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.
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.”
The city’s first bone marrow transplant has been performed successfully in the district by a leading haematologist on a woman.Bone marrow transplant is a complex procedure like Kidney and liver transplantation and is a boon for patients suffering from various diseases like Thalassemia, Blood Cancer, Myeloma and Lymphomo, Dr Pritesh Junagade, who is also haemato-oncologist, told reporters last night.”The 21-year-old woman from Sangamner, who underwent the procedure, had a plastic anaemia and she needed regular blood and platelet transfusion to keep her alive. Her brother was tested to see if his bone marrow matched. It did and the marrow was removed from the donor and placed in the patient,” he said adding four weeks later, the patients blood count was normal.Dr Junagade, who was in London for seven years and returned to Nashik, said the transplant was carried out successfully at the cost of Rs 5.5 lakh.
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.”
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.
AHMEDABAD: It was double whammy for little Urvish Bhavsar. Born with thalassemia major, a serious blood disorder which requires regular blood transfusion, he was later diagnosed with blood cancer also. And now he is cured of both!
Urvish, 7, recently underwent stem cell transplant where peripheral stem cells from his sister’s blood were collected and transplanted in him.
The procedure has turned out to be successful as his blood cells now show XX chromosomes which basically mean that the new blood in his body is from a girl — in his case, his two-and-half-year-old sister Richa!
“This is one of the rarest cases where a child has been successfully treated for two major illnesses. Urvish’s blood samples show that the transplant has worked. He will be cured of both thalassemia and cancer,” said Dr Sandeep Shah, head of the Bone Marrow Transplant (BMT) department at Gujarat Cancer Research Institute (GCRI). It has been 28 days since the transplant and he is recuperating at GCRI. His mother Sunanda can’t believe that her seven-year-long struggle has ended.
“Urvish was diagnosed with thalassemia major when he was three months old. We had a tough time going through his blood transfusions. When he joined kindergarten he was diagnosed with blood cancer. We were shattered but decided to go ahead with the treatment as we had to do everything possible to save his life,” says Sunanda. Urvish’s father Umang runs an optical accessories store in Naroda. The Bhavsars had discussed stem cell transplant as a treatment for thalassemia but had to wait as the elder daughter was not a match. Meanwhile Urvish was put through chemotherapy.
Once that was over, it was decided that stem cell transplant would be the best treatment for both illnesses. Moreover, his younger sister Richa was found to match as a donor and the transplant was done successfully. “Despite being in and out of hospitals ever since he was born, he scored 95 per cent marks in class I. He loves going to school,” said an elated Sunanda. Dr Kirti Patel, acting director of GCRI, said that so far 112 BMTs have been done in GCRI of which six were also cord blood transplants. “Cases like Urvish’s are rare and give us the impetus to surge ahead,” said Dr Patel.