Stem cell transplant cheap in India, but very few centres

January 16, 2011

Courtesy: bombaynews.net
Stem cell transplant in India costs a fraction of what it does abroad but the country has very few centres where the procedure can be done and not enough dedicated medical staff, says an expert.

Stem cell transplant, a process by which new cells are introduced into damaged tissue in order to treat disease or injury, has shown promise in treating various kinds of diseases, including some cancers. However, there are only 10-11 centres in India where it can be done, says Lalit Kumar, professor of medical oncology at the All India Institute of Medical Sciences (AIIMS) here.

A stem cell transplant can cost up to Rs.1 crore (approx $223,000) abroad, depending on the type of procedure, and the patient is asked to deposit the full amount before the transplant, Kumar told IANS.

In comparison, in India it costs Rs.10-20 lakh in private hospitals, while in government hospitals it is much cheaper – Rs.3-6 lakh – depending on the type of procedure, he said.

According to Kumar, stem cell transplant has shown 50 percent success in treating certain kinds of cancers and even more in other major conditions like beta thalassemia, a genetic blood disorder, and aplastic anaemia, a condition where bone marrow does not produce sufficient new cells to replenish blood cells. Stem cell transplant has shown 70-80 percent success in treating non-malignant diseases like aplastic anaemia.

Stem cells can be taken from siblings or family members after tissue matching, known as allogeneic transplant, from the patient’s blood, known as autologous transplant or can be harvested from a newborn’s umbilical cord, which is a rich source of such cells.

Among the major hospitals that carry out stem cell transplant are AIIMS and the Army Hospital in the capital, the Tata Memorial Centre and Jaslok Hospital in Mumbai and CMC in Tamil Nadu’s Vellore town. There are more than 500 centres in the world where stem cell transplant is done, he said.

‘Around 500 stem cell transplants are done in India in a year, which is very small compared to the need. We need many, many more centres in India,’ Kumar said.

India also needs to set up more stem cell banks and a registry of donors, like in the West, with complete information such as blood group and tissue matching to make it easier for matching for a stem cell procedure, he said.

‘A registry of donors is useful when a match can’t be found in the family of the patient for stem cell transplant.’

Besides setting up more stem cell transplant centres or setting aside an exclusive block in a hospital for the purpose, more trained doctors are needed as well as hospital staff, he feels.

‘There should also be more awareness among physicians so that they refer the patients at the right time for a stem cell transplant,’ he said.

Kumar said there is a better success rate in the case of thalassemia if the patient is referred by the treating doctor for a stem cell transplant early.

He added that more awareness should be spread about the procedure among the patient’s family and the community.

‘There is a lack of awareness about stem cell transplant among people. Many people asked to donate stem cells, even among the patient’s own family, feel they will get weakened by donating. And this is also true among the educated.

‘Stem cell donation is just like blood donation,’ Kumar said.

AIIMS has its stem cell transplant wing on the seventh floor of the cancer department. There are nine beds, and they are generally full, the doctor said.

The hospital does about five procedures in a month. For a procedure called allogeneic, where a genetically similar donor’s tissue is used, like a sibling or even an unrelated donor, great care has to be taken before and after the procedure.

In some cases, despite matching with the donor, the patient can reject the graft. Then it involves a long process of giving immunosuppressants, or medications that help prevent organ rejection in transplants and reduce inflammation, or steroids to help the patient in accepting the transplant, he said.


Cells that can save a life

December 10, 2010

Courtesy: health.asia.one

Life can sometimes deal kids and their parents a tough blow. But if there’s a choice between certain death or the chance of leading of a normal life, even if that means going though a complicated and extremely expensive transplantation process, then there’s little doubt about the option most will select – provided, of course, that the obstacles are removed.

“Many of my young patients simply wish to go to school,” says Dr Suradej Hongeng, associate professor with the Paediatric Hematology Oncology and Bone Marrow Transplant service at Ramathibodi Hospital

“The blood stem cell transplant is best way and the most efficient treatment to completely cure diseases related to blood cell irregularities including aplastic anaemia, thalassemia, acute and chronic leukaemia, lymphoma cancer, and primary immunodeficiency,” he says.

