Friday, June 19, 2009

Stem Cell Transplantation: All you should know.

These days many of you must have come across the term Stem cell transplant just like Bone Marrow transplant. Both the terms are commonly used though there are some important differences between the two that must be clearly understood.

Blood stem cells (hematopoietic stem cells ) are found in the bone marrow and were detected and isolated from the bone marrow cell cultures.In a typical bone marrow transplant, these cells were first harvested and subsequently re-infused and grown with the purpose of re-constituting the damaged bone marrow. But of-course, these stem cells, in smaller numbers, are also available in the peripheral blood stream and therefore could be harvested through leukopheresis using a pheresis machine and then storing them cryogenically using liquid nitrogen.

What has further enabled easy harvesting of these stem cells is the use of HGF ( hematopoietic Growth Factors) . HGFs play a vital role in the entire development cycle of blood cells from stem cells stage to their maturity and help generate large number of cells that are easy to harvest in viable numbers. Patients that are being prepared for a transplant are first administered HGF injections to increase their WBC as well as their peripheral stem cell counts. The harvesting of these cells is then far more easy and a lot quicker saving valuable time.

These cells are then infused in the patient and made to grow new blood stem cells in an accelerated fashion thereby minimizing the risk of infection in the patient ( an extremely important factor in the transplant process) and also enabling a much shorter timeframe for the entire process.

Overall, there are two types of transplants---autologous and allogenic. In autologous transplant, the stem cell is derived from the same person who is undergoing the transplant. This is primarily used to deliver very high doses of chemptherapy to the patient which would have otherwise not been possible because of tremendous damage that high dose chemo causes to the bone marrow.

The allogenic transplant on the other hand essentially requires a donor who in most cases is a sibling. The donor needs to be tested and HLA matched before being selected.There is only a 25% probability that one sibling will be HLA matched to another sibling. In smaller families, therefore, it becomes rather improbable to be able to find a matched donor.

The other possible options are to have a partially matched sibling or a matched unrelated donor.
Using partially mathced siblings for a transplant is a riskier endeavour and will require even more intensive chemotherapy and radiation therapy regimens.
The other possibility of finding a matched unrelated donor can be a game of chance unless one gets very lucky and through random testing a match is sudeenly found. A National registry, however, with a HLA database will go a long way in tackling this challenge. In US there is a National Marrow Donor Program which is a central depository of over 5 Million HLA matched volunteers. The database is also linked with the regisrties of various other countires for international matching.


The allogenic transplant,therefore, is a much more complex exercise with significant risk of graft rejection as well. The success rates of partially matched and matched unrelated donor based transplants is lower than the matched sibling donors based transplants and also only a few centres attempt to do the former.

However, the scope of stem cell transplantation is large and very promising for the future and provides a ray of hope for the patients and in some cases the only possibility of any kind of cure whatsoever.

We are in the process of setting up a world class transplant programme at International Oncology's cancer centre at Fortis Noida.

Let us work towards leveraging the great potential that this tehcnology offers becuase "Every Life Matters"

Pradeep K Jaisingh
www.internationaloncology.com

Friday, June 5, 2009

ASCO 2009-----Orlando

American Society of Clinical Oncology or ASCO as it is popularly known is the biggest annual gathering of oncologists in the world and this year the conference was held in Orlando. Over 30,000 professionals connected with the filed of cancer care attended the meeting and included oncologists( medical, surgical and radiation) , researchers,pharmaceutical industry executives and scientists, venture capitalists etc.

On 30th May evening was the dinner event hosted by the Indo American Cancer Association ---IACA ( http://www.iacaweb.com/) where a large number of oncologists of Indian origin working in US were present along with the oncologists visiting from India. It was quite a nice gathering as it presented an opportunity for people travelling from India to interact with their counterparts settled in US and exchange professional inputs.

IACA has been doing an excellent job under the leadership of its current President Dr Vinay Jain who has spearheaded some impressive new initiatives. One of these initiatives is to provide fellowship opportunites to oncologists from India.
Those interested in applying for the fellowshio can apply using the link

http://iacaweb.com/index.php?option=com_forme&fid=1&fellow=fellow

Preference will be given to candidates who are from geographical areas of Indian Subcontinent which are under-served in terms of basic care of the cancer patients including palliative care. The eligible candidates must have worked in an oncologic discipline for 1 to 5 years and achieved some basic knowledge of oncology and are interested in upgrading their skills in Patient care, Clinical research or Palliative care.

I think this is a very useful initiative that will help upgrading the skill levels of professionals in the field working in the under-served region of India.

Apart from this several members of IACA have made excellent efforts to work in areas like children's cancer , cancer care in rural India and also palliative care / hospice initiatives for the terminally ill patients in India.

It is always great to see the commited young professional wanting to make a difference and doing their part in such an important healthcare area.

Please do join in and do your part for improving the cancer care in India because " Every Life matters"

Pradeep K Jaisingh