​BONE MARROW TRANSPLANT PROGRAMME

What are bone marrow transplant and peripheral blood stem cell transplant?

Bone Marrow Transplant and Haematopoietic Stem cell Transplant are non-surgical modes of treatment to cure advanced stages of malignancies as well as non-malignant haematological diseases and multiple other disorders.
As the name suggests, bone marrow transplant and peripheral blood stem cell transplant mean replacing or restoring dysfunctional cells with healthy cells.The diseased cells in your body are first destroyed completely through conditioning therapy, which is inducing high doses of chemotherapy or irradiation.You’ll be then infused with healthy cells that will start multiplying on their own in about 2 to 3 weeks.

    What are the different types of Bone Marrow Transplants?

    There are three types of Bone Marrow Transplants based on from who the donor cells are harvested

    Autologous transplant is when you are receive your own stem cells.

    Allogeneic transplants in when you receive cells donated by your sibling or parent. However, an unrelated donor or a person who is not related to you can also give you stem cells for transplant.

    Syngeneic transplant is when you are infused with stem cells donated by your identical twin.

      What are bone marrow and hematopoietic cells?

      Bone marrow is the soft, sponge-like material found inside your bones and contains immature cells known as hematopoietic or blood-forming cells. The Hematopoietic cells keep dividing into more blood-forming cells; and mature into one of three types of blood cells: infection-fighting white blood cells, oxygen-carrying red blood cells and clot-forming platelets.

      Though most hematopoietic stem cells are found in the bone marrow, some cells called peripheral blood stem cells are found in your bloodstream. Blood in the umbilical cord also contains hematopoietic cells. Cells from any of these sources can also be used in transplant.

        What is conditioning/ Chemotherapy and radiation therapy before bone Marrow Transplant and Peripheral Blood Stem Cell Transplant?

        ​The first step to BMT and PBSCT is destroying the diseased cells from your body through high doses of chemotherapy or radiation called conditioning. At Aster Medcity, we have the most advanced technology for these procedures, including Kerala’s first True Beam Linear Accelerator and dedicated radiotherapy rooms to ensure maximum patient safety. All radiotherapy treatments we provide are based on NCCN (USA) and ESMO (Europe) guidelines.

        As cancerous cells divide faster than healthier cells, we can, through conditioning destroy the existing bone marrow cells so that we can infuse healthy, transplanted cells into your body effectively.

          What is Donor- Recipient Matching?

          Your body is unique and has a set of proteins called human leukocyte-associated (HLA) antigens, on the surface of your body cells. We identify this set of proteins from samples drawn from your blood or buccal swab smears.

          We have the expertise and facilities to evaluate bone marrow morphology and immunohistochemistry at our state-of-the-art lab. The other relevant specialised tests include flowcytometry, cytogenetics and molecular genetics.

          In most cases, the success of allogeneic transplantation depends on how well the HLA antigens of the donor and recipient’s stem cells. Higher the number of matching HLA antigens, greater are chances of your body accepting the donor’s stem cells.

          You are less likely to develop graft-versus-host disease graft-versus-tumour effect post allogeneic transplant: when white blood cells from the donor attack the cells in the patient’s body after the chemotherapy and/or radiation therapy, if the stem cells are closely matched. It is estimated that only 25 to 35 percent of patients have a HLA-matching sibling. The chances of obtaining matching stem cells from an unrelated donor too vary, so finding the right donor is the key to a successful BMT or PBSCT.

            How is bone marrow obtained for transplant?

            With advance in technology, obtaining cells from a donor or harvesting has become relatively simple. Bone marrow is harvested using needle from the hip or at times breastbone area, after inducing general or local anaesthesia.

            The harvested bone marrow is processed to remove blood and bone fragments, combined with a preservative and frozen at sub-zero temperatures to keep the stem cells alive but dormant until required. This technique is known as cryopreservation. We have a cryopreservation unit where we can cryopreserve stem cells for many years.

            In order to harvest PBSCs, the donor is given medications to produce and release excess stem cells into the blood stream.

            Called apheresis, blood is drawn from the donor and subject to a process that removes only the stem cells. The blood is then returned to the donor and the collected cells, stored in the cryopreservation unit. This usually takes 4 to 6 hours.

            We also obtain stem cells from umbilical cord on consent, to treat children and adults. We can cryopreserve these cells or even the entire cord for years.

              Donating Cells: What’s the risk?