Patients who have matched blood stem cell will go through procedures to restore stem cells that have been destroyed by high doses of chemotherapy or radiation therapy.

“Without healthy bone marrow, the patient is no longer able to make the blood cells needed to carry oxygen, fight infection, and prevent bleeding. The successful stem cell transplantation can restore the bone marrow’s ability to produce the blood cells the patient needs. The overall procedure takes about two months for the patient to once again live a normal life. However, the cost of treatment is as high as Bt1 million for one patient,” Dr Suradej continues.

Thailand has a large number of patients suffering from diseases caused by blood cell irregularities, genetic disorders and diseases such as blood cell cancer and lymph gland cancer and in particular thalassemia, which affects as many of 600,000 to one million Thais. At least 20 million – 40 per cent of the population – are carriers of at least one of the abnormal genes and every year, 12 out of 1,000 infants is born with thalassemia.

For poorer Thais, stem cell transplants have always been out of reach. Now, some of them will be getting a helping hand thanks to Ramathibodi Foundation under the royal patronage of Her Royal Highness Princess Maha Chakri Sirindhorn, which recently launched the stem cell transplantation project in honour of Their Majesties the King and the Queen to mark the auspicious occasion of His Majesty the King’s seventh cycle birthday anniversary on December 5, 2011 as well as Her Majesty the Queen’s 80th birthday anniversary on August 12, 2012.

Professor Saengsuree Jootar, director of the project, says that the main purpose is to help those patients with financial problems. Initially, 100 possible patients who have matched blood stem cells will be treated under the project. Some are patients of Ramathibodi Hospital while others are receiving treatment at other hospitals. Yet others are patients under the royal patronage.”

In case of the Surakriangsaks family, seven-year-Pisitpong, was diagnosed with thalassemia when he just 12 months old. His parents were told back then that the only cure was a stem cell transplant. “I felt like my heart would break every time I saw my baby receive a blood transfusion. We seemed to spend so much time at the hospital,” says Pisitpong’s mother.

“Then doctors encouraged us to have a second child. It is the best to transplanted stem cells that match the recipient’s own stem cells as closely as possible. I prayed so hard for a baby with matched stem cell. Two years later Supasek was born and we were so lucky. He saved his brother life.” The family joined the foundation prior to the launch of the bone marrow transplantation project initiated in honour of HM the Queen’s 72nd Birthday.

“I believe every body loves life. They want to be cured and live normally,” says Dr Suradej. “When I was a medical student, many patients died as we could do nothing to save them. If a person has leukaemia, of course it depends on their condition, but at the maximum they have about six months to live. Today, we have the treatment to save them but it is still very expensive. With the last project we saved 79 lives and spent Bt80 million. Raising Bt100 million this time is certainly not easy but I believe that when you wish for the sake of others, it will come true,” adds the doctor with a smile.

The use of stem cells in Thailand is quite controversial, not least because of the advertising campaign that claims they are a “magic medicine” curing everything from brain and heart disease to old age. Pregnant women have also become targets through campaigns encouraging them to bank the placenta and umbilical cord for future benefits.

Dr. Suradej explains that apart from treatments for diseases linked to blood cell irregularities, which have medical approval, stem cell usage is still the subject of medical research. “This is very much about medical ethics. The only party that benefits from stem cell storage, which costs a great deal, is the storage company. Even the American Academy of Paediatrics does not recommend it, because the chance of using it is very minimal. If you want to do something useful with your stem cells, I’d recommend donating them to the Thai Red Cross Society. That way the stem cell storage will be for the public benefit and more valuable for the purpose of saving lives.”


In A First, Narayana Hrudayalaya Initiates Combined Cord Blood Repository

August 27, 2010

Courtesy: timesofindia

Parents can now donate their newborn’s cord blood for use by any patient or store it for their own use. For the first time, Narayana Hrudayalaya has initiated the combined cord blood repository with both public and private banking facilities.

Cord blood stem cells from a child are used to treat diseases like thalaseemia, a condition where the body has fewer healthy red blood cells and less haemoglobin than normal and Faconi, an inherited anaemia that leads to bone marrow failure. These cells could be used to cure these diseases in siblings and even in parents provided the Human Leukocyte Antigen (HLA) type matches.

