Stem Cell Transplantation

Clinical and Laboratory Services

The aim was to develop comprehensive haematology services for patients with the entire range of haematological diseases. In beginning therefore, the emphasis was on establishing technology and standardizing practices related to management of anemias, haemostatic disorders, transfusion medicine and the care of people with haematological malignancies in a way that was not available in the country. The challenge was to introduce state of the art protocols for care, for patients with acute leukemias and those requiring stem cell transplants.

Malignant disease

The department of Haematology is involved in the treatment of the entire spectrum of haematological malignancies. This includes all acute and chronic leukemia’s. We also treat all subtypes of lymphoma’s and myeloma’s. All efforts are made to integrate modern technology in a cost effective manner to treat all patients. Some of the highlights of this area of work can be summarized under the different malignant conditions we treat:

  • Acute Lymphoblastic Leukemia: We treat both paediatric and adult acute lymphoblastic leukemia patients. Our treatment regimens are based on the international Berlin Frankfurt Munich (BFM) regimens. Karyotyping, molecular markers are routinely used to risk stratify patients. We treat about 75-100 patients with newly diagnosed ALL every year. For relapsed patients an allogeneic stem cell transplant is considered where possible. All efforts are made to treat all newly diagnosed cases, especially the pediatric population, where the clinical outcomes are excellent and have been reported by us in peer received journals.
  • Acute Myeloid Leukemia: We diagnosis about 200 – 250 patients with acute myeloid leukemia every year. Karyotyping and molecular markers to risk stratify patient is routinely used. Risk stratified therapy based on age and performance status is offered. For young patients conventional induction and salvage chemotherapy and an allogeneic stem cell transplant in complete remission is offered (except good risk) in first complete remission. For elderly patients treatment or supportive care is individualized based on age and performance status.
  • Acute promyelocytic leukemia: At our centre we have pioneered the use of a low cost effective regimen with arsenic trioxide to treat this condition. We have reported our clinical experience and also conducted a multi centre clinical trial in the country on the use of this regimen. Ongoing research and clinical trials are attempting to further improve the clinical outcomes.
  • Chronic myeloid leukemia: There are more than 1000 patients with a diagnosis of Chronic myeloid leukemia registered at our centre and receive treatment on the GIPAP program free of cost. Our centre has been involved with international standardization of the molecular test and this gives us a better handle to intervene early in cases that are not responding to therapy. A number of research projects are ongoing at our center to address mechanisms of resistance in this condition
  • Lymphoma and myeloma: All subtypes of lymphoma and myeloma are diagnosed and treated at out centre. We have access to excellent histopathology, immunohistochemistry, flow cytometry and molecular tests to make a correct diagnosis of the subtype which is critical in this field. From routine chemotherapy to stem cell transplant, where appropriate, is offered at our centre. All patients with multiple myeloma < 65 years of age are offered an autologous stem cell transplant at out centre.

Stem Cell Transplantation

Beginning in 1986 we have developed the largest and most sought after stem cell transplantation service in the country. While we do about 110 allogeneic transplants every year for wide range of haematological diseases, the major indications for allogenic transplants are beta thalassemia major, bone marrow failure syndromes such as aplastic anemia and myeloidysplastic syndromes and acute myeloid and lymphoblastic leukemias. Autologus transplants are mainly done for patients with myeloma and relapsed lymphomas.

In 2008, we moved into a new transplant unit with 10 beds. It is a model on which many other such units have been designed in India. Apart from allowing us to consolidate our services, we have also been able to initiate a regular program for transplants using alternative donors (other than matched related), using international donor registries to identify matched unrelated donors as well as haplo-identical donors from the family. This way many more patients who could not benefit from this form or treatment earlier can now be helped. This is another area where from the department are internationally noted.

Apart from these services specially mentioned above, the department also provides start of the art care for patients with haematological malignancies, particularly acute and chronic leukemias. Children and adults from all over India and some neighboring countries also get referred here particularly if initial treatment at their local countries has failed.

In all these services clinical work is complemented by many laboratory tests utilizing molecular genetics, immunophenotyping and cytogenetic techniques towards the diagnosis and management of various heritable genetic disorders, haematological malignancies and bone marrow failure syndromes. Our work and the clinical care we provide would just not be the same without them.

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