Bone Marrow Transplant Now Possible Even Without a Fully Matched Donor

Bone Marrow Transplantation (BMT) or Hematopoietic stem cell transplantation is a procedure that is done in selected patients with blood cancers (leukemia, myeloma, and lymphoma) or with abnormal blood cell formation (aplastic anemia, thalassemia) for achieving cure. It involves collecting stem cells from a matched donor (matching is done by a test called HLA typing), and giving it to the patient after giving the patient very high doses of chemotherapy. It is a complicated procedure and requires a lot of expertise. But it is the only treatment that may be able to cure children and adults with some blood-related cancers, especially in the relapsed setting.

One of the main hindrances faced in transplants is the availability of a completely matched donor. The best donor for a BMT is usually an HLA-matched sibling. But with more nuclear families, the chances of getting a matched donor in the family have become very less. Nowadays, we see many children and young adults with blood cancers who have the potential to be cured by BMT, but unfortunately, they do not have a matched donor, so they cannot undergo the transplant.

One approach for finding a matched donor is to look for an unrelated HLA-matched donor in registries- both Indian and international registries. But this process takes time and is also expensive. There is also a higher risk of complications in the form of graft versus host disease in this kind of transplant. The good news is that there are many more successful BMTs being done in India now using this approach.

Another approach that is becoming popular is doing a half-match transplant called a Haploidentical bone marrow transplant. This means we can use a donor which is half-match (3/6 HLA match) and this could be the mother, father, or child of the patient as they are always half-matched. So, this is a donor who is always present and can be got easily!

This was tried earlier but was given up as the complications of doing this half-match transplant were very high. In recent years, with new techniques, there have been improvements in this kind of BMT. The complications have come down significantly and many such successful haploidentical BMTs have been done all around the world.

Master Rahul is one such child who has benefited from this type of BMT. He was 6 years when he was diagnosed to have a blood cancer called Acute Lymphoblastic Leukaemia. He was treated for 2 years, but unfortunately, his disease relapsed in the brain. He received chemotherapy, but he again relapsed. He was referred to us for a BMT, as this was his only chance of cure. But, unfortunately, he was a single child and there was no matched donor in the family. Search for an unrelated donor in the registry did not yield any success. So, he was taken up for a Haploidentical bone marrow transplant with his mother as the donor. He underwent this procedure successfully and his disease is in remission. He has now completed 1.4 years after this BMT and is slowly getting back to normal life.

This approach of using a half-match donor for BMT is exciting. It enables us to find potential donors in the family itself. It holds a lot of promise in our country where finding unrelated donors is difficult and the cost is always a concern.

Bone Marrow Transplantation (BMT) is a complicated procedure that is essential for cure in certain patients with blood cancers (leukemia, myeloma) or benign diseases (like aplastic anemia, and thalassemia).

The best donor for a BMT is usually an HLA-matched sibling. But with more nuclear families, the chances of getting a matched donor in the family have become less. One of the main hindrances faced in transplants is the availability of a completely matched donor.  We see many children and young adults with blood cancers who have the potential to be cured by BMT, but unfortunately, they do not have a matched donor, so they cannot undergo the transplant.

One approach for finding a matched donor is to look for an unrelated HLA-matched donor in registries- both Indian and international registries. But this process takes time and is also expensive. The good news is that there are more BMTs being done in India now using this approach.

Another approach that is becoming popular is doing a half-match transplant called a Haploidentical bone marrow transplant. This means we can use a donor which is half match (3/6 HLA match) and this could be the mother, or father, or a child of the patient as they are always half-matched. So, this is a donor who is always present and can be got easily! In recent years, with new techniques, there have been improvements in this kind of BMT. The complications have come down significantly and many such successful haploidentical BMTs have been done all around the world.

Master Rahul is one such child who has benefited from this type of BMT. He was 6 years when he was diagnosed to have a blood cancer called Acute Lymphoblastic Leukaemia. He was treated for 2 years, but unfortunately, his disease relapsed in the brain. He received chemotherapy, but he again relapsed. He was referred to us for a BMT, as this was his only chance of cure. But, unfortunately, he was a single child and there was no matched donor in the family. Search for an unrelated donor in the registry did not yield any success. So, he was taken up for a Haploidentical bone marrow transplant with his mother as the donor. He underwent this procedure successfully and his disease is in remission. He has now completed 1 year after this BMT and is slowly getting back to normal life.