If they need to bank a child’s cord blood, a decision needs to be taken about 2-3 months before the expected date of delivery. This helps to collect the cord blood and tissue immediately after delivery. The entire collection process has to be completed within 5 minutes of delivery of the child. The process is simple and can be done by any qualified obstetrician or a trained nurse and does not affect the health of either the newborn child or the mother. Otherwise, it’s difficult to collect and store the cells.

Dr Prem Anand Nagaraja, director, Narayana Hrudayalaya Tissue Bank and Stem Cell Research Centre, Bangalore, said: “Cord blood is obtained from the wasted placenta and umbilical cord at the time of childbirth. After the child is born and the cord is divided, residual blood in the placental circulation is collected using sterile procedures. The remaining umbilical cord is delivered and discarded. Stem cells extracted from this cord blood as well as cord tissue can be preserved for a long time in liquid nitrogen and used to treat many diseases and cure patients.”

Wide application

Four-year-old Mayur is suffering from Fanconi’s anaemia. Since he is the only child and bone marrow from his parents doesn’t match his HLA, he has no option but to go on regular blood transfusions to keep up his platelet count.

His mother Prathibha is now eight months pregnant and antenatal tests show that the foetus is free of the dreaded diseases. Newer indications for stem cell therapy are disease conditions like breast cancer, renal cell cancer, heart disease, spinal injury, Parkinson’s disease and Alzheimer’s disease. Research and clinical trials worldwide prove the success of cord blood stem cells in over 75 such disease conditions.

Dr Sharat Damodar, consultant haematologist, Narayana Hrudayalaya, said: “All these true stories speak volumes about the therapeutic potential of bone-marrow derived stem cells from a matched donor. In the absence of such a donor, cord blood derived stem cells can help cure dreaded hematological diseases like Thalassemia major, Aplastic anemia, Fanconi’s anaemia and over 14 such other conditions.”


A girl who was brought into the world to save her brother

August 27, 2010

Courtesy: dnaindia.com

This Raksha Bandhan will be the Bhavsar family’s most memorable yet. Their two-year old daughter Richa, who is also the saviour of her elder brother’s life, will tie him a rakhi in what will be his first truly happy festive celebration till date. While most parents will smile on this day, the Bhavsars will shed a silent tear of happiness as their last bundle of joy asks for health and happiness for the brother who owes her his life.

Richa, the Bhavsars’ youngest child, was brought into the world with the hope that she might save her brother from dying. Urvish, the family’s second child and presently seven-years old, was diagnosed with blood cancer at the age of four. Already a thalassemia major, the only way he could be saved was a bone marrow transplant from a sibling.

Little Richa proved the perfect biological match for her brother. Peripheral blood cells were collected from her blood and a stem cell transplant was undertaken on Urvish. The boy underwent a series of chemotherapy sessions and later, a bone marrow transplant in June. The procedure has borne positive results for Urvish. While his blood cells earlier had XY (male) chromosomes, they now have XX (female) chromosomes, which means that the blood flowing in his body is from his own sister Richa!

Dr Sandeep Shah, head of the Bone Marrow Transplant (BMT) department at Gujarat Cancer Research Institute (GCRI), said that this is a medical miracle where a child has been successfully treated for two major illnesses. Urvish’s blood samples show that the transplant has worked. And he will be cured of both thalassemia and cancer.

“However, he is still admitted at the hospital and has currently developed pneumonia. We wish that along with Richa’s bone marrow which cured him, her best wishes now take him towards good health and speedy recovery,” said Shah, adding that by next Raksha Bandhan, the boy is expected to have completely normalised.

Umang Bhavsar, who runs an optical accessories store in Naroda, was shattered when Urvish was diagnosed with blood cancer, after already being a thalassemia patient since he was three months old.The desperate parents, who were told that a sibling with a bone marrow matching Urvish’s would be the only hope, decided to have a third offspring (their first child’s bone marrow didn’t match with her brother’s).

However, their agony was compounded by the fact that Urvish’s younger brother Harsh, now five, didn’t prove a match. “Finally, in sheer desperation, we planned a fourth child, in the hope that we might prove lucky this time, and get a child who will save Urvish’s life,” said Umang. Richa proved a saviour, as her bone marrow matched 100 per cent with her brother’s.

