Posted on: 23/08/2014

About stem cellsHALF MATCH STEM CELL TRANSPLANT, A NEW HOPE FOR BLOOD CANCER PATIENTS?

In a first of its kind case, doctors in Ahmedabad have been successful in implementing Haplo Identical Hematopoetic Transplant or Half Match transplant for a blood cancer patient. This protocol is designed by John Hopkins Institute in the US and is in practice since two years.

HLA matching – the gold standard for stem cell transplant

Stem cell transplant mostly from the Bone Marrow is the last option for many patients suffering from an aggressive form of blood cancer. However this needs to be handled carefully keeping in mind the patient’s own immune system.  The immune system normally keeps us healthy by destroying anything in the body it sees as foreign, such as bacteria or viruses. There is a high probability that a working immune system recognizes donor cells from other people as foreign, too. Handling this becomes very important in an allogeneic stem cell transplant.

 

Many factors play a role in how the immune system knows the difference between self and non-self, but the most important for transplants is the human leukocyte antigen (HLA) system. Human leukocyte antigens are proteins found on the surface of most cells. They make up a person’s tissue type, which is different from a person’s blood type. Therefore even if the blood group of the patient and donor are matching, it cannot be transplanted unless there is a HLA match as well.

 

Each person has a number of pairs of HLA antigens. We inherit one of each of these pairs from each of our parents (and pass one of each pair on to each of our children). Doctors try to match these antigens when finding a donor for a person getting a stem cell transplant.

How well the donor’s and recipient’s HLA tissue types match plays a large part in whether the transplant will work. A match is better when all 6 of the known major HLA antigens are the same — a 6 out of 6 match. People with these matches have a lower chance of graft-versus-host disease, graft rejection, having a weak immune system, and getting serious infections.

 

Till now for bone marrow and peripheral blood stem cell transplants, sometimes a donor with a single mismatched antigen is used — a 5 out of 6 match. For cord blood transplants a perfect HLA match doesn’t seem to be as crucial for success, and even a sample with a couple of mismatched proteins may be OK. Mostly this level of matching is possible only amongst the siblings else it is very difficult as well as expensive to get a complete match from the select European or national donor registries.

Haplo Identical Hematopoetic Transplant or Half Match Transplant

In a first of its kind case, doctors in Ahmedabad have successfully tried out a new treatment protocol designed by John Hopkins institute in the US on a 26 year old blood cancer patient “Dilip Bharwad”, who was suffering from an aggressive form of blood cancer not responding to chemotherapy.

He needed a stem cell transplant on an urgent basis, however all the matches - one match from Germany and multiple donors registered with the Indian registry failed to donate stem cells. Doctors then chose his father Bhuvan Bharwad (45) who was just a 'half match', to step in to save his son's life. And it worked. 

Recently, Dilip walked out of a private hospital after 20 days of hospitalisation. His cancer is in remission. All his blood cells have been completely replaced by his father's cells.

The treating oncologist Dr Shah mentioned that the patient had a 30% chance of getting completely cured.

Father, mother and children are the default half match of a person. If this protocol is successful, it could pave way for stem cell transplants that are economical and readily available to patients with blood cancer and later to others. 

With only a few donors registered in the Indian donor registries, it is next to impossible to get donors locally. It is also exorbitant — donor matches from the US registry cost Rs 20-25 lakh and from the German registry, Rs 8-10 lakh.

In the half match protocol, a high dose of chemotherapy is given on days three and four of the treatment to prevent graft rejection. Unlike the perfect match, where engraftment happens after 12-13 days, engraftment in half match transplant takes place after 20 days.

To know more about the latest update on this treatment protocol and treating centers offering the same as well as for getting your reports reviewed, post a query or write to us on : [email protected]

 

 

To know more about the latest update on this treatment protocol and treating centers offering the same as well as for getting your reports reviewed, post a query

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