Dear Atanu, Welcome to the forum...
There is an APOLLO SPECIALITY HOSPITAL, CHENNAI, where I am to understand that a lot of research is underway. We plan to visit the hospital in Dec 2007.
Also, Dr. Myman Chandy from VELLORE Hospital is an expert in Thallasemmia and BMT with related donor.
Hope this helps.
Roopa
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I came across this article in the HINDU, India national newspaper.
http://www.hinduonnet.com/seta/2004/02/12/stories/2004021200021400.htmBlood — a preferred choice
Harvesting stem cells from blood is a painless procedure. Faster engraftment translates to reduced chances of getting infected and quicker recovery time.
THE NEXT time you bleed, remember you lose not just the well-known blood components like red blood cells that carry oxygen, white blood cells that fight infection and platelets but also stem cells. Stem cells, the building blocks of the body, are not restricted to bone marrow, cord blood or other organs, but are found circulating in the body. Wait a minute before you scoff at this as another piece of information that the medical community is throwing at you; it is a potential lifeline for those suffering from certain types of cancer and genetic disorders like thalassemia. And you have a big role to play. You could be a donor if your sibling is suffering from one of these diseases.
Stem cells found in the blood stream are called `peripheral blood stem cells.' Although easily accessible, the concentration of stem cells is in no way comparable to those found in the bone marrow. Bone marrow is by far the rich source of stem cells in the body and the concentration is nearly hundred times that of peripheral stem cells. Incidentally, only less than one in lakh cells in the bone marrow is a stem cell.
It was therefore only natural for doctors to harvest the bone marrow for stem cells. But this traditional procedure has its own share of problems. For one, the donor is administered general anaesthesia before the bone marrow containing stem cells is harvested. "Nearly 300 aspirations are required to collect nearly 1000ml of bone marrow," said Dr.V. Lakshman, Senior Consultant Haematology, Apollo Speciality Hospital, Chennai. Aspiration is the process of removing small quantity of sample (usually 3ml) at a time from the bone marrow using a long needle.
That is not all. As in any transplantation procedure, the patient undergoes a high dose of chemotherapy and/or radiation prior to the procedure to cleanse the bone marrow of all cells. Once new stem cells are introduced, it takes nearly three weeks in the case of bone marrow transplantation for new white blood cells, red blood cells and platelets to be produced. The patient is susceptible to infections during this intervening period when the WBCs that fight infections are either missing or just being formed. The aim is therefore to reduce this vulnerable period.
The peripheral stem cell harvest and transplantation is able to do just that. In this case, the stem cells are extracted from the donor's blood in a process quite similar to how platelets are removed. The donors are connected to a cell separation machine or `apheresis' device. A needle is inserted in each arm and blood is withdrawn from one arm and circulated through the machine to extract the stem cells. The remaining cells are returned to the donor through a needle in the opposite arm. Typically, the stem harvest takes about three hours. The procedure is the same in the case of autologous transplant where the patient's stem cells are harvested.
This procedure is painless and can be done without anaesthesia. Donors may occasionally experience coldness, numbness around the lips, or cramping in the hands during the harvest. Since the number of stem cells in blood is far less compared to bone marrow, drugs called growth factors are given prior to harvesting them. These drugs help in exponentially increasing the number of stems cells in blood from 0.02 per cent to 0.5-1 per cent.
The stem cells harvested from the blood are transplanted in to the patient's body through the large central vein in the neck or groin. The current thinking is that the stem cells introduced thus find their way to the bone marrow, where they begin to produce new blood cells (WBCs, RBCs and platelets). The greatest advantage with this procedure is that engraftment (the process of forming new blood cells) is faster compared to bone marrow transplantation. "Engraftment takes place within 10-14 days. Faster engraftment translates to slimmer chances of getting infected and reduced stay in the hospital," pointed out Dr. Lakshman. But other requirements such as perfect tissue match between the donor and recipient remain the same and risk of mortality hovers around 30 per cent in the first 100 days.
Apollo Speciality Hospital, Chennai, has so far done 128 transplantations. Of this 120 are peripheral blood stem cell harvest and transplantation. "We now do only peripheral bone stem harvest and transplantation and no longer do bone marrow transplantation," said Dr. Jose M. Easow, Consultant in Medical Oncology, Haematology, Blood & Marrow Transplantation at the Apollo Speciality Hospital, Chennai.
Unfortunately, not everyone is an ideal candidate for this procedure. According to Dr. Easow, patients who are 45 years and above are not ideal candidates. Those who suffer from aplastic anaemia can be treated with stem cell transplant provided the number of transfusions done prior to transplant is less than 15. Same is the case with thalassemia patients. "More the transfusions, varied will be the antigens present in the blood. This increases risk of stem cell rejection despite a perfect tissue match," explained Dr. Easow.