Dr Shah from GCRI said that so far, 118 BMTs have been done in GCRI, of which six were also cord blood transplants. “However, Urvish’s case is the rarest of all as he was cured of both cancer and thalassemia. And success in his case has inspired us to surge ahead with similar others.”


Newborns and their power to save lives

August 22, 2010

Courtesy by: expressbuzz.com

Doctors say blood obtained from a newborn’s umbilical cord can be used to treat many blood diseases.

“Stem cells extracted from this cord blood as well as cord tissues can be preserved for a long time and used to treat many diseases and cure patients,” said Dr Prem Anand Nagaraja, director of Narayana Hrudayalaya Tissue Bank and Stem Cell Research Centre.

Dr Sharat Damodar, consultant haematologist at Narayana Hrudayalaya, said in absence of a matched donor, stem cells could help cure dreaded heamatological diseases such as thalassemia major, Aplastic anemia, Fanconi’s anemia and 14 such conditions.

Four-year-old Mayur, diagnosed with Fanconi’s anemia, has no sibling (to donate bone marrow) and the marrow from both his parents does not match his HLA. He has to depend on regular blood transfusion to keep up his platelet count. But there is hope for him. His mother is eight-month pregnant and antenatal tests have shown his yet-to-be born sibling is free from Fanconi’s anemia. Mayur can get cured from the stem cells obtained from his younger sibling’s umbilical cord. “Cord blood obtained from the wasted placenta and umbilical cord at the time of childbirth is collected using sterile procedures,” said Dr Nagaraja.

The decision to use a child’s cord blood is made three months before the expected delivery date.

Cord blood is collected immediately after delivery and the window of opportunity to collect and store them is very small. The entire process has to be completed within five minutes of the delivery.


Cryo Cell Pakistan

August 10, 2010

Introduction
Thalassemia is the most common inherited single gene disorder in the world. The thalassemias are a diverse group of genetic blood diseases characterized by absent or decreased production of normal hemoglobin, resulting in a microcytic anemia of varying degree.

Your blood count may be a little lower than other people of your age and sex, but this produces no symptoms. You were born with this condition and you will have it all of your lifetime. There is no need for treatment and most people who have inherited this are not sick and probably do not know they have it. A mild form of Thalassemia minor may be mistaken for iron deficiency anemia. Iron medicines are not usually necessary and will not help your anemia. They could even be harmful if taken over a long period of time.

If you marry a person who does not have Thalassemia Minor, your children may have Thalassemia Minor. If you marry a person who does have Thalassemia Minor, some of your children may have Thalassemia Major. You must decide if you want to take this risk in planning your family.

Symptoms of Thalassemia Major
An infant with Thalassemia Major appears normal at birth. If a child is well for the first five years of life, a diagnosis of Thalassemia Major is unlikely. The double dose of two Thalassemia genes causes an anemia that is so severe that regular blood transfusions must be given throughout life

A newborn with Thalassemia Major appears normal at birth. As they grow, infants with Thalassemia Major exhibit paleness and fussiness. Weakness and slow growth appear in the first or second years of life. The abdomen may swell due to an enlarged liver and spleen. Changes occur in the appearance of the face and head. The eyes appear slanted and the cheekbones become prominent.

Treatment for Thalassemia Major
Treatment involves blood transfusions that must be given every 4 to 6 weeks to sustain life.
Complications that may arise from regular blood transfusions include an overload of iron build up in vital organs causing diabetes, liver disease and heart failure. The spleen may become so enlarged or overactive that it has to be removed surgically. In the past, many patients died in their teens due to these complications.

Management of thalassemia is not enough. Researchers are investigating two potentially curative treatments:  Stem Cell transplantation and gene therapy. Both methods have shown promise.

In stem cell Therapy, there are two ways to go about it.

  1. Bone Marrow Transplant
  2. Cord Blood Transplant

Some children with thalassemia can be cured with a bone marrow transplant. However, this form of treatment is most successful when a donor who is an exact genetic match is available. Generally, a sibling or other family member is most likely to be an exact match. The procedure can cure about 85 percent of children who have a fully matched family donor. However, only about 30 percent of children with thalassemia have a family member who is a suitable donor.

