Stem cell transplantation is a component of the super-specialty training in Clinical Hematology. However, the field has advanced significantly and it is increasingly recognized that for those who intend on continuing to do stem cell transplants after their training in Clinical Hematology the current training is inadequate. It is widely recognized that an additional year or two of training and experience is required to make post-doctoral candidates competent to carry out stem cell transplantation independently. In the United States of America with a population of about 300 million there are approximately 135 transplant centers that report data to the Center for International Blood and Marrow Transplant (CIBMTR). Internationally about 13000 transplants were reported to CIBMTR, the majority from Europe and the USA. Currently there are four centers in India that report data to CIBMTR and about another 40 centers that offer stem cell transplants intermittently. We are the largest stem cell transplant program in the country and we currently do about 250 transplants a year. The need in the country is reflected in our waiting list for elective transplants which goes up to 2 to 3 years. Additionally, the need in the country for training in stem cell transplantation cannot be met by the current programs that are available in the country. There are very few centers that have large transplant program to offer such a training program. The proposed course could help meet these needs and will consist of a one year program.
The fellows spend their time in transplant dedicated activities in the department such as clinical care in the wards, laboratory areas that deal with transplant related activity such as apheresis, cryopreservation, blood banking and molecular testing.
The main objectives of the program can be summarized as follows:
- The Stem cell transplant fellow should demonstrate a comprehensive working knowledge and practical competency of the basic, cellular and molecular biology of hematopoiesis and BMT/SCT. In addition, the trainee should demonstrate an understanding of tumor immunology and the biologic and immunologic relationships between a donor’s hematopoietic cells and the host.
- Indication and role of autologous, full intensity allogeneic, low intensity allogeneic and tandem BMT/SCT in the management of hematologic diseases. The trainee should also be familiar with the role of the National Marrow Donor Program (NMDP) in identifying unrelated stem cell donors.
- The preparative regimens used in anticipation of autologous and allogeneic BMT/SCT.
- Practical experience in (or alternatively observe and understand) the method of collecting and handling bone marrow and peripheral stem cells for transplantation including their cryopreservation. This should include demonstrating an understanding of the approaches used to mobilize hematopoietic stem cells to the peripheral blood.
- Working knowledge and practical competency of the process of performing autologous and allogeneic BMT/SCT.
- Understanding and practical competency of the need for prophylactic and supportive care measures in the management of patients undergoing BMT/SCT. These should include an understanding of the pharmacologic and environmental approaches to preventing infectious diseases, the use of immunosuppressive therapies to prevent or decrease graft-versus-host disease, the effects of different approaches of “pre-treating” the stem cells (e.g. T-cell depletion) prior to transplantation, and the proper use of blood products while awaiting engraftment of the transplanted hematopoietic stem cells.
- Understanding and practical competency of recognizing the presentation, making the diagnosis, and managing the complications that can occur post-transplant, including marrow engraftment failure, acute and chronic graft-versus-host disease, opportunistic infections, veno-occlusive disease, and others.
- Understanding and ability to organize ancillary services needed to set up a stem cell transplant unit which include but are not limited to design and maintenance of transplant rooms, set up an apheresis unit, cryopreservation, Blood bank and HLA laboratory services, microbiology services, molecular laboratory and data management.
The fellowship is open to individuals with a DM in Clinical Hematology or Medical Oncology