue type 'match'. Our tissue type is determined by our DNA. There are millions of possible tissue types, so a large bank of stem cells increases the chance of finding a matched unit when one is needed

Leukaemia
Is a cancer of the blood forming system, the blood forming system is found in the bone marrow. In leukaemia, some blood cells do not grow properly, but remain within the bone marrow and continue to reproduce in an uncontrolled way. These cells fill up the bone marrow and prevent it from making healthy white blood cells. This means the body is less able to fight off infections. There are many different kinds of leukaemia.

Match / Matched
Refers to a tissue typing match, the scientific term for this is HLA-type match. Tissue types must be matched as closely as possible between the person donating stem cells and the person receiving them to reduce the risk of rejection.

Peripheral blood
This is the blood that circulates around the arteries and veins of the body.

Processing
The way in which the stem cells found in umbilical cord blood are extracted from the blood, counted, tested and frozen ready for long-term storage.

Regenerative medicine
This is about treatments in development that, in the future, may be able to treat diseases and injuries by using stem cells to repair or regenerate damaged cells and tissues in the body.

Stem cell
A special kind of cell that can divide many times to make exact copies of itself, or to make specialised cells that do a particular task in the body for example a blood cell, bone cell or liver cell. Some people call stem cells ‘master’ cells or ‘blank’ cells because they can change into so many different types of cell.

Tissue type / typing
Tissue types are similar to blood types. For a person to receive a transplant of cells or tissue from someone else, they must have the closest possible tissue type 'match'. Our tissue type is determined by our DNA. There are millions of possible tissue types, so a large bank of stem cells increases the chance of finding a close match when one is needed.

Transplantation
Taking cells, tissues, or organs and placing them into the same person or a different person to treat disease.

Unit
Stems cells collected from the umbilical cord are properly described as a ‘cord blood stem cell unit’.

For Detailed Dossier on Bone Marrow Transplantation, please write to us at  mktg@mediescapes.com

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