A large subset of leukemia patients need a bone marrow transplant as a curative option apart from chemotherapy
Blood cancer has long been regarded as a death sentence. However, over the last two decades, there has been considerable progress in the treatment of blood cancer, with survival rates ranging from 60 to 80 percent in various subtypes.
There are two types of blood cancers – acute leukemia and chronic leukemia. Acute leukemia can be lymphoid or myeloid. With the progress in various chemotherapy regimens, the cure rates in pediatric acute lymphatic leukemia have been as high as 80 to 90 percent, but the numbers are lower in our country, in the range of 60 to 80 percent. There are various reasons for this, ranging from delays in diagnosis, to higher infection rates to disease biology and pharmacogenetics.
Acute myeloid leukemia has lower cure rates with chemotherapy alone, and a large subset of these patients need a bone marrow transplant (BMT) as a curative treatment option.
Bone Marrow Tranplant
BMT was a treatment that was not easily available in our country ten years ago, but now there are more than 100 transplant centers in the country that can offer this treatment. BMT needs a stem cell donor, and this traditionally has to be a sibling who, when fully HLA matched is eligible to donate. However, we realized that a lot of patients did not have fully matched sibling donors, hence the need to look for other donor options. The stem cell registries of the world were able to offer the option of unrelated, matched stem cell donors. Adults between the ages of 18 and 60 can enroll in these registries voluntarily and donate stem cells when needed, The Indian registry called DATRI currently has around 5 lac donors which is grossly inadequate for our country. We certainly need more people to become voluntary donors. Due to the non availability of unrelated donors, the next option is to use a half matched parent, child or sibling called a haplo transplant and this is the new therapy for leukemias that need BMT as a curative treatment option.
BMT is able to offer cure rates of 50 to 60 percent in blood cancers and as high as 80 to 90 percent in the non cancerous diseases like thalassemia and aplastic anemia. These cure rates are the best for patients with leukemia. There is no risk to the donor as the stem cells are collected from the peripheral veins using an apheresis machine, similar to how platelets are collected in the daycare ward. There is no requirement for anesthesia. This technology has made stem cell collection a very easy and simple procedure.
Donors need not worry
Donors are worried that they are depleted of their stem cells, and this can affect their longevity. Unlike a kidney transplant, where an organ is removed from a donor, here the stem cell numbers are increased using stem cell growth factor injections, and the excess number of cells is collected and infused into the patient. There is no depletion of stem cells in the donor. This information is very important to disseminate to the general public and encourage donors to come forward and donate for a noble deed.
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