Tale of Two Bone Marrow Transplants in BLK amid COVID Constraints

States, Embassies and Ministry of Health extended helping hands to save lives

New Delhi: Two lives were saved in BLK super Specialty hospitals through Bone Marrow transplants, a highly specialized procedure amid travel restrictions due to COVID19. But for helping hands extended by state governments, embassies and health ministry, this would not have been possible. The patients had to obtain special permissions. One girl was cured of very severe Aplastic Anemia and another Nepali man living in Australia was saved from Acute Myeloid Leukemia. The Nepali national had to be air evacuated from Sydney.

Nitya Singh (name changed) a 15 year old patient suffering with severe aplastic anemia from Punjab had to take special permission from their state authorities to reach BLK hospital, New Delhi, whereas Arjun 31 year old, Nepali resident staying in Australia was suffering with Acute Myeloid Leukemia got air evacuated along with his brother, with the help of Indian embassy, ministry of Health and Nepal embassy to get the lifesaving treatment.

Both patients’ life was saved by successful Bone marrow transplant procedure performed by Dr Dharma Choudhary, Senior Director & HOD, Centre for Hemato-oncology & Bone Marrow Transplant, BLK Super Speciality Hospital and his team during lockdown.  Delay in these treatments could have resulted in severe consequences. 

Ms. Nitya Singh had petechial rashes over upper limbs, oral cavity, low grade fever, bleeding per vaginum with elevated liver enzymes.  Being both parents from the medical background sensed it was not normal and they decided to get a thorough check up done for their daughter.  They took special permission from their state government authorities as the lockdown was prevailing in the entire country due to the ongoing pandemic Corona Virus.  They visited BLK Super Speciality Hospital and visited Dr. Dharma Chaudhary in Bone Marrow Transplant unit and Roop underwent various examinations. She was diagnosed to have Very Severe Aplastic Anemia. She was advised for Allogenic Bone Marrow Transplant on urgent basis.

Her sister who was studying at Singapore volunteered herself to be a donor.  She flew from Singapore to help her sister but as per international guidelines during lockdown, she had to be quarantined for 14 days at the airport.  In the meantime Nityas condition started deteriorating she developed high grade fever and abscess in axillae.  Dr. Dharma along with his team decided to perform Haploidentical bone marrow transplant taking her mother as a donor.  Haploidentical Bone Marrow Transplantation (BMT) is a procedure in which, instead of fully HLA matched family donor (which could have been her sister), a half matched bone marrow transplant was done taking the mother as a donor. All the requisite tests done and her mother was fit to be a donor for the half match allogenic bone marrow transplant.  Bone marrow transplant procedure performed on June 2, 2020. Nitya accepted the graft well and got discharged in good condition in 3rd week of June. Presently the patient is well and asymptomatic and on follow-up with Dr Dharma Chaudhary.

Air Evacuation from Sydney helped Delhi doctors to save a Nepali national.

Mr. Arjun Prasad Timilsina, 31 Yr old, resident of Nepal (living in Australia) was diagnosed with Acute Myeloid Leukemia- High risk in Australia in January 2020.  He underwent few cycles of chemotherapy in Australia. The induction therapy failed twice in Australia then he was given high dose of chemotherapy.  Then he met his friend who underwent BMT procedure performed by Dr. Dharma Chaudhary few years back.  He introduced Arjun to Dr. Dharma Chaudhary in India.

Arjun connected to Dr. Dharma Chaudhary through emails and video conferencing.  After going through his reports Dr. Chaudhary suggested him a Bone Marrow transplant as the only treatment for better quality of life.  In the month of May he decided to come to India for treatment but by then lockdown had started and he was unable to come to India.  He approached the embassy of Nepal and India in Australia and Ministry of Health, India and his efforts worked and finally he was air evacuated from Australia to India through VandeMatram mission flights along with his brother who was his full match for the Bone marrow transplant. At the arrival after thorough investigations he underwent successful allogenic stem cell transplant from full match sibling donor (brother) on June 11,2020.  Currently he is asymptomatic and got discharged in good condition.

Allogeneic stem cell transplantation involves transferring the stem cells from a healthy person (the donor) to the patient’s body after high-intensity chemotherapy or radiation. The donated stem cells can come from either a related or an unrelated donor.

Before an allogeneic stem cell transplantation, the patient receives a conditioning regimen of chemotherapy and, sometimes, radiation therapy. This conditioning treatment is given to destroy any remaining cancer cells in the body. This helps weaken the patient’s immune system to help keep the body from rejecting the donated cells after the transplant. It also allows the donor cells to move through the bloodstream to the bone marrow, where the donor cells will begin to grow and produce new blood cells, including red blood cells, platelets and white blood cells. This process is called “engraftment.”

When a transplant is successful, the donor stem cells can replace stem cells in the bone marrow. It may also provide the only long-term cure of the patient’s disease. One of the benefits of allogeneic stem cell transplantation is that after the donated cells engraft in the patient, they create a new immune system. The donated cells produce white blood cells that attack any remaining cancer cells in the patient’s body. This is called the “graft-versus-tumor effect.” and it may be even more important than the very intensive conditioning regimen that is administered to destroy the cancer cells. This benefit can only occur in allogeneic stem cell transplantation.

But sometimes it is difficult to find HLA match. Then, a haploidentical transplant may be an option. This is a type of allogeneic transplant where the donor matches exactly half of your HLA.  A haploidentical, or half-matched, donor is usually are mother or father of a child. Parents are always a half-match for their children. Siblings (brothers or sisters) have a 50% (1 out of 2) chance of being a half-match for each other. Very few institutes are there in India who doHaploidentical or half match bone marrow transplant.  But Dr. Dharma Chaudhary has performed more than 250 haploidentical bone marrow transplants in the past few years.

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