Recent studies suggest that using umbilical cord blood from a newborn sibling may be as effective as a bone marrow transplant. Like bone marrow, cord blood contains unspecialized cells called stem cells that produce all other blood cell.

The beneficial results of stem cell transplantation from HLA identical family members for patients with severe thalassemia are clear. Class I patients have a very high probability of cure with a very low early and late morbidity and mortality. Delay of transplantation until the patient is in a risk category beyond class I substantially reduces the probability of transplant success and jeopardizes the reversibility of liver and cardiac damage. It is reasonable to suggest that patients with β-thalassemia who have HLA-identical donors should be transplanted as soon as possible.

Umbilical cord blood (UCB) has been shown to be capable of reconstituting the bone marrow of the patient with thalassemia after myeloablated pre-conditioning treatment. The major advantage of UCB over other sources of stem cells is the ability to cross HLA barriers, and there is evidence of less GVHD. The use of related – donor UCB stem cells with HLA mismatches at one to three antigens needs to be considered. It would be worthwhile to do a prospective study to evaluate the role of UCB stem cell transplantation in the treatment of the thalassemias and hemoglobinopathies.

Thalassemia is widely distributed throughout the world and is one of the major public health problems. The use of bone marrow transplantation, the only curative therapy for thalassemia, is limited because less than 30% of the patients have unaffected and HLA-identical siblings as donors. Cord blood stem cells, an alternative source of stem cells for transplantation, have been successfully transplanted into patients with several diseases after myeloablative therapy.

Testing for Thalassemia
If a person has Thalassemia Minor, the cause of the slight anemia is known and no other blood tests or treatments such as iron are needed. More important, since individuals with Thalassemia Minor can pass the Thalassemia gene to their children, most people would like to know if there is a risk that their children could inherit this severe blood disease.

A safe and reliable prenatal test to diagnose Thalassemia Major in a fetus as early as 10-12 weeks after conception has been developed. Couples who are at risk may want to consider this possibility.

Success rate of Stem Cell Transplantation (SCT) for Thalassemia?
In low-risk cases (less than 10 years of age, having regular chelation therapy, non liver enlargement and no transfusion-associated diseases like hepatitis or HIV), SCT provides a 80-90% cure probability, with 5% mortality rate and a 10% chance of rejection (thus leaving the child thalassemic).

Cost of storing Umbilical Cord Blood
In Pakistan, one Company namely Cryo Cell Pakistan, with the help of their affiliate in USA, offering collection, extraction and storing services. The normal fee was about USD. 2,000 but they are offering handsome discount on their price in the introductory period. Further details may be obtained from their website www.Cryocell.com.pk.


Boy needs aid for transplant

July 30, 2010

Courtesy: thestar.com.my

A 10-year-old boy suffering from thalassemia since he was one desperately needs a stem cell transplant.

Liew Chon Kong has been undergoing blood transfusions every month at the Sultanah Aminah Hospital since he was four.

Lam Mei Lin, 37, said Chon Kong, the elder of two sons, has been suffering from constant headaches and extreme fatigue since young.

“The doctors have said the best option now is to go for the transplant, as frequent blood transfusions put him at risk of an iron overload.

“Such overload can damage his heart and liver,” she told a press conference organised by Johor MCA Public Complaints Bureau chief Chia Song Cheng.

Lam, an administration officer at a factory, added that none of her family members had matching stem cells.

She had spent more than RM28,000 to search for a match via the Sultanah Aminah Hospital as well other hospitals in Singapore, but to no avail.

“I have since consulted a transplant team at Chang Gung Memorial Hospital in Taiwan, who has informed us that they have found a match.

“However, the suitable stem cells as well as the transplant cost about RM350,000 and the surgery is scheduled for October,” she said, adding that her husband was an air-conditioning technician.

Lam added that she had managed to collect RM50,000, but needed help from the public to raise the rest of the amount.

“I appeal to the public for their kindness as my son’s life depends on the surgery,” she said.

Chia hoped people could show their kindness to Chon Kong’s family.

Well-wishers can contact the Johor MCA headquarters at 07-2233915; or write to the party state headquarters at Fifth Floor, Bangunan MCA Negri Johor, Jalan Segget, 80,000 Johor Baru.


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