              If you are the bone marrow donor, you might feel tired and lethargic after donating the cells. However you will return to normalcy in a few days or sometimes, in a few weeks. As it is a procedure done under anaesthesia, you might need to do all relevant health checks before donating.

              Aphersis, however is easier, except for occasional giddiness, headache and some discomfort caused mainly due to the medicines given for increasing stem cells.

                How are healthy, transplanted cells infused?

                You will be infused with healthy, transplanted cells in the BMT unit through an IV line – just like you’d be on drips. As there will be no disease -fighting white blood cells and blood-clotting platelets after the conditioning, your susceptibility to infections will be extremely high. You’ll need to be extremely careful so that you don’t contract any infection and follow the doctor’s advise meticulously to avoid any complications.

                Since the stem cells used for autologous transplantation should relatively be free of cancer cells, the harvested cells can sometimes be treated before transplantation in a process known as “purging”. This process removes maximum cancer cells from the harvested cells and minimise the chance of reoccurrence.

                  What happens after the transplant?

                  The post-conditioning period and 3-4 weeks post infusion are the most crucial for BMT and PBSCT patients as the chances of infection are at an all time high.

                  Our entire medical team is trained to observe international standards when it comes to hygiene and infection control, so that you are ensured a safe, sterile environment to recuperate.

                  The stem cells, after entering your bloodstream, travel to the bone marrow and begin to produce new white blood cells, red blood cells, and platelets in a process known as “engraftment.” This usually occurs within about 2 to 4 weeks after the transplantation. Complete recovery of your immune function will take longer - up to several months for autologous transplant and 1 - 2 years for allogeneic or syngeneic transplants. We will evaluate your blood health through various tests including bone marrow aspiration to confirm whether new blood cells are being produced and there’s no relapse.

                    What are the possible post-transplant complications?

                    ​Apart from susceptibility to infection and bleeding, you may experience short-term side effects such as nausea, vomiting, fatigue, loss of appetite, mouth sores, hair loss, and skin reactions.

                    There are also potential long-term issues that your doctor will explain in detail to you before beginning the treatment.

                      What is Mini Transplant?

                      Called a non-myeloablative or reduced-intensity transplant, a mini uses lower, less toxic doses of chemotherapy and/or radiation to prepare you for an allogeneic transplant. ​

                      Called a non-myeloablative or reduced-intensity transplant, a mini uses lower, less toxic doses of chemotherapy and/or radiation to prepare you for an allogeneic transplant.

                        Doctors Logo
                        Dr. Vivek Radhakrishnan
                        Associate Consultant
                        Dr. Vivek Radhakrishnan

                        Dr. Vivek Radhakrishnan, Consultant, CoE Oncology is a Haemato-Oncologist and Medical Oncologist with more than 4 years of experience. Trained extensively in Haemato-Oncology, Bone Marrow Transplantation (BMT) and Solid Organ Cancers at some of the best institutions in USA, Europe and India. He is an expert in comprehensive management of of blood cancers like Leukemia, Lymphoma and Myeloma and solid organ tumour.

                        He has special interest in BMT, which includes autologous and allogeneic and alternative donor transplant. He has also undergone training in the application of personalised medicine in oncology.

                        Qualifications

                        Fellowship in Cellular therapy & Haematological Malignancies (MD Anderson Cancer Center, Houston, Texas) | ESMO Fellowship in Translational Research (Personalised Medicine) in Oncology (Innsbruck Medical University, Austria) |Pfizer-ASBMT Fellowship in Haematopoietic Cell Transplantation/ Alternative Donor Transplants (Duke University, Durrham, North Carolina) |Post Doctoral Fellowship in Bone Marrow Transplantation and Haematology (Tata Medical Center) | European Certification in Medical Oncology - ECMO (European Society of Medical Oncology, Lugano, Switzerland) |DM in Medical Oncology( Madras Medical College, Chennai) | MD in Oncology ( Madras Medical College, Chennai)| MBBS (JSS Mysore, Karnataka)

                        Achievements

                        Consultant in Medical Oncology & Haemato-Oncology, and Head, Bone Marrow Transplant (BMT) Division, Apollo Cancer Institute, Apollo Hospitals, Bangalore;
                        Specialist training at MD Anderson Cancer Centre, Houston
                        Faculty and Attending Physician in Dept. of Clinical Hematology/Oncology and BMT, Tata Medical Center, Kolkata, India
                        Post-Doctoral Fellowship in BMT under the mentorship of Prof. Mammen Chandy
                        Specialist training at Duke University, North Carolina, USA
                        Travel award to train at the University of Frankfurt, Germany: Childhood hematological malignancies and BMT
                        Head, Department of Medical Oncology & Haemato-Oncology, MIOT Hospitals, Chennai
                        Won awards for exceptional academic performance
                        Written research articles in international journals and Chapters in textbooks
                        Proficient in English, Malayalam Hindi

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                        Dr. Reghu KS
                        Senior Specialist
                        Dr. Reghu KS

                        A Paediatric Oncologist trained in comprehensive management of childhood and adolescent cancers, Dr. Reghu KS has more than 7 years of experience as a Paediatrician (including 3 years in Paediatric Oncology). His fields of special interest include paediatric leukaemia, solid tumours, pediatric brain tumours, paediatric hematology and Bone Marrow Tra

                        Qualifications

                        DM in Paediatric Oncology (Regional Cancer Centre, Thiruvananthapuram) | Fellow in Paediatric Hematology and Oncology (Tata Medical Centre, Kolkata) | MD in Paediatrics (Govt. Medical, Calicut) | MBBS (Govt. Medical College, Thiruvananthapuram)

                        Achievements

                        Consultant Paediatrician, Ananthapuri Hospital, ThiruvananthapuramAssistant Professor in Paediatrics SUTAMS, Trivandrum ThiruvananthapuramTrained in multimodality management of cancers in children, with thrust on their special needs, growth and development and long-term survivorship.

                        Published 4 research articles

                        Proficient in English, Malayalam & Hindi

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                        Dr. Arunlal M
                        Consultant
                        Dr. Arunlal M

                        A Radiation Oncologist with more than 4 years of experience, Dr. Arunlal is trained extensively in radiotherapy. His areas of expertise are advanced modalities of conformal radiation therapy including intensity modulated radiotherapy, stereotactic radiosurgery, stereotactic body radiotherapy and interstitial brachytherapy.

                        Qualifications

                        Fellowship in Advanced Techniques in Radiation Oncology (Rajiv Gandhi University of Health Sciences, Bangalore) | MD in Radiotherapy (Madras Medical College, Chennai) | MBBS (Govt. Medical College, Kottayam)

                        Achievements

                        Instrumental in initiating the SBRT programme while working at AIMS, Kochi

                        Clinical Assistant Professor at Amrita Institute of Medical Sciences, Kochi

                        Lecturer in Radiotherapy at Medical College, Kottayam

                        Published articles in peer reviewed journals

                        Proficient in English, Malayalam and Hindi

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                        Dr. Anup R Warrier
                        Consultant
                        Dr. Anup R Warrier

                        Dr. Anup R Warrier is Consultant, Department of Infectious Diseases & Hospital Infection Control. A Physician with over 9 years of experience and specialised training in management of infectious diseases and infections in hospitals, his special interests are Tropical Infections, Fever of Unknown Etiology evaluation, infections in the ICU & HIV Medicine, Antimicrobial Stewardship and cost – effective, evidence based infection Control.

                        Qualifications

                        DNB in General Medicine | Fellowship in Infectious Diseases (P D Hinduja Hospital,Mumbai) | Board Certified in Infection Control, Certification in Travel Health, European Diploma in Surgical Infections (SIS-Europe)| MBBS (Govt. Medical College, Thiruvananthapuram)

                        Achievements

                        Infectious Diseases Specialist, KIMS Hospital, Trivandrum

                        In-Charge of Infection Control Program at KIMS Hospital, Trivandrum

                        Specialized training in Infectious Diseases from premier Institutes in India & USA

                        Close association with the Intensivists helped gain experience in managing infections in the critically ill

                        Developed the Infection Control Program at KIMS to the effect that international benchmarking could be done in line with INICC

                        One of the few Physicians in Kerala formally trained and practicing HIV Medicine

                        Experienced in evaluation & management of prolonged & undiagnosed fevers and also complicated Tropical Infections.

                        Management of adult immunizations, fever & infections in travelers

                        Published Research articles

                        Proficient in English, Malayalam, Hindi and Telugu

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                        Dr. Anjali K Kale
                        Senior Consultant
                        Dr. Anjali K Kale

                        Dr. Anjali K Kale is Chief Consultant Pathologist, Department of Pathology. She has over 36 years of experience in Clinical Pathology and is an expert at Anatomic Pathology, Microbiology and Transfusion Medicine. Trained in India and the US, she was instrumental in setting up state-of-the-art Laboratories with Blood Bank/Transfusion Medicine Department in two leading hospitals.

                        Qualifications

                        Certification in Anatomic & Clinical (American Board of Pathology)| M.D. in Microbiology (B.J. Medical College, Pune)| Diploma in Clinical Pathology
                        (Armed Forces Medical College, Pune)| MBBS (Armed Forces Medical College, Pune)

                        Achievements

                        Fellowship in Transfusion Medicine, New York Blood Center, New York

                        Fellowship in Hematology & Blood Banking, Albert Einstein College of Medicine,New York

                        Resident, Anatomic & Clinical Pathology, Albert Einstein College of Medicine, New York

                        Postgraduate Student in Microbiology, B.J. Medical College, Pune

                        Director, Pathology and Laboratory Medicine, Max Healthcare, New Delhi

                        Head of Department, Pathology and Laboratory Medicine, Amrita Institute of Medical Science, Kochi

                        Lecturer, Pathology and Microbiology, Bharati Vidyapeeth Medical College, Pune

                        Blood Bank Office, Lokmanya Hospital, Pune

                        Assistant Pathologist, Sancheti Institute of Orthopedics

                        Demonstrator, Pathology and Microbiology, Armed forces Medical College, Pune

                        Set up blood banks for Max Hospitals in Saket and Patparganj, New Delhi

                        Was responsible for setting up the state-of-the-art laboratories and Blood Bank/ Transfusion Medicine Department at AIMS, Kochi, in its starting phase.

                        Frequently invited by hospitals and medical societies in Kerala to make presentations on Transfusion Medicine

                        Published Research articles in International Medical Journals

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                        Dr. Rajappan Pillai. P
                        Consultant
                        Dr. Rajappan Pillai. P

                        Dr. Rajappan Pillai .P, Consultant, Paediatric Intensive Care, CoE Child and Adolescent Care is a Paediatric Intensive Care Physician since 2006, and specialised training at the finest facilities in the United Kingdom, including the Great Ormond Street Hospital. An expert in providing highly advanced life support facilities like Inhaled Nitric Oxide, ECMO and Mechanical Ventilation to critically ill children and also stabilising and transporting them from peripheral hospitals to the main hospital, he specialises in Cardiac Intensive Care, Retrieval Services, Post Solid Organ Transplant Intensive Care and Aeromedical Transfer.

                        Qualifications

                        Fellowship - Paediatric (Kings College Hospital, London) |Fellowship- Retrieval& Aeromedical Transfer (Children’s Acute Transfer Services, London) | Fellowship - Paediatric & Cardiac Intensive care (Great Ormond Street hospital, London, United Kingdom) | MD in Pediatrics (JJM Medical College, Davangaree| MBBS (Government Medical College, Alappuzha, University of Kerala) |

                        Achievements

                        Previuos faculty in Neonatal and Paediatric Intensive Care at Christian Medical College, Vellore

                        Trained in triaging, stabilisation and retrieval of critically ill children at CATS, one of the largest specialist Paediatric retrieval services in Europe

                        Trained in Aeromedical transfer of critically ill children

                        Trained in highly complex Paediatric medical and surgical emergencies at Great Ormond street hospital for childre, London, one of World’s best Children’s Hospitals

                        Trained in managing post op cardiac patients and ECMO patients at the Cardiac intensive care unit at Great Ormond street hospital for childre- one of the busiest center of Children’s cardiac surgery in the World and among the biggest ECMO center for children in Europe.

                        Trained in Post-operative management of Pediatric Liver Transplant patients at King’s College Hospital, London- the biggest center for pediatric liver transplant in the World

                        work Experience

                        Clinical Fellow, Paediatric Liver transplant & Intensive care unit, Kings College Hospital, Denmark hill. London

                        Senior Clinical Fellow, Paediatric & Cardiac Intensive Care Unit, Great Ormond Street hospital. London

                        Retrieval Fellow, Children’s Acute Transport Service (CATS), Great Ormond Street Hospital, London

                        Clinical Fellow, Paediatric Intensive care unit, St Mary’s hospital, Imperial Healthcare trust. London

                        Assistant professor, Paediatric intensive care unit, Christian Medical college, Vellore

                        Assistant Professor, Neonatal intensive care unit, Christian Medical College, Vellore

                        Associate Professor, Neonatal intensive care unit, Pushpagiri Medical College, Thiruvalla

                        Proficient in English, Malayalam Hindi, Tamil & Kannada

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