Jaslok Conducts India's First Allogeneic BMT In Lymphoma

Shardul Nautiyal - Mumbai

Stem cell transplant specialist Dr Maheboob Basade

The first of its kind allogeneic bone marrow transplantation (BMT) for Non-Hodgkin's Lymphoma (NHL) was recently performed at Mumbai-based Jaslok Hospital by BMT specialist Dr Maheboob Basade. “It was a rare and high-risk transplant as the mortality rate for patients with NHL is as alarming as 40 per cent,” informs Dr Basade.

The patient was a 21 year old young girl from Oman, who was diagnosed with NHL-large B-cell type, anaplastic type in neck node biopsy. The patient had been undergoing treatment, since her diagnosis in 2003. “Initially, she was given eight courses of CHOP chemotherapy, which gave a good response. She was then given involved field radiation till June 2004. But in December 2004, the disease relapsed, this time attacking her stomach,” explains Dr Basade.

Before coming to Dr Basade, the patient had undergone RICE chemotherapy in Oman, an aggressive form of chemotherapy. She had sensitive disease each time, which implies that the disease responds to chemotherapy each time. Since autologous stem cell transplantation is not available in Oman, which is usually done following second line of chemotherapy as a part of consolidation treatment, she was referred to Dr Basade in May 2005. In the mean time, the disease had again relapsed in neck lymph nodes, and hence autologous stem cell transplantation could not be done. Autologous stem cell transplantation is done in remission, when the disease is not active.

The patient was then put on third line chemotherapy with mini-BEAM. The plan was to harvest stem cells after three courses of mini-BEAM. Though autologous stem cell harvest was done, but as her stem cell yield was very poor, no autologous transplantation was possible. She was given three more courses of mini-BEAM chemotherapy to avoid further recurrence of the disease. Meanwhile, search for allogeneic donor was made in siblings and her younger sister was found to be fully HLA-matched.

Allogeneic stem cell were harvested from bone marrow of her younger sister. As the donor was 25 kg and the recipient 80 kg, so a large volume of BM stem cells was to be harvested.

On the seventh day, the stem cell from the sister was infused back to the patient. It took three weeks for white cells to regain normalcy. “This period of three weeks is the most critical part of allogeneic stem cell transplantation and maximum deaths occur because of infections and other complications during this period,” says Dr Basade.

The patient fared well during this critical period, although she required five days of antibiotic support. The transplant was successful and she was shifted out of the BMT unit. After four weeks of transplant, the patient’s BM aspiration (examination) was done to confirm the engraftment. The engraftment was finally confirmed and the patient was ready for discharge.

“The patient has been discharged with prescribed medications. Dose of prednisolone should be tapered off gradually over few days. She has been advised to visit her doctors at her hospital in Oman every week. Weekly CBC, renal functions, liver functions and cyclosporine levels have been recommended to be checked, as there may be a chance of developing Graft Versus Host Disease (GVHD),” says Dr